Postoperative course and safety profile of the suture scaffold technique in breast-conserving surgery: a single-institution observational study.

Oncoplastic surgery (OPS) has emerged as a new approach for extending breast conserving surgery (BCS) possibilities, reducing both mastectomy and re-excision rates, while avoiding breast deformities. OPS is based upon the integration of plastic surgery techniques for immediate reshaping after wide excision for breast cancer. This is a prospective feasibility cohort study of oncoplastic breast surgery after neoadjuvant chemotherapy that was carried at the National Cancer Institute, Cairo University and included 70 patients. The primary outcome was the local recurrence rate. Secondary outcomes included survival and margins obtained as well as cosmetic outcomes. Survival analysis was performed. Oncoplastic breast surgery did not compromise oncologic safety in the patients included in the study. It even allowed wider margins of resection which could be associated with better oncologic outcomes. At the same time, it gave a better cosmetic outcome and therefore higher patient satisfaction. Oncoplastic breast surgery includes a wide spectrum of surgical techniques, ranging from the basic level I techniques in breast conserving surgery to the more complex procedures of level II which are broadly classified into volume replacement (therapeutic mammoplasty) and volume displacement procedures. We suggest that oncoplastic breast surgery techniques should be the standard of care in breast surgery. They are the basis for breast conserving surgery techniques in early breast cancer. In our experience, oncoplastic surgery is feasible in locally advanced tumours after downstaging with neoadjuvant chemotherapy without compromising the oncologic safety.

Introducing an oncoplastic MDT to facilitate teaching and training in the breast unit

Introduction: The highest priority for modern clinical oncology is functionally-sparing and organ-conserving treatment. In Russia, breast cancer (BC), among all malignant tumors, accounted for 21.1 % of women in 2017. Oncoplastic radical resections (OPS-BCS = oncoplastic surgery – breast conserving surgery) have been widely used. This term means resection of the breast for cancer using plastic surgery to restore the shape of the breast, in most cases with one-stage correction of the contralateral breast. Purpose: It was the creation of various techniques of oncoplastic breast surgery, applicable for the appropriate localization of breast cancer and the evaluation of surgical, oncological and aesthetic results. Methods: From 2013 to 2017, in the P.A. Hertsen Moscow Oncology Research Center, organ-conserving surgery were performed in 570 patients with BC with an average age of 54.2. Stage 0 was diagnosed in 4.6 %, I – 5.9 %, IIA – 28.7 %, IIB – 6 %, IIIA – 5.1 %, IIIC – 3.3 %, IIIB – 0.2 %, IV – 0.2 %. Radical resection in the standard version was performed in 290 patients with breast cancer, oncoplastic breast surgery in various modifications – in 280. All patients after the organ-conserving surgical treatment received radiation therapy. Patients received chemotherapy, targeted therapy and hormone therapy according to the indications in depending the disease stage and the immunohistochemical type of the tumor. Results: After an urgent and planned morphological study positive margins of resection were revealed in 10 patients, which required reresection of the edges to a negative state of them in case of an urgent intraoperative response and mastectomy – in case of a planned response. Within 4 years, local recurrences were detected in 4 patients (0.7 %), which required a mastectomy with a one-stage reconstruction. In 1 patient (0.2 %), the disease progressed as metastases to the lung – in this case lobectomy and a necessary chemotherapy were conducted. Cosmetic results were defined as excellent in 70 % cases, good – 25 %, satisfactory – 5 %. Conclusion: If there are indications for organ-conserving treatment of breast cancer and the patient’s decision concerning this surgery, the patient should be offered methods of oncoplastic surgery for the prevention of psychological and emotional stress, effective rehabilitation, and a quick return to active social life.

Background: Oncoplastic surgery (OPS) has emerged as a new approach for extending breast conserving surgery (BCS) possibilities, reducing mastectomy and re-excision rates, while avoiding breast deformities. OPS integrates plastic surgery techniques for immediate reshaping after wide excision for breast cancer. This techniques is emerging and our experience in Egypt has been gradually increasing. Our aim was to extend the applicability of OPS into more advanced tumours following neoadjuvant chemotherapy. Method: A prospective feasibility cohort study of OPS after neoadjuvant chemotherapy was carried at the national Cancer institute – Cairo University and included 40 patients. We aimed to look at long term oncologic safety and cosmetic outcomes. The primary outcome was the local recurrence rate. Secondary outcomes included survival and margins obtained as well as cosmetic outcomes. Survival analysis was performed with Kaplan-Meir curves. Cosmetic outcomes were assessed using a modified Breast Q questionnaire (EORTC 10801). Results: 40 patients were included in this study. All were diagnosed with locally advanced breast cancer between September 2012 and January 2015 at the National Cancer Institute – Cairo University. All were treated primarily with neoadjuvant chemotherapy (Anthracycline-based). The median age was 44.45 (Range 22- 65) years with median follow-up period of 42 (Range 24 – 60) months. 27.5% showed complete pathological response. 62.5% of patients had a level I OPS procedure, 10% had a level II procedure, and 27.5% had a volume replacement procedure with a Latissimus Dorsi flap. The median resection margins with level I, level II, and volume replacement were 10 mm,25 mm and 15 mm respectively. The difference in margins between level I and II was statistically significant (p = 0.028), so was the difference between the 3 types of procedures (p = 0.035). Three patients (7.5%) had local recurrence and required mastectomy; at 11, 13 and 16 months respectively. One of those (2.5%) developed distant bone metastasis. Cumulative disease-free survival (DFS) for the whole cohort was 90.2%. Overall survival (OS) was 100% as there was no mortality reported during the follow-up period. Cumulative disease-free survival for patients with level I surgery was 85.4% while for those with level II and volume replacement it was 100% with no statistically significant difference (p = 0.2) because of small number of events. The cumulative disease-free survival when the median resection margin obtained was less than 20 mm was 86.3%, whereas when the median margin was equal or more than 20 mm, it was 100%. This difference was not statistically significant (p = 0.2). The cosmetic outcomes ranged between excellent result (70%), very good (15%), good (10%) and poor results (5%) on a very simplified scale that was used for the purpose of the study. Discussion: Oncoplastic breast surgery didn't compromise oncologic safety in the patients included in the study. The local recurrence rate, the DFS and OS were all within acceptable ranges .It even allowed wider margins of resection which could be associated with better oncologic outcomes. At the same time, it gave a better cosmetic outcome and therefore higher patient satisfaction. Citation Format: Youssef M, Namour A, Youssef O, Morsi A. Oncoplastic breast surgery is oncologically safe in locally advanced breast cancer after neoadjuvant chemotherapy, an Egyptian experience [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P3-13-25.

40 - Upper Hemisphere Oncoplastic Surgery

Objective To assess different techniques of oncoplastic breast-conserving surgery, according to breast shape, protrusion, size, and symmetry. Background Oncoplastic surgery has emerged as a new approach to allow wide excision for breast-conserving surgery without compromising the natural shape of the breast. It is based on integration of plastic surgery techniques for immediate breast reshaping after wide excision for breast cancer. Patients and methods This prospective study was carried out on 35 patients; all patients had breast tumor and were being managed at Menoufia University Hospitals by different modalities of oncoplastic breast surgery during the period from April 2012 to December 2013. The appropriate oncoplastic technique was selected for every patient taking into consideration the location and size of the mass and breast size and ptosis. Results Seven patients underwent simple oncoplastic procedures with volume displacement techniques, 20 patients underwent more advanced oncoplastic techniques of volume replacement with local dermoglandular flaps, and eight patients required reconstruction with distant pedicle musculocutaneous flaps. All our patients had negative clear specimen margins. Only three complications were encountered: one case of skin necrosis in the skin envelope after skin-sparing mastectomy and two cases of traumatic fat necrosis with the inverted-T technique. Conclusion This study showed that creative use of reconstructive techniques can yield excellent results, fulfilling all patient and surgeon expectations with a minimum rate of morbidity. Younger women with a small-size breast will benefit from a simple oncoplastic technique with volume displacement procedures. Women with large ptotic breasts need more complex mammoplastic techniques with or without flaps. Oncoplastic surgery should be the standard approach to breast cancer treatment whenever feasible.

Introduction: In the context of breast oncologic surgery, the major advantage of the oncoplastic approach lies in embracing the medical principle of primum non nocere, aligning with the needs for breast conservation and aesthetic outcomes in oncologic treatment. This approach expands surgical options, reduces the rates of mastectomy, and helps prevent deformities. The initial record of oncoplastic surgery dates back to Grisotti's publication in 1994, which reported that approximately 15% of patients experience poor aesthetic results after purely conservative surgery—outcomes influenced by factors such as the extent of excision relative to breast size, tumor location, and the effects of radiotherapy. In this scenario, there arises a need to seek the best functional and aesthetic results in the primary surgical procedure. With the consolidation of oncoplastic surgery within the range of oncologic surgical interventions, various techniques have been developed to achieve adequate tumor excision while avoiding excessive tissue removal that could lead to deformities. Among the most common oncoplastic techniques are elliptical segmentectomy incision, circum-areolar approach for segmental resection, progressive mastopexy, batwing (or bat wing) technique, hemibatwing, donut mastopexy/round-block, bilobed excision, central quadrantectomy, triangular incision, inframammary incision, and reduction mastopexy. Among these techniques, the batwing stands out as a suitable approach for excising cancers located in the upper or central quadrants of the breast, due to its short operative time, low complication rate, good applicability across different breast profiles, minimal dissection and remodeling requirements, low delay for adjuvant treatment, and favorable aesthetic outcomes, with high patient satisfaction. In this context, an integrative bibliographic review of the topic Batwing Oncoplastic Surgery was conducted, based on data collected from studies published in the last 15 years (2008–2023) in the United States National Library of Medicine database (PubMed). Methodology: This is an integrative review study, with data collection carried out through a bibliographic survey to achieve the proposed objectives, based on the examination of relevant research to the theoretical foundation, identified and analyzed through published evidence related to the topic Batwing Oncoplastic Surgery. The study in question is a literature review of an integrative type, with a qualitative approach. For the continuation of this study, the following steps were followed: a) definition of the topic; b) formulation of the guiding question; c) search for descriptors; d) database research; e) establishment of inclusion and exclusion criteria for articles; f) evaluation of information extracted from the selected articles; g) discussion of the results; and finally, h) compilation of the review. For the foundation, the following guiding question was posed: What information is available about the oncoplastic breast surgery technique Batwing? The search for studies was conducted in January 2024 through the United States National Library of Medicine database (PubMed), using the keywords: "oncoplastic" AND "breast surgery batwing technique." The inclusion criteria were: full text available; languages: English, Spanish, and Portuguese; published within the last 15 years. For exclusion, the following criteria were used: articles outside the specified time frame, duplicates, coursework papers, or studies that did not address the guiding question. Conclusion: The literature review reveals that breast oncoplasty is becoming a fundamental part of breast cancer treatment. This approach allows surgeons to perform extensive tumor resections without compromising aesthetic outcomes, prioritizing both tumor removal and cosmetic results. Given the variety of surgical techniques available, it is crucial to consider the patient’s profile, lesion characteristics, systemic conditions, comorbidities, healing capacity, breast volume, and tumor location to identify potential risk factors for surgical complications. A key principle in any breast reduction procedure is preserving vascular supply to the areola–nipple complex and the remaining breast tissue. Therefore, planning the skin incision is the first and most critical step, tailored to the tumor’s location. Considering these principles, the Batwing technique stands out as it is recommended for lesions located in the upper and central quadrants, and is also applicable to deep or adjacent tumors near the areola–nipple complex. This approach is favored due to its shorter surgical time, lower tissue dissection, and highly satisfactory aesthetic results, positioning it as a major advantage among oncoplastic surgical options.

Summary:Oncoplastic surgery is widely popular due to its ability to achieve curative tumor resection and symmetry of both breasts, and as a result of reduced psychological distress after mastectomy. Immediate nipple reconstruction was discussed and the gold standard procedure is inconclusive. Immediate nipple reconstruction with simultaneous breast reconstruction provides satisfactory esthetic results, compared with the delayed procedure. The “inverted lotus bud flap” was demonstrated as a new technique for immediate nipple reconstruction. The advantage of this technique is adequate nipple projection with minimization of scarring. In conclusion, oncoplastic breast surgery with immediate nipple reconstruction was demonstrated to be a safe and esthetically reliable procedure, leading to reduced psychological distress. This single-stage procedure promotes psychosocial well-being after breast cancer surgery. Immediate nipple reconstruction using the “inverted lotus bud flap” technique is versatile, reliable, and offers good esthetic results.

Oncoplastic surgery in breast conservation: a prospective evaluation of the patients, techniques, and oncologic outcomes

Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials

Breast cancer has the highest cancer rate among women in the world. The types of surgery that are often performed are mastectomy, breast conserving surgery (BCS) without reconstruction, and mastectomy or BCS with reconstruction. In this study, we wanted to assess the QoL in patients with mastectomy without reconstruction, BCS without reconstruction, and BCS or mastectomy with reconstruction in breast cancer patientys in Indonesia. This study was a retrospective cohort study that assessed patients' QoL after completing therapy with different types of surgery. The inclusion criteria were all breast cancer patients who did a follow-up medical check-up at outpatient clinics from 2018-2023. Patients were disease-free, had been free of therapy, and were tumor-free for more than 6 months at the time of the evaluation.The participants' QoL was assessed using the SF-36 questionnaire. Data were recorded quantitatively and analyzed through bivariate and multivariate methods. A significant difference in the total QoL score was found in the three groups (p=0.011). Physical function with a p-vcalue of 0.001 and vitality with a pvalue- of 0.015 were significantly different in the three group. After we conducted a post hoc test on these 3 groups, it was found that patients who underwent breast reconstruction surgery generally reported the best total QoL score and better physical functions score. On the other hand, patients who had BCS had the lowest vitality scores compared to those who underwent mastectomy and breast reconstruction groups. This research shows that the QoL of the breast reconstruction group has the highest value in the total QoL score and the physical function domain as well. Meanwhile, in the vitality domain, the BCS group had a significantly lower score than the mastectomy group and reconstruction group.

Background: With 2.3 million new breast cancer cases globally in 2020 and advances in treatment, the focus has shifted to managing long-term complications such as arm lymphedema. While oncoplastic breast surgery is increasingly used to enhance cosmetic outcomes, its effect on arm lymphedema remains unclear. However, the manipulation of breast tissue and increased vascular and lymphatic disruption raise concerns regarding an elevated risk of postoperative lymphedema. This scoping review explores the existing literature on oncoplastic breast surgery and arm lymphedema. Methods: This review is part of a systematic review registered in PROSPERO, focusing on lymphedema outcomes. The systematic search identified 4,185 publications, with four studies meeting the inclusion criteria for oncoplastic surgery and arm lymphedema. Transforming to a scoping review, an extra study was included, totaling five studies. Data were extracted on study design, population, type of surgery, lymphedema measurement, and risk factors. Citations and screening were managed using Covidence. Results: The five studies included 1,532 patients with follow-up periods ranging from 12 months to 7.4 years. Lymphedema rates for OBCS varied between 0% and 11%, with an overall rate of 6.7%. Conclusion: Due to inconsistent reporting and a lack of long-term follow-up data, no definitive conclusions regarding the risk of arm lymphedema related to oncoplastic breast surgery could be drawn. Future prospective studies with standardized lymphedema measurements and specific evaluations of oncoplastic breast surgery techniques are needed. Addressing these gaps is crucial for improving patient outcomes and guiding clinical decisions.

INTRODUCTION: In patients submitted to neoadjuvant chemotherapy (NC), the breast conservative surgery (BCS) rates vary from 37 to 82%, but it occurs in 1.7% to 28% of patients with locally advanced breast cancer (LABC). New techniques of breast surgery like oncoplastic techniques (OT) and skin-sparing mastectomy (SSM) can security improve the indications of BCS in patients with LABC, but there are limited publications with this kind of patients. MATERIAL AND METHODS: A prospective controlled trial, NCT 00820690 (www.clinical.trials.gov), approved by the Ethics committee (135/2008) evaluated patients with LABC, submitted to NC. Patients with LABC, tumors clinical measured and clinical stage III were eligible for inclusion. Prior to and after the NC the breast was clinically and radiologically evaluated.The surgeons evaluated the possibility of performing BCS before and after the NC. Tumor margin, response to NC, the relationship of tumor size-breast size, comorbidities and desire of the patient were considered for OT evaluation. Skin tattoo was performed in tumor skin projection, which was resected during the surgery. We analyze indications, surgeries performed and safety of BCS, based on margins and local recurrence. RESULTS: According to Consort, 78 patients were enrolled to NC regimen. Invasive ductal carcinoma was present in 93.8% of the tumors. The median tumor size before NC was 6.9 cm (3-14). Based of clinical stage, 61.5% were IIIa, 33.3% IIIb and 5.1% IIIc. 64.0% were submitted to mastectomy, 10.3% quadrantectomies, 15.4% SSM, 7.7% pedicle techniques, 2.6% other OT. All margins were free in patients submitted to quadrantectomy. BCS was performed in 36.0%. Based on pathologic response, 39.7% had concentric tumor decrease, 23.8% tumor fragmentation, 10.3 stable disease, 7.7% progression and 8.9 had complete pathologic response. The median follow up is 19 months (8-40) and 80.8% are alive and free of disease. Local recurrence occurred in 7.7% of the patients, all in patients submitted to mastectomy. DISCUSSION: The surgical planning before and after NC is essential. For safety and oncologic reasons, associated with irregular pathologic response, the resection of all tumor bed area is recommended. CONCLUSION: OT increases the concept of BCS in LABC patients, which improves surgical planning, free margins rate and cosmetic results without increasing local recurrence.

Objective To explore the application value of laparoscopic pedicled omentum acquisition technique in laparoscopic breast-conserving surgery of carcinoma. Methods From November 2016 to November 2017, there were 11 patients with carcinoma underwent laparoscopic breast-conserving surgery and plastic surgery with laparoscopic pedicled omentum acquisition technique in Beijing Friendship Hospital, Capital Medical University, and retrospectivly analyzed the clinical data of these patients. The operation time, intraoperative blood loss, drainage tube time, length of incision, surgical complications, postoperative cosmetic effect and tumor recurrence were recorded and analyzed. Results In 11 patients, the average of the total operation time was 186 min, the average intraoperative blood loss was 22 ml, the average drainage tube time was 3.1 d, and the average total length of the was 5.2 cm. There was no severe complication after surgery but only one patient had an increase of belching. The postoperative cosmetic results were excellent with the mean score was 14.7 (the total score was 15) along with getting full score in of breast and scar of the incision . There was no locoregional recurrence or distant metastases. Conclusion The combination of laparoscopic breast-conserving surgery of carcinoma and the laparoscopic pedicled omentum acquisition technique assure the recovery of the shape safely and effectively, also provide better postoperative cosmetic results. Key words: Breast neoplasms; Laparoscopy; Omentum transplantation; Plastic surgery; Breast-conserving surgery

Oncoplastic breast surgery has become a popular choice of treatment for breast reconstruction after mastectomy. There are two different techniques in oncoplastic surgery depending on the volume of the excised breast tissue. One is the volume displacement procedure, which combines resection with a variety of different breast-reshaping and breast-reduction techniques; the other is the volume replacement procedure in which the volume of excised breast tissue is replaced with autologous tissue. In this study, current authors performed various volume replacement techniques based on the weight of the excised tumor and its margin of resection. We used a latissimus dorsi myocutaneous flap for cases in which the resection mass was greater than 150 g, and for cases in which the resection mass was less than 150 g, we used a regional flap, such as a lateral thoracodorsal flap, a thoracoepigastric flap, or perforator flaps, such as an intercostal artery perforator flap or a thoracodorsal artery perforator flap. In the patients with small to moderate-sized breasts, when a postoperative deformity is expected due to a large-volume tumor resection, the replacement of non-breast tissue is required. Many of whom have small breasts, oncoplastic volume replacement techniques in breast-conserving surgery allow an extensive tumor excision without concern of compromising the cosmetic outcome and can be reliable and useful techniques with satisfactory aesthetic results.