Oncoplastic Surgery For Breast Cancer Research Articles

Incidence of Internal Mammary Lymph Nodes with Silicone Breast Implants at MR Imaging after Oncoplastic Surgery.

To assess the incidence of benign and malignant internal mammary lymph nodes (IMLNs) at magnetic resonance (MR) imaging among women with a history of treated breast cancer and silicone implant reconstruction. The institutional review board approved this HIPAA-compliant retrospective study and waived informed consent. Women were identified who (a) had breast cancer, (b) underwent silicone implant oncoplastic surgery, and (c) underwent postoperative implant-protocol MR imaging with or without positron emission tomography (PET)/computed tomography (CT) between 2000 and 2013. The largest IMLNs were measured. A benign IMLN was pathologically proven or defined as showing 1 year of imaging stability and/or no clinical evidence of disease. Malignant IMLNs were pathologically proven. Incidence of IMLN and positive predictive value (PPV) were calculated on a per-patient level by using proportions and exact 95% confidence intervals (CIs). The Wilcoxon rank sum test was used to assess the difference in axis size. In total, 923 women with breast cancer and silicone implants were included (median age, 46 years; range, 22-89 years). The median time between reconstructive surgery and first MR imaging examination was 49 months (range, 5-513 months). Of the 923 women, 347 (37.6%) had IMLNs at MR imaging. Median short- and long-axis measurements were 0.40 cm (range, 0.20-1.70 cm) and 0.70 cm (range, 0.30-1.90 cm), respectively. Two hundred seven of 923 patients (22.4%) had adequate follow-up; only one of the 207 IMLNs was malignant, with a PPV of 0.005 (95% CI: 0.000, 0.027). Fifty-eight of 923 patients (6.3%) had undergone PET/CT; of these, 39 (67.2%) had IMLN at MR imaging. Twelve of the 58 patients (20.7%) with adequate follow-up had fluorine 18 fluorodeoxyglucose-avid IMLN, with a median standardized uptake value of 2.30 (range, 1.20-6.10). Only one of the 12 of the fluorodeoxyglucose-avid IMLNs was malignant, with a PPV of 0.083 (95% CI: 0.002, 0.385). IMLNs identified at implant-protocol breast MR imaging after oncoplastic surgery for breast cancer are overwhelmingly more likely to be benign than malignant. Imaging follow-up instead of immediate metastatic work-up may be warranted.

Positive Margins After Oncoplastic Surgery for Breast Cancer.

Oncoplastic techniques applied to breast-conserving surgery (BCS) allow large-volume resections without compromising cosmetic results. Level II oncoplastic techniques are based on mammoplasties. When required, they allow resection of more than 20 % of the breast volume; however, a subgroup of these patients will still have positive margins. The clinical management of positive margins after level II oncoplastic surgery (OPS) is a challenge. All patients who had undergone level II oncoplastic techniques at The Paris Breast Center between 2004 and 2013 were reviewed. The choice of the optimal mammoplasty technique was based on the tumor location and the 'quadrant per quadrant atlas'. A total of 277 level II oncoplastic techniques were performed on 272 patients. The mean tumor size was 26 mm (range 2-160 mm), with a mean resected weight of 175 g (range 50-1540 g). The rate of positive margins was 11.9 %. Risk factors for positive margins identified in univariate analysis were histologic subgroup, tumor size, T stage and grade. In multivariate analysis, only patients with invasive lobular carcinoma had a significantly higher risk of positive margins. A second operation was required in 33 cases, and a third operation was required in three cases because of positive margins. Final breast conservation rate was 91 %. Level II OPS results in a low positive margin rate despite large tumor size. Patients with involved margins can be offered a second BCS if the remaining volume allows this.

P335 Our preference and clinical experience in oncoplastic breast cancer surgery

P335 Our preference and clinical experience in oncoplastic breast cancer surgery

Central pedicle reduction mammoplasty: a reliable technique.

Reduction mammoplasty is one of the most frequently performed procedures in plastic surgery for macromastia or gigantomastia. Recently it is also evolved for oncoplastic breast cancer surgery due to equivalent in terms of outcome for breast conserving surgery with radiotherapy versus mastectomy. Various techniques and modification has been made to achieve long lasting and aesthetically good result with minimal morbidity. Central (posterior) reduction mammoplasty is known for its versatile pedicle due to its good blood supply and innervation for maintaining of nipple sensation with unremarkably long term complication and proven in preservation of breastfeeding function. It is one of the good and reliable options to correct breast hypertrophy and ptosis. Various modifications were introduced by different authors to improve the technique and reduce scar formation which will give more satisfaction to patients.

The Concept of Oncoplastic Breast Surgery Applied in Surgery for a Giant Fibroadenoma

The treatment of a 40-year-old woman with a giant fibroadenoma in her left breast is presented. The fibroadenoma measured 14 × 5 × 3 cm and weighed 170 g. We demonstrate that the surgical strategy and the reconstructive techniques in oncoplastic breast cancer surgery successfully can be applied to the treatment of these rare benign tumours improving the cosmetic and functional outcome.

P88. A consecutive series of oncoplastic surgery for breast cancer based on a quadrant-per-quadrant atlas

P88. A consecutive series of oncoplastic surgery for breast cancer based on a quadrant-per-quadrant atlas

Oncoplastic surgery for breast cancer based on tumour location and a quadrant-per-quadrant atlas

The majority of published techniques for oncoplastic surgery rely on an inverted-T mammoplasty, independent of tumour location. These techniques, although useful, cannot be adapted to all situations. A quadrant-per-quadrant atlas of mammoplasty techniques for large breast cancers was developed in order to offer breast surgeons a technique dependent on tumour location, which reduces the risk of postoperative complications and delay to adjuvant therapy. From 2005 to 2010, a series of eligible women with breast cancer were treated by quadrant-specific oncoplastic techniques. All complications and any delay to adjuvant treatment were recorded prospectively, along with local and distant cancer recurrences. Cosmetic outcome was evaluated using a five-point scale. A total of 175 patients were analysed. The median tumour size, after histological examination, was 25 (range 4-90) mm. Twenty-three patients (13.1 per cent) had involved margins. Seventeen of these patients were treated by mastectomy and three had a re-excision. Complications occurred in 13 patients (7.4 per cent), which led to a delay to adjuvant treatment in three (1.7 per cent). After a median follow-up of 49 (range 23-96) months, three patients had developed a local recurrence. The mean score after cosmetic evaluation was 4.6 of 5. A quadrant-per-quadrant approach to oncoplastic techniques for breast cancer was developed that tailors the mammoplasty for each tumour location. This panel of techniques should be a useful guide for breast surgeons, and extends the possibilities for breast conservation for large or poorly limited cancers, with a low complication rate and good cosmetic results.

59. Oncoplastic surgery for breast cancer

59. Oncoplastic surgery for breast cancer

Oncoplastic breast surgery: Current status and best candidates for treatment

The term oncoplastic surgery was coined to describe an evolving area of breast surgery that applies the principles of surgical oncology and plastic and reconstructive surgery to the management of women with breast cancer. Oncoplastic surgery does not describe a particular surgical procedure; it represents a comprehensive approach to surgical planning intended to achieve 1) widened surgical margins; 2) reduced local recurrence risk; 3) optimized cosmetic outcome; and 4) breast volume reduction when patients with macromastia develop breast cancer. This specialized field of cancer surgery, once confined to surgeons practicing in Europe, has gained popularity and attention in the United States, with surgeons anxious to achieve these goals for patients. Multiple factors have combined to allow surgeons to use innovative surgical solutions to simultaneously improve oncologic outcome and surgical cosmesis. This article explores current aspects of oncoplastic surgery, summarizes how various methods are applied in clinical practice, and discusses future directions in the emerging field of oncoplastic breast cancer surgery.

Oncoplastic surgery for breast cancer: an alternative to mastectomy?.

Abstract Abstract #5154 Background:
 The phrase “Oncoplastic breast surgery” originated with the concept of avoiding mastectomy by means of wide tumour excision coupled with breast reconstruction. Oncoplastic procedures (OP) have been standardised in our institution. The surgical technique was defined according to the quadrant and the breast consistence of the patient, the pathological conditioning associated specimen orientation and inked breast margins.
 Material and methods:
 Each woman with a potentially large partial breast removal and a consequent risk of mastectomy has an OP proposed. Pre operative explanations underlined the oncological problem, the technical procedure, the post operative potential morbidity, the necessity to obtain definitive pathologic reports, the timing of controlateral surgery for symmetrization. An independent phone questionnaire was made in order to evaluate the main disorders felt by the patients, the quality of pre operative explanations and the cosmetic and psychological impact.
 133 women were operated between 2001 and 2007, the mean age was 51, the mean Bra size 95, the initial TNM staging noticed 40% T0 – 17% T1 – 30% T2 – 13% T3. 40% of tumors were pure DCIS, 40% of patients have had preoperative chemotherapy.
 Results:
 The operative technique was an OP alone in 54%. For the external quadrants, we performed mainly a Durfourmentel technique (54%), for the upper quadrants the batwing procedure (10%) and for the inferior quadrants a classic mammoplastic surgery (36%). The mean weight of the specimen was 166 g (20-530), the mean operative time 84' for unilateral surgery, 130' for bilateral, the mean hospital stay 3.8 d. 20% of patients needed a second surgery, twice for post operative morbidity, 25 times for R1 resection. In these cases, 14 second mastectomies were performed, 6 tumorectomies and 2 second OP.
 The mean diameter of the tumor evaluated on pathology reports was 24.6 mm; the rate of positive margins was 21% for DCIS removal and 28% after neoadjuvant setting. With 33 months FU, we noticed 2 deaths due to the cancer, 5 local recurrences and 12 patients treated for metastases.
 The independent phone questionnaire revealed a favourable cosmetic result in 70%, bad in 13%. 36% of women wished a second time plastic surgery but relinquished. 48% evaluated the preoperative explanation unsatisfactory. The main reproaches voiced by the patients were the risk of second step surgery according to the final pathological reports and the length of the scars. 75% of women were not afraid to conserve their breast but all were satisfied. 60% were worried due to the follow-up but 83% think that the mastectomy is not less frightening. 17% hesitated to have the same surgical approach.
 Conclusion
 OP procedure is a safe alternative to mastectomy in selected cases with acceptable morbidity and good cosmetic results. Pre operative explanations are essential. Since April 2007, we have initiated a prospective multicentric trial in order to evaluate the free margin rate according to the indication and the quality of life of these women. Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 5154.

The Role of Oncoplastic Surgery in Breast Cancer

The authors discuss the objectives of oncoplastic surgery in breast cancer management. Indications and advantages are summarised. Some surgical techniques are described.The authors report their own experience with oncoplastic surgery (26 patients who had immediate breast reconstruction after tumorectomy, and 126 patients who had lumpectomy alone. Oncoplastic surgery was characterised by a wider excision, with negative margins in all cases. In isolated breast conservative tumorectomy, 20% of the margins were positive, requiring re-excision or radical mastectomy.Oncoplastic surgery is preferred especially in younger patients with smaller breasts, since it is less cosmetically mutulating and allows complete tumor resection with save margins.

Oncoplastic surgery for breast cancer

Higher levels of evidence proving difficult

Novel strategies in oncoplastic surgery for breast cancer: immediate partial reconstruction of breast defects

BACKGROUND: Oncoplastic surgery defines the use of plastic and reconstructive techniques combined with oncologic surgery. In women with breast cancer oncoplastic surgery is one of the most important novelties from the last century to improve cosmetic outcome and quality of life. Recent reports have also demonstrated a possible oncologic improvement by increasing the resection free margins. This may reduce the local-recurrence rate, however, this hypothesis remains unproven. METHODS: Review of the literature. RESULTS: This review on oncoplastic breast cancer surgery gives a short summary and update of the recent literature and demonstrates recently developed techniques. In addition we demonstrate the cosmetic outcome of patients after oncoplastic surgery using the breast analyzing tool software (BAT©). CONCLUSIONS: Oncoplastic surgery is the next step after the introduction of breast conserving therapy for breast cancer and should be offered to any eligible patient. Cosmetic analyses should be done objectively.

Comparative Study of Surgical Margins in Oncoplastic Surgery and Quadrantectomy in Breast Cancer

Oncoplastic surgery for breast cancer is a novel concept that combines a plastic surgical procedure with breast-conserving treatment to improve the final cosmetic results. The aim of this study was to evaluate the oncological safety of oncoplastic procedures by studying the status of the surgical margins of the excised tumor specimen in comparison with standard quadrantectomies. Thirty consecutive breast cancer patients undergoing oncoplastic surgery (group 1) and 30 patients undergoing standard quadrantectomy (group 2) were prospectively studied with regard to the stage of breast cancer, the surgical procedures performed, the volume of breast tissue excised, and the histopathology of the tumor specimen, with specific details on surgical margins. Patients who underwent oncoplastic surgery (group 1) were younger (mean age, 48.73 years) than patients who had a classic quadrantectomy (group 2; mean age, 55.76 years; P = .022). The mean volume of the excised specimen in group 1 was 200.18 cm(3), compared with 117.55 cm(3) in group 2 (P = .016). Surgical margins were negative in 25 cases out of 30 in group 1 and 17 out of 30 in group 2 (P = .05). The average length of the surgical margin was 8.5 mm in group 1 and 6.5 mm in group 2, but the difference was not statistically significant (P = .074). Oncoplastic surgery adds to the oncological safety of breast-conserving treatment because a larger volume of breast tissue can be excised and a wider negative margin can be obtained. It is especially indicated for large tumors, for which standard breast-conserving treatment has a high probability of leaving positive margins.