Extreme Oncoplasty Research Articles

ASO Visual Abstract: Extreme Oncoplasty: Oncologically Safe When Compared with Mastectomy.

ASO Visual Abstract: Extreme Oncoplasty: Oncologically Safe When Compared with Mastectomy.

Comparative analysis of the degree of patient satisfaction after breast-conserving surgery with or without oncoplastic surgery: systematic review and meta-analysis.

Conservative surgery is the gold standard for the treatment of single and small tumors and, combined with the concept of oncoplastic tumors, brings good aesthetic results while maintaining cancer safety. The objective was to comparatively analyze the degree of satisfaction of patients undergoing breast conserving surgery (BCS), with and without oncoplastic surgery (OPS) using level II OPS techniques. Review with a search in the databases MEDLINE (by PubMed), EMBASE, Clinical Trials, Scopus, Web of Science, BVS and Oppen gray. The meta-analysis of random effects was performed using the Der Simonian-Laird method considering the odds ratio (OR) with a 95% confidence interval (95% CI). There was no statistically significant difference in the aesthetic outcome between women who underwent OPS and BCS (OR 0.90; 95% CI 0.62-1.30). The staging (OR 1.93; 95% CI 0.97-3.84; I 2 = 15.83%); tumor location [central (OR 1.28; 95% CI 0.06-27.49; I 2 = 17.63%); lower (OR 0.75; 95% CI 0.21-2.65; I 2 = 2.21%); superior (OR 0.67; 95% CI 0.26-1.74; I 2 = 0.00%] and tumor size (OR 8.73; 95% CI -11.82-29.28; I 2 = 93.18%) showed no association with the type of BCS performed, with or without OPS. The degree of satisfaction remains even in cases of extreme oncoplasty. The level of patient satisfaction in relation to BCS was similar to that of the group undergoing OPS, highlighting that OPS allows the patient's satisfaction rate to be maintained even in the case of large or multicentric tumors.

Extreme Oncoplasty: Oncologically Safe When Compared with Mastectomy

BackgroundExtreme oncoplasty is a breast-conserving operation using oncoplastic techniques in a patient who does not meet the traditional criteria for breast conservation and in whom most physicians would suggest a mastectomy. These tumors are generally multicentric and/or multifocal, they span more than 50 mm, or they can be large recurrences in a previously irradiated breast.MethodsA prospective single institution database was queried from 2008 through mid 2023 for patients who met the criteria for extreme oncoplasty and were treated with excision plus whole-breast radiation therapy (WBRT) or mastectomy without WBRT. Patients with recurrent breast cancer were excluded. Endpoints were local, regional, and distant recurrence as well as overall and breast-cancer-specific survival.Results272 patients were treated with oncoplastic mammaplasty, using a standard or split reduction excision followed by postoperative WBRT. An additional 101 patients elected to be treated with mastectomy without postoperative radiation therapy. With a median follow-up of 7 years, there were no significant differences in local, regional, or distant recurrence, nor in breast-cancer-specific survival or overall survival.ConclusionsWe strongly support extreme oncoplasty plus WBRT as the default procedure of choice for patients with large multifocal/multicentric lesions amenable to reconstruction with volume displacement mammaplasty.

Early Outcome of Superomedial Pedicle as Extreme Oncoplastic Procedure versus Modified Radical Mastectomy in Patients with Stage T3 Breast Cancer Not Responding to Neoadjuvant Chemotherapy

Abstract Background Breast cancer, according to national cancer institute, is the most common site of cancer in women in Egypt as it accounts for about 38.8% of total malignancies among Egyptian females; it is an important cause of mortality among women. Aim of the Work To assess the feasibility of extreme oncoplasty (achieving negative margins) for T3 breast cancer patients not responding to neoadjuvant chemotherapy by using a superomedial pedicle flap. Patients and Methods This study was conducted on 30 female patients with stage T3 breast cancer not responding to neoadjuvant chemotherapy with no skin involvement or upper medial quadrant tumor, with large breast size (cup D), accepting both intervention modalities and fit for both anesthesia and radiotherapy. It was performed at the (General Surgery Department) at Ain Shams University Hospitals and El Haram specialized Hospital starting from March 2020. Approval of the Ethical Committee and written informed consent from all participants were obtained. Patients were divided into two groups. Group A includes 15 patients underwent Modified radical mastectomy with axillary clearance. Group B includes 15 patients underwent Superomedial pedicle mammoplasty and axillary clearance. Results Superomedial pedicle mammoplasty is equivalent to modified radical mastectomy in terms of oncological safety, with advantages over mastectomy in terms of quality of life and esthetic outcomes. Thus, Extreme oncoplasty provides an alternative to Modified radical mastectomy, extends the scope of breast conservation, provides better clinical outcomes, and improves quality of life. Conclusion This study showed that superomedial pedicle mammoplasty technique is a feasible extreme oncoplastic approach for patients with large tumors and not responsive to neoadjuvant chemotherapy considered for Modified radical mastectomy with acceptable complication rates, negligible rates of reexcision and no early recurrence in 3 months period.

Pushing the Limits of Breast-Conserving Surgery with Extreme Oncoplasty

Introduction: We aimed to report the long-term surgical outcomes of extreme oncoplasty techniques in selected patients with unifocal (UF)/cT3 or multifocal-multicentric tumors (MFMC). Material and Methods: Patients who were initially recommended to have mastectomy underwent extreme oncoplastic breast-conserving surgery (eOBCS) including therapeutic reduction mammoplasty, racquet, and round-block mammoplasty, Grisotti flap, or combined technique were included. Preoperative tumor parameters, clinical outcomes, rate of local recurrence, survival, and patients’ satisfaction were assessed. Results: Eighty-six patients with a median age of 51 years were followed for a median follow-up of 75 (8–154) months; 31 (36%) had cT3 and 55 (64%) had MFMC tumors. The majority of patients (83.6%) had invasive cancer. The median UF tumor size was 58 mm (range 51–100) on imaging and 51 mm (range 50–60) on final pathology. The median tumor span for MFMC was 65 mm (range 53–95) on imaging, whereas the median of the largest tumor size was 30 mm (range 22–60) on final pathology. Seventy-one patients (82.5%) were ER-positive, 17 (19.7%) were HER2 positive, and 8 (9.3%) were triple-negative breast cancer. Four patients (4.7%) required further intervention for having positive margins (3 re-excisions, 1 completion mastectomy). Three local recurrences (3.4%) and 10 (11.6%) distant metastasis occurred. The cosmetic outcome was excellent in 37 (43%) patients. No major complications were observed. Conclusions: eOBCS can be a good option for patients who initially require mastectomy. Appropriate patient selection, a multidisciplinary approach, and patient consent are essential steps of the procedure.

Extreme oncoplasty - Data on local recurrence at 24 months

Extreme oncoplasty - Data on local recurrence at 24 months

P206 Pushing the iımits of breast conservation therapy with extreme oncoplasty

P206 Pushing the iımits of breast conservation therapy with extreme oncoplasty

Extreme oncoplasty

Abstract This Keynote Address presents the evolution of a technique called ‘Extreme Oncoplasty’. Extreme oncoplasty is a combination of surgical oncology and plastic surgery techniques that is used for breast preservation in patients who do not meet that usual criteria for breast conservation and would normally receive a mastectomy.

Extreme Oncoplasty - Editorial Commentary

Extreme Oncoplasty - Editorial Commentary

Extreme oncoplasty - editorial commentary

Abstract This is a short commentary on the editorial article by Prof. Melvin Silverstein, where he describes his surgical career including his experiences with Extreme Oncoplasty (EO). The editor in this commentary emphasizes the utilization of EO in the Indian scenario where most patients present with advanced stages and might need even extreme Oncoplastic Breast Surgery based clinical management.

Safety and cosmetic outcome following extreme oncoplasty: A prospective observational study

Introduction: Large tumour size, multifocal and multicentric disease, high tumour-breast ratio are barriers to successful BCT. Extreme oncoplasty allows wider resection and achieves preservation in apparently non-conservable lesions.

Extreme oncoplasty for centrally located breast cancer in small non-ptotic breasts: extending the indications of chest wall perforator flaps with areolar reconstruction.

BackgroundBreast cancers located centrally require excision of nipple-areola complex. A simple central wide excision is a safe option but results in suboptimal aesthetic outcome. An oncoplastic option involves therapeutic mammoplasty with or without areolar reconstruction, limited to moderate and large ptotic breasts. For small non-ptotic breasts, most surgeons would resort to mastectomy with/without reconstruction.MethodsLateral chest wall perforator flap (CWPF) is an option for partial breast reconstruction in small to moderate sized, non-ptotic breasts for laterally located tumours. We have extended the application of CWPF for central tumours to avoid mastectomy in selected patients.ResultsWe here present a case series of four patients with small to medium-sized non-ptotic breasts, who had centrally located breast cancer or ductal carcinoma in-situ (DCIS). Three patients had single stage CWPF reconstruction, and one had central excision with immediate reconstruction following a failed attempt at therapeutic mammoplasty. All had the areola reconstructed using flap skin; one patient had simultaneous nipple reconstruction.ConclusionsCWPF is an option for treatment of centrally located breast cancers/DCIS needing nipple-areola complex excision for patients wishing to avoid mastectomy. Patients with small to medium-sized non-ptotic breasts are suitable, and need to be carefully selected.

Extreme Oncoplastic Breast Surgery in Patients Presented to Ain Shams University Hospital, Initial Experience

Abstract Background Breast cancer, according to national cancer institute, is the most common site of cancer in women in Egypt as it accounts for about 38.8% of total malignancies among Egyptian females; it is an important cause of mortality among women. Objective s: Assess the feasibility of extreme oncoplasty and achievement of negative margins in the enrolled patients. Assess the aesthetic results of the extreme oncoplasty of the enrolled patients. Patients and Methods This is a prospective cohort study to assess the feasibility of extreme oncoplasty and achievement of negative margins in the enrolled patients and the aesthetic results of the extreme oncoplasty. This study was conducted at Ain-Shams University Hospitals. Approval of the Ethical Committee and written informed consent from all participants was obtained. Extreme oncoplasty techniques was proposed for patients in whom inclusion criteria was met. Diagnosis and staging examinations were carried out according to the standard protocol being conducted at Ain Shams University Hospitals. Results We report the oncoplastic outcomes after EO in a single institutional cohort of 20 patients with multifocal/Multicenteric or large tumors (≥50mm).While no major complications were observed after EO procedure, a low rate of minor complications (7.7%) was observed. Conclusion The combination of plastic surgery techniques with breast oncology surgery gives the surgeon a new tool for treatment of breast cancer. The preliminary results of our study indicate that selective patients (with multifocal/Multicenteric or large tumors) who were initially considered for mastectomy can be alternatively treated using Extreme oncoplasty (EO) followed by radiotherapy. EO can be considered as a safe and feasible surgical option for such patients without compromising aesthetic outcomes.

Extreme Oncoplasty: Breast Conservation in Patients with Large, Multifocal, and Multicentric Breast Cancer.

IntroductionExtreme Oncoplastic Breast Conservation Surgery (EOBCS) is offered in selected patients with multifocal or multicentric breast cancer (MFMC). Recent evidence has suggested that EOBCS may be a valuable resource for patients with MFMC who may avoid the risk associated with mastectomy in favour of the benefits of breast conservation without risking their oncological outcomes. Our study examined the practice of EOBCS in two regional breast units in Glasgow, United Kingdom.Materials and MethodsA prospectively collected database of 50 patients treated with EOBC in two breast units in Glasgow between 2007 and 2018 were evaluated, and clinical outcomes were observed.ResultsFifty patients (median age 55) underwent EOBCS, of which 43 (86%) had invasive disease. Median tumour size was 55mm (50–90) and multifocal disease was identified in 22 (44%) patients. Nine patients (18%) were found to have positive margins and underwent a second procedure, with 6 (12%) proceeding to mastectomy. Five-year disease free survival rate was 91.5%, while cancer-specific survival was 95.7%.ConclusionEOBCS is oncologically safe in short-term follow-up. Large scale studies are required to confirm these preliminary results, in order to offer EOBCS as a valid option to patients with advanced or multifocal breast cancer.

Extreme oncoplasty: The last opportunity for breast conservation-Analysis of its impact on survival and quality of life.

Extreme oncoplasty: The last opportunity for breast conservation-Analysis of its impact on survival and quality of life.

P112. Oncoplastic conservation for cT3 or multifocal / multicentric cancers (extreme oncoplasty) is oncologically safe

Introduction: cT3 breast cancers or multifocal / multicentric (MFMC) cancers are treated with mastectomy most commonly. However, oncoplastic techniques may allow breast conservation in selected patients, which is called extreme oncoplasty. The evidence for extreme oncoplasty is limited, hence we investigated this in our institutions.

P270 - Surgical management of multifocal/multicentric and locally advanced breast cancer with extreme oncoplasty

P270 - Surgical management of multifocal/multicentric and locally advanced breast cancer with extreme oncoplasty

Extreme Oncoplastic Surgery for Multifocal/Multicentric and Locally Advanced Breast Cancer.

Introduction Breast conserving surgery (BCS) followed by radiation therapy (RT) has become the preferred alternative to mastectomy for patients with early stage breast cancer (BC). Randomized trials have confirmed equivalent locoregional control and overall survival for BCS and mastectomy. Extreme Oncoplasty (EO) extends the indications of BCS for patients who would otherwise require mastectomy, ensuring better aesthetic outcomes and oncological safety. Methods BC patients with multifocal/multicentric (MF/MC) tumors, extensive DCIS, or large tumor >50mm underwent EO at our breast unit. Therapeutic reduction mammaplasty (TRM) with wise pattern preoperative markings and dual pedicle technique involving parenchymal rearrangement was used for oncoplastic reconstructions in majority of the cases followed by RT. Patient reported outcome measures (PROMs) were assessed using the validated Breast-Q questionnaire. Results Of the 39 patients in the study, 36 had unilateral and 3 had bilateral BC. Mean age was 47.2 years. Median tumor size was 75mm. 17 (43.6%) patients received NACT; none achieved a complete clinical response. 28 (71.8%) patients were administered to adjuvant chemotherapy. 33(84.6%) patients received RT to the breast with a median dose of 50Gy in 28 fractions and a boost dose of 10Gy in 5 fractions to the tumor bed. No major complications or local recurrences were observed. Excellent Breast-Q scores were observed in patients undergoing EO after 12 months of follow-up. Conclusion EO followed by RT results in acceptable local-regional control, low rate of complications, and high patient satisfaction. In selected patients, EO could provide a safe alternative for breast conservation surgery instead of mastectomy.

Extreme oncoplasty: Expanding indications for breast conservation

IntroductionPresence of multiple lesions and/or tumor span ≥5 cm are traditional indications for mastectomy. Patient desire for breast conservation has increased the interest in extreme oncoplastic breast conserving surgery (EOBCS) to avoid mastectomy; however, perioperative outcomes in this population have not been well described. MethodsThis is an observational cohort of breast cancer patients with multiple lesions and disease span ≥5 cm who underwent EOBCS. Patient demographics, disease span, margin width, mastectomy and re-excision rates, and cosmesis were evaluated. ResultsOne hundred-eleven patients underwent EOBCS between 2012 and 2017. Eighty-two patients presented with multifocal or multicentric disease with an average of 3.2 lesions per breast spanning 57.1 ± 23.6 mm. Eighteen patients presented with unifocal tumors measuring an average of 67.6 mm (range 50–160 mm) on imaging. Eleven patients with an imaging size of <5 cm had a disease span ≥5 cm on final pathology. No tumor on ink occurred in 87 (78.3%) patients. Fifty-seven (51.4%) patients had additional surgery for inadequate margins. Fifteen (12.6%) patients elected to have mastectomy while 42 (37.8%) patients opted for re-excision. Good to excellent cosmetic results were reported in 95% of patients who ultimately achieved breast conservation. Recurrence rate was 1.1% in patients who completed EOBCS and adjuvant radiation therapy. ConclusionEOBCS can allow for breast conservation in patients who are traditionally counseled to undergo mastectomy. Although the re-excision rate was significant, most patients ultimately achieved breast conservation with adequate margins. Further study is warranted to determine the long-term oncologic outcomes of this approach.

Hypofractionated Radiation Therapy After Extreme Oncoplasty for Patients With T2-T3 Breast Cancers: Physician Rated Cosmesis and Patient Reported Outcomes

Hypofractionated Radiation Therapy After Extreme Oncoplasty for Patients With T2-T3 Breast Cancers: Physician Rated Cosmesis and Patient Reported Outcomes