Conventional Breast-conserving Surgery Research Articles

Determinants for patient satisfaction regarding aesthetic outcome and skin sensitivity after breast-conserving surgery.

BackgroundWith the development of new surgical techniques in breast cancer, such as oncoplastic breast surgery, increased knowledge of risk factors for poor satisfaction with conventional breast-conserving surgery (BCS) is needed in order to determine which patients to offer these techniques to. The aim of this study was to investigate patient satisfaction regarding aesthetic result and skin sensitivity in relation to patient, tumour, and treatment factors, in a consecutive sample of patients undergoing conventional BCS.MethodsWomen eligible for BCS were recruited between February 1, 2008 and January 31, 2012 in a prospective setup. In all, 297 women completed a study-specific questionnaire 1 year after conventional BCS and radiotherapy. Potential risk factors for poor satisfaction were investigated using logistic regression analysis.ResultsThe great majority of the women, 84%, were satisfied or very satisfied with the overall aesthetic result. The rate of satisfaction regarding symmetry between the breasts was 68% and for skin sensitivity in the operated breast it was 67%. Excision of more than 20% of the preoperative breast volume was associated with poor satisfaction regarding overall aesthetic outcome, as was axillary clearance. A high BMI (≥30 kg/m2) seemed to affect satisfaction with symmetry negatively. Factors associated with less satisfied patients regarding skin sensitivity in the operated breast were an excision of ≥20% of preoperative breast volume, a BMI of 25–30 kg/m2, axillary clearance, and radiotherapy. Re-excision and postoperative infection were associated with lower rates of satisfaction regarding both overall aesthetic outcome and symmetry, as well as with skin sensitivity.ConclusionsSeveral factors affect patient satisfaction after BCS. A major determinant of poor satisfaction in this study was a large excision of breast volume. If the percentage of breast volume excised is estimated to exceed 20%, other techniques, such as oncoplastic breast surgery, with or without contralateral surgery, or mastectomy with reconstruction, may be considered.Electronic supplementary materialThe online version of this article (doi:10.1186/s12957-016-1053-8) contains supplementary material, which is available to authorized users.

Evaluation of Surgical Outcomes of Oncoplasty Breast Surgery in Locally Advanced Breast Cancer and Comparison with Conventional Breast Conservation Surgery.

The purpose of this study was to compare early oncologic outcomes of oncoplastic breast surgery and conventional breast conservation surgery in patients of locally advanced breast cancer. A single-center, prospective, non-randomized study enrolled select cases of locally advanced breast cancer (TNM T3/T4, N0/1/2) who after neoadjuvant chemotherapy, were considered for breast conservation surgery with oncoplasty techniques. The specimen volume resected, the mean margins and mean closest margin obtained were noted. The re-surgery rates, complication rates, and incidence of locoregional recurrence were also noted. Variables were compared with a retrospective cohort of similar patients who had undergone conventional breast conservation surgery. Fifty-seven patients underwent OBS (group 1) and were compared with 43 cases that had undergone conventional BCS (group 2). Majority of the patients in group 1 (73%) had cT3 with N0 or N+ and a minority (17%) were with limited skin involvement (cT4 and N0/N+). Relatively larger sized, post-NACT tumors could undergo OBS(4.4 vs 2.3cm). Relatively greater proportion of tumors in central and lower quadrants were addressed by oncoplasty than traditional BCS (17/57, 29% vs 4/43, 9%, p=0.04). The mean specimen volume excised in group 1 was more than that in group 2. (187.54 vs 125.19; p=0.01). The mean of the margins were obtained more in group 1 (1.04 vs 0.69cm); p<0.01) as also the mean closest margin (0.86 vs 0.49cm; p<0.01). The incidence of close or involved margins was lesser in the OBS group (8vs 24%). Overall incidence of complications was similar in both groups (8/57, 14% vs 4/43, 9%; p=0.34 NS). The median follow-up period of group 1 is 18months (range 06-30months) while group 2 is 34months (14-44months. There was no recurrence in group 1, but there were 5 cases (11%) in group 2. Oncoplasty breast surgery offers more opportunity for breast conservation and oncologic safety than conventional breast conserving surgery.

Evaluation of surgical outcomes following oncoplastic breast surgery in early breast cancer and comparison with conventional breast conservation surgery

BackgroundThe aim of this study was to determine whether oncoplastic breast surgery (OBS) ensures better tumour resection than conventional breast conservation surgery (BCS). MethodsA prospective comparative study, conducted over a 3-year period, enrolled patients with early breast cancer who underwent OBS. The total volume of glandular resection, tumour volume resection and width of the margins obtained were noted. The incidence of complications, requirement of revision surgery and locoregional recurrence during follow-up period were also noted. The data were compared with matched controls who had undergone convention BCS in the past. ResultsThirty-three patients underwent oncoplastic surgery and the data was compared with 46 patients of conventional breast conservation. The mean volume of specimen was higher in the oncoplastic group (173.5cm3 vs 101.4cm3, p=0.03) though the tumour volume excised was similar (43.2cm3 vs 36.4cm3, p=0.14). The mean margin widths were larger in the oncoplastic group (14mm vs 6mm, p=0.01). There were more instances of close and positive margins seen in conventional BCS groups. The incidence of complication rate was similar. Median follow-up 18 months for oncoplasty group showed no cases of locoregional recurrence while in median follow-up of 38 months for conventional BCS group, six cases of locoregional relapse were noted. ConclusionsOncoplastic surgery results in excision of larger volume of breast tissue and correspondingly obtain wider surgical margins as compared to conventional BCS. Longer follow-up is required to determine if wider resection translates into better locoregional control.

Factibilidad y resultado estético de la cirugía oncoplástica en el tratamiento de cáncer de mama

BackgroundBreast cancer is the leading oncological cause of death in Mexican women over 25 years old. Given the need to improve postoperative cosmetic results in patients with breast cancer, oncoplastic surgery has been developed, which allows larger tumour resections and minor cosmetic alterations. ObjectiveTo determine the oncological feasibility and cosmetic outcome of oncoplastic surgery at the Instituto de Enfermedades de la Mama, FUCAM, AC. Material and methodsA review was conducted from January 2010 to July 2013, which included patients with breast cancer diagnosis treated with conventional breast-conserving surgery or with oncoplastic surgery in the Institute of Diseases of the Breast, FUCAM AC. Clinical and histopathological parameters were compared between the two groups, and a questionnaire of cosmetic satisfaction and quality of life was applied. ResultsOf the 171 patients included, 95 of them were treated with conventional breast-conserving surgery and 76 with oncoplastic surgery. Pathological tumour size was significantly larger in patients treated with oncoplastic surgery (p = 0.002). There were no differences found between the groups as regards the number of patients with positive surgical margin, the rate of complications, and cosmetic satisfaction. ConclusionThis study demonstrates the oncological feasibility and high cosmetic satisfaction of oncoplastic surgery with minimal psycho-social impact on patients.

Oncoplastic surgery: pushing the limits of breast-conserving surgery.

In recent decades, the surgical management of breast cancer has steadily and considerably improved. Mutilating procedures have given way to more individualized surgical approaches aiming to preserve the breast as much as possible. For large tumors, preoperative chemotherapy is a major tool, but emerging oncoplastic surgery techniques are also a new approach in the armamentarium of breast cancer surgery, as a third option between conventional breast-conserving surgery and mastectomy. As this new treatment modality allows wider margin excision, it reduces the need for re-excision procedures and possibly increases breast conservation rates by extending the indications of breast-conserving surgery. This review will provide an overview of current practices and clinical data available to date on oncoplastic surgery.

Use of an absorbable adhesion barrier for reconstruction of partial mastectomy defects in the upper quadrant of large ptotic breasts

IntroductionAn absorbable adhesion barrier (Interceed®) is generally used during gynecologic or pelvic surgery. We report a new oncoplastic technique using the absorbable Interceed® sheet for upper quadrant breast cancer in large ptotic breasts with no other flaps. Materials and methodsFrom January 2007 to June 2013, a total of 25 patients with breast cancer underwent conventional breast-conserving surgery with the Interceed® sheet insertion technique. Tumors were removed with oncologically safe margins, and adjacent breast tissue was repositioned to adjust the breast's shape. When shaping was completed, the breast skin turgor was strengthened using Burrow's triangle displacement technique. Interceed® was then placed between breast skin and pectoralis muscle fascia with four-quadrant anchoring sutures. ResultsThe tumors were located in the upper central (n = 12), upper inner (n = 11), and upper outer (n = 2) quadrants. The mean weight of the removed breasts was 82.1 g, and the mean operative time was 161.3 min. There were two postoperative complications—a wound infection and fat necrosis—which were resolved with conservative management. Radiation-induced fibrosis and skin thickening were identified by magnetic resonance imaging 8–12 weeks after radiotherapy. Overall patient and surgeon satisfaction with the cosmetic results were evaluated as excellent (n = 12), good (n = 11), or fair (n = 2). ConclusionUse of the absorbable Interceed® sheet during surgery for upper quadrant breast cancer is feasible in patients with large ptotic breasts.

Therapeutic mammaplasty – Impact on the delivery of chemotherapy

Therapeutic mammaplasty allows breast conservation and maintains breast cosmesis in women with larger and ptotic breasts. They are associated with more post-operative complications, potentially delaying adjuvant treatment. Our aim is to investigate the impact of therapeutic mammaplasty on the timing of adjuvant chemotherapy, compared with conventional breast conservation surgery. MethodsRetrospective data collection of breast cancer patients undergoing breast-conserving surgery at a single institution from 2009 to 2013. Results1000 patients underwent breast-conserving surgery, 40 underwent therapeutic mammaplasty. Patients with a complication of mammaplasty had no delay to starting chemotherapy compared to those without complication (median 36 vs. 40 days). There was no delay to chemotherapy for patients requiring further breast cancer excision surgery following therapeutic mammaplasty compared with standard breast conservation surgery (36 vs. 39 days). ConclusionsThere is no delay in commencing adjuvant chemotherapy following therapeutic mammaplasty surgery, even if there is a complication of surgery. However, patients with involved margins had a significant delay to chemotherapy whilst awaiting re-excision surgery.

Technical feasibility and cosmetic advantage of hybrid endoscopy-assisted breast-conserving surgery.

80 Background: We developed a new procedure called hybrid endoscopy-assisted breast-conserving surgery (EBCS), which consists of a combination of plastic surgery and endoscopic surgery techniques. The purpose of this study was retrospectively to analyze the clinical outcome of hybrid-EBCS and compare the cosmetic outcomes between hybrid-EBCS and conventional breast-conserving surgery (CBCS). Methods: We reviewed medical records of patients who had undergone hybrid-EBCS (n = 73) or CBCS (n = 90) between May 2005 and April 2011 and had been followed-up in our department until March 2012. The clinical outcomes, and cosmetic outcomes of these 2 groups were compared. The safety of hybrid-EBCS was also analyzed by confirming its complications and pathological surgical margin. Results: In the hybrid-EBCS group, operation time was longer by 30–50 minutes. Blood loss was not significantly different between the 2 groups. The surgical margin of hybrid-EBCS was as follows: 1 patient (1.4%) had a positive margin; 4 patients (5.5%) had a margin of less than 2 mm; in 9 patients (12.3%), the margin was &gt; 2 mm and &lt; 5 mm; and in 59 patients (80.8%), it was more than 5 mm. Seven cases (9.6%) of postoperative complications occurred in 6 hybrid-EBCS patients. To date, no local recurrence has been observed in hybrid-EBCS patients (postoperative observation period: 18.1 ± 5.6 months). Compared with the CBCS group, the hybrid-EBCS group had better cosmetic results, especially with a less noticeable operative scar (p &lt; 0.01). Conclusions: Hybrid-EBCS can provide sufficient free margin, and its surgical curability is acceptable. Additionally, this method is superior to CBCS in terms of cosmetic outcome.

Vertical scar therapeutic mammaplasty - a future direction for oncoplastic breast conservation

Introduction: Vertical Scar Therapeutic Mammaplasty (VSTM) has been advocated as an alternative treatment option for breast cancer in comparison to conventional breast conserving surgery (BCS) and other oncoplastic breast conservation techniques. However, there is a paucity of published data on VSTM that evaluates the oncological outcomes. A study was performed comparing re-excision rates of VSTM with published rates for conventional BCS.

Comparison of Outcomes of Standard and Oncoplastic Breast-Conserving Surgery

PurposeThe aim of this study is to determine and to compare the oncological outcomes of bilateral reduction mammoplasty to standard breast-conserving surgery for breast cancer.MethodsOne hundred sixty-two patients who received a quadrantectomy because of breast cancer (group 1) and 106 breast cancer patients with macromastia who underwent breast-conserving surgery via bilateral reduction mammoplasty (group 2) between 2003 and 2010 were enrolled in this study.ResultsThe mean follow-up time was 37 months for group 1 and 33 months for group 2. Surgical margins were wider than 2 mm in 82.7% and 10 mm in 76.5% of the patients in group 1. Eleven percent of patients had positive surgical margins in this group. When compared to group 2, the rates were 89%, 84%, and 8.4%, respectively. Three patients (1.8%) in group 1 and one patient (0.9%) in group 2 had local recurrence of the disease and received a mastectomy. No statistical significances were noted for either local recurrence or overall survival between the two groups.ConclusionBilateral reduction mammoplasty has some advantages as compared to the standard conventional breast-conserving surgery techniques without having any unfavorable effects on surgical margin confidence, local recurrence, and survival rates.

Technical Feasibility and Cosmetic Advantage of Hybrid Endoscopy-Assisted Breast-Conserving Surgery for Breast Cancer Patients

We developed a new procedure called hybrid endoscopy-assisted breast-conserving surgery (EBCS), which consists of a combination of plastic surgery and endoscopic surgery techniques. The purpose of this study was retrospectively to analyze the clinical outcome of hybrid EBCS and compare the cosmetic outcomes between hybrid EBCS and conventional breast-conserving surgery (CBCS). We reviewed medical records of patients who had undergone hybrid EBCS (n=73) or CBCS (n=90) between May 2005 and April 2011 and had been followed up in our department until March 2012. The clinical outcomes and cosmetic outcomes of these two groups were compared. The safety of hybrid EBCS was also analyzed by confirming its complications and pathological surgical margin. In the hybrid EBCS group, operation time was longer by 30-50 minutes. Blood loss was not significantly different between the two groups. The surgical margin of hybrid EBCS was as follows: 1 patient (1.4%) had a positive margin, 4 patients (5.5%) had a margin of <2 mm, in 9 patients (12.3%) the margin was ≥2 mm and <5 mm, and in 59 patients (80.8%) it was ≥5 mm. Seven cases (9.6%) of postoperative complications occurred in 6 hybrid EBCS patients. To date, no local recurrence has been observed in hybrid EBCS patients (postoperative observation period, 18.1±5.6 months). Compared with the CBCS group, the hybrid EBCS group had better cosmetic results, especially with a less noticeable operative scar (P<.01). Hybrid EBCS can provide sufficient free margin, and its surgical curability is acceptable. Additionally, this method is superior to CBCS in terms of cosmetic outcome.

The Feasibility of Endoscopy-Assisted Breast Conservation Surgery for Patients with Early Breast Cancer

PurposeBreast conservation surgery (BCS) has become a standard treatment method for patients with early breast cancer. Endoscopy-assisted BCS (EABCS) can be performed through an inconspicuous periareolar and a small axillary incision for sentinel node biopsy, which may give better cosmetic outcomes than conventional BCS skin incisions. This study was designed to evaluate the feasibility of EABCS for patients with early breast cancer.MethodsForty-three patients were candidates for EABCS, and EABCS was performed in 40 patients with breast cancer between January 2008 and July 2010. Their clinicopathological features were retrospectively analyzed. Operative time, margin status, complications, and relapse-free survival were compared with those of patients treated by conventional BCS and who were treated at the same institute during the same period.ResultsThe most common lesion site of the EABCS and conventional BCS groups was the upper area of the breast. Tumor size in all patients was less than 4 cm (range, 0.4-3.7 cm), and nodal involvement was found in eight (20%) patients in the BCS group. The mean operative time was 110 minutes for the EABCS group and 107 minutes for the conventional BCS group, and those were not significantly different. No significant difference in frozen or final margin status was observed between the EABCS and conventional BCS groups. Relapse-free survival was statistically equivalent between the groups with a median follow-up of 12 months. Postoperative complications occurred in five cases in four patients with EABCS, which was not significantly different from conventional BCS.ConclusionPerforming EABCS in patients with early breast cancer seems to be feasible and safe. Further study with a longer-term follow-up may be needed to confirm the clinical value of EABCS.

Oncoplastic Surgical Techniques for Personalized Breast Conserving Surgery in Breast Cancer Patient with Small to Moderate Sized Breast

Oncoplastic surgery has revolutionized the field of breast conserving surgery (BCS). The final aims of this technique are to obtain an adequate resection margin that will reduce the rate of local recurrence while simultaneously improving cosmetic outcomes. To obtain successful results after oncoplastic surgery, it is imperative that patients be risk-stratified based on risk factors associated with positive margins, that relevant imaging studies be reviewed, and that the confirmation of negative margins be confirmed during the initial operation. Patients who had small- to moderate-sized breasts are the most likely to be dissatisfied with the cosmetic outcome of surgery, even if the defect is small; therefore, oncoplastic surgery in this population is warranted. Reconstruction of the remaining breast tissue is divided into volume displacement and volume replacement techniques. The use of the various oncoplastic surgeries is based on tumor location and excised breast volume. If the excised volume is less than 100 g, the tumor location is used to determine which technique should be used, with the most commonly used technique being volume displacement. However, if the excised volume is greater than 100 g, the volume replacement method is generally used, and in cases where more than 150 g is excised, the latissimus dorsi myocutaneous flap may be used to obtain a pleasing cosmetic result. The local recurrence rate after oncoplastic surgery was lower than that of conventional BCS, as oncoplastic surgery reduced the rate of positive resection margins by resecting a wider section of glandular tissue. If the surgeon understands the advantages and disadvantages of oncoplastic surgery, and the multidisciplinary breast team is able to successfully collaborate, then the success rate of BCS with partial breast reconstruction can be increased while also yielding a cosmetically appealing outcome.

The Use of a Corrective Procedure with Vicryl Mesh for Oncoplastic Surgery of the Breast

Purpose: In addition to the oncological results, cosmetic results are very important to cancer patients. Currently, the use of oncoplastic surgery is an emerging approach. In this study, we examined the clinical outcomes of the use of a corrective procedure with an absorbable implant, a Vicryl mesh� , as compared with the use of conventional breast conserving surgery (BCS). Methods: Fifty six patients who completed questionnaire were enrolled in the study. For 33 cases, BCS was performed concurrently with the use of a Vicryl mesh and for the other 23 cases, conventional BCS alone was performed. Contraindications of the use of corrective procedure were a patient age over 60 year, diabetes, neoadjuvant chemotherapy and a previous excisional biopsy performed on the same breast. Patients rated their cosmetic outcomes by use of a four point scale. Results: For one of 34 cases, the Vicryl mesh was removed due to infection and this patient was excluded from the study. Twenty seven of the remaining 33 patients (82%) who underwent the corrective procedure with Vicryl mesh were satisfied with their outcome. For patients that received conventional BCS only ten of 23 patients (43%) were satisfied with their outcome (p= 0.05). Patient age, body mass index (BMI) and tumor location did not affect the cosmetic outcomes of the corrective procedure. When the resection area of the breast was 40-70 cm 2 , 88% of the patients were satisfied with their outcome. Conclusion: This study suggested that the use of Vicryl mesh correction was superior to the use of conventional BCS alone for cosmesis. This method appears to provide a satisfactory outcome for oncoplastic surgery of the breast.

Minimising surgical treatment of early breast cancer

Breast-sparing oncoplastic procedures (BSOP) offer a radical new alternative to mastectomy and conventional breast-conserving surgery in early breast cancer treatment. Wider clearance reduces local recurrence, with a direct impact on long-term survival [1]. Loss of volume is the leading cause of breast deformity, especially for central, medial and inferior tumours [2]. BSOP require the simultaneous deployment of oncological and reconstructive skills, and the emergence of oncoplastic surgeons is increasing the availability of these procedures in clinical practice [3].

Breast-Conserving Surgery Using Projection and Reproduction Techniques of Surgical-Position Breast MRI in Patients with Ductal Carcinoma In Situ of the Breast

In this study, we report a breast-conserving surgery (BCS) approach that uses projection and reproduction techniques of breast MRI obtained in the surgical position to the breast surface in patients with ductal carcinoma in situ (DCIS) of the breast. Between February 2005 and January 2007, a total of 104 patients with operable breast cancer at our hospital had surgical-position breast MRI examinations. The 24 patients with relatively localized DCIS received BCS using the projection and reproduction techniques of the surgical-position breast MRI. During the same time period, 28 patients with relatively localized DCIS in whom prone-position breast MRI was performed, had conventional BCS using mammography-guided hookwires. In this study, we compared the surgical outcomes of our surgical approach with those of the conventional approach in a total of 52 patients with relatively localized DCIS. Average volume of the pathologic specimens in the new technique group (27.5 cm(3)) was substantially smaller than that in the conventional BCS group (57.6 cm(3), p = 0.0007). In addition, the positive margin rate was substantially lower in the new technique group (12.5%) than in the conventional BCS group (39.3%; p = 0.029). This study demonstrates that BCS can be done guided by the precise projection and reproduction techniques of the lesion obtained by surgical-position breast MRI. To the best of our knowledge, this is the first report of BCS technique for DCIS in this manner. Our surgical approach can be clinically useful in surgical planning and management in patients with DCIS.

Problems with the Use of Breast Conservation Therapy for Breast Cancer in a Patient with Neurofibromatosis Type 1: A Case Report

Patients with neurofibromatosis type I and breast cancer represent a subset of people who may be considered at high risk for secondary cancers after conventional whole breast radiation therapy and breast conservation surgery. A case of a 49-year-old woman with neurofibromatosis type I is presented. She was diagnosed with a 1.1-cm right breast infiltrating ductal carcinoma. Clinical, diagnostic imaging, and pathologic features are discussed. Her initial treatment plan of breast conserving therapy was thwarted when her sentinel node biopsy was positive for micrometastatic disease in 1/14 lymph nodes. She elected to have a bilateral simple mastectomy. This case addresses the rare dilemma of offering breast conservation therapy as a viable option for patients with neurofibromatosis type I. Current data on radiation-induced secondary cancers such as sarcoma after treatment for breast and other cancers are reviewed.