Oncoplastic Breast Reconstruction Research Articles

The Oncological and Surgical Outcomes of Immediate Oncoplastic Breast Reconstruction With Contralateral Breast Adjustment.

Oncoplastic surgery is an expanding approach for managing breast conservation because it offers improved cosmetic outcomes while maintaining oncological safety. This study aimed to assess the oncological and surgical outcomes of patients who underwent oncoplastic procedures at a single institution. The study population includes all consecutive breast cancer patients who underwent lumpectomy followed by immediate oncoplastic breast reconstruction with contralateral breast adjustment between 2010 and 2021. Following IRB approval, patient demographics, tumor characteristics, surgical details, complications, and follow-up were evaluated for this group. Quality of life (QOL) and patient-reported outcome measures were assessed through questionnaires. Following multidisciplinary tumor board discussion, 77 patients (82 breasts) underwent oncoplastic surgery. Of these, 92.2% underwent breast MRI prior to surgery with mean mass enhancement of 2.35 cm (range, 0-8.5 cm) and non-mass enhancement of 5.77 cm (range, 0-14 cm), and 44% presented with multifocal disease. The final positive surgical margin rate was 2.4%, and all conserved breasts received adjuvant radiation therapy. The 5-year local recurrence rate for invasive tumors was 4.1%. QOL scores were generally high, with most patients reporting good to excellent cosmetic outcomes and high personal satisfaction with breast appearance and softness. Physicians reported breast symmetry in 89.5%. The findings suggest that oncoplastic surgery with contralateral breast adjustment is safe, effective, and an excellent option for breast cancer patients wishing for breast conservation even for large or multifocal masses, with favorable oncologic and cosmetic outcomes. The QOL analysis indicates high patient satisfaction. These results support the use of oncoplastic surgery in the management of breast cancer.

Oncoplastic Breast Reconstruction in Morbidly Obese Patients: An Acceptable Practice.

Breast cancer is the most common noncutaneous malignancy amongst women. Lumpectomy with adjuvant radiation is a mainstay of surgical treatment. Oncoplastic breast reconstruction reduces the resultant breast deformity. Obesity is a risk factor for the development of complications after breast reconstruction. This study's purpose was to determine if oncoplastic breast reconstruction is a safe procedure in obese patients. A single institution retrospective chart review was performed on women undergoing oncoplastic breast reduction from 2009 to 2021. Patients were then divided into groups based on body mass index (BMI). A statistical analysis was performed comparing rates of complications and time to adjuvant therapy. An estimated 340 patients were identified with an average age of 56.2 years (140 with BMI <30 kg/m2, 87 with BMI 30-34.9 kg/m2, 62 with BMI 35-39.9 kg/m2, and 51 with BMI >40 kg/m2). There was a significant difference between the BMI greater than 40 kg per m2 and BMI less than 30 kg per m2 group in the number of returns to the operating room (P = 0.0096), major complications (P = 0.0002), and minor complications (P = 0.0051). Average time to adjuvant treatment was 47 days and there was no statistically significant difference between the groups (P = 0.1691). There was a significant difference in major and minor complications between the BMI groups; however, there was no delay in the time to adjuvant therapy. Therefore, we conclude that with appropriate counseling on surgical risks, oncoplastic breast reduction is an acceptable option for breast cancer patients after lumpectomy, regardless of BMI.

Oncoplastic surgery and breast reconstruction in the elderly: an unsolved conundrum

Oncoplastic surgery and breast reconstruction in the elderly: an unsolved conundrum

COVID-associated complications after reconstructive breast surgery: a retrospective cohort study.

The COVID pandemic significantly influenced reconstructive breast surgery regimens. Many surgeries were cancelled or postponed. COVID entails not only respiratory, but also coagulative symptoms. It, therefore, potentially increases the risk of postoperative complications. The incidence of perioperative COVID infection and its influence on postoperative recovery after reconstructive breast surgery is still unknown. This dual center retrospective cohort study included patients that underwent reconstructive breast surgery between March 2020 and July 2021. Post-mastectomy autologous or implant-based breast reconstruction (ABR; IBR), as well as post-lumpectomy oncoplastic partial breast reconstruction (PBR) were eligible. Patient data were extracted from electronic medical records. Data regarding COVID-19 infection was collected through a questionnaire. The primary outcome was complication rate. The ABR, IBR and PBR groups consisted of 113 (12 COVID-positive), 41 (2 COVID-positive) and 113 (10 COVID-positive) patients. In the ABR and PBR groups, postoperative complications occurred significantly more often in patients with perioperative COVID-infection. Especially impaired wound healing occurred significantly more often in the ABR and PBR breasts, but also at the donor site of ABR patients with perioperative COVID. Perioperative COVID-infection increases susceptibility to complicated wound healing after reconstructive breast surgery. A possible explanation lies in the dysregulation of haemostasis by the virus, and its direct effects on microvasculature. A hypercoagulable state results. We recommend to postpone elective breast surgery for 4-6weeks after COVID-19 infection. Also, precautionary measures remain important to minimize the risk of perioperative COVID-19 infection.

Oncoplastic Breast Reconstruction for Large Pediatric Breast Tumors: A Case Series.

Large breast fibroadenomas in pediatric females may cause discomfort, asymmetry, and psychological stress, and patients may elect for surgical excision. There are no criteria for reconstruction after the excision of these masses, and the research is limited in describing oncoplastic techniques in pediatric fibroadenoma excision. Nononcoplastic techniques, such as mastectomy with implant or flap reconstruction, have been used for pediatric fibroadenoma excision reconstruction. Oncoplastic techniques using Wise pattern or circumareolar incisions have shown to have efficacious outcomes. In addition, pediatric females undergoing breast surgery risk long-term complications such as continued breast asymmetry due to further breast growth, nipple and breast hypoesthesia, and future breastfeeding difficulty. This case series describes the oncoplastic techniques used for large benign mass excision and reconstruction of 3 pediatric females. A Wise pattern technique was used for all 3 patients, and 2 underwent a free-nipple graft. Oncoplastic techniques for pediatric breast mass excision provide satisfactory aesthetic outcomes with minimal surgical morbidity. Further research assessing the long-term effects of pediatric breast mass excision and reconstruction would be beneficial.

28. Enhanced Recovery After Surgery (ERAS) Protocol Allows Safe Same-day Discharge in Expander Based and Oncoplastic Breast Reconstruction

PURPOSE: Data following Enhanced Recovery After Surgery (ERAS) with same-day discharge in breast reconstruction is limited. This study evaluates early postoperative outcomes following same-day discharge in tissue expander-immediate breast reconstruction (TE-IBR) and oncoplastic breast reconstruction (OBR). METHODS: A single-institution retrospective review of TE-IBR patients from 2017-2022 and OBR patients from 2014-2022. Patients were divided by procedure and recovery pathway: Group 1 (TE-IBR, overnight admission), Group 2 (TE-IBR, ERAS), Group 3 (oncoplastic, overnight admission), and Group 4 (oncoplastic, ERAS). Group 1 and 2 were subdivided by implant location: Group 1a (pre-pectoral) and 1b (sub-pectoral); Group 2a (pre-pectoral) and 2b (sub-pectoral). Demographics, comorbidities, complications, and reoperations were analyzed. RESULTS: 160 TE-IBR patients (Group 1: 91; Group 2: 69) and 60 OBR patients (Group 3: 8; Group 4: 52) were included. Of the 160 TE-IBR patients, 73 underwent pre-pectoral reconstruction (Group 1a: 25; Group 2a: 48) and 87 underwent sub-pectoral reconstruction (Group 1b: 66; Group 2b: 21). There were no differences in demographics and comorbidities between Groups 1 and 2. Group 3 had a higher average BMI than Group 4 (37.6 vs 32.2, p <0.022). There was no significant difference between Groups 1a and 2a or between Groups 1b and 2b in rates of infection, hematoma, TE loss, or reoperations. Notably, no ERAS patients required hospital admission. Group 3 and Group 4 showed no significant difference in any complications or in reoperations. CONCLUSION: Our research shows that same-day discharge in both TE-IBR and OBR does not increase risk for major complications or reoperations.

Giant fibroadenoma of the breast treated with reduction mammoplasty and excision of lesion: A case report

Oncoplastic surgery was developed to allow for large tumor excision, immediate breast reconstruction, and optimal breast shape and symmetry. These techniques, used in past for malignant tumors, are useful for cosmetic issues caused by benign breast disease. Here, we present a case report Wise-pattern reduction mammoplasty for oncoplastic reconstruction of a giant fibroadenoma. A 29-year-old woman with 40 C size breasts presented to the clinic with the left breast enlargement from the past 7 months. Breast surgery team excised the mass with a Wise-pattern reduction technique. Immediately postoperatively, the patient showed excellent symmetry. Follow-up postoperatively showed good wound healing, preserved symmetry, and a viable, sensate nipple. Oncoplastic breast reconstruction in a reduction pattern technique after giant fibroadenoma removal provides an excellent outcome, allowing for improved symmetry.

Microsurgery in oncoplastic breast reconstruction.

Oncoplastic breast reconstruction has allowed for the optimization of oncologic and reconstructive outcomes after breast-conserving surgery (BCS). Volume replacement procedures in oncoplastic reconstruction most commonly utilize regional pedicled flaps, though several studies have reported benefits to free tissue transfer for oncoplastic partial breast reconstruction in the immediate, delayed-immediate and delayed settings. Microvascular oncoplastic breast reconstruction is a useful technique in the appropriate patients with small-to-medium size breasts and larger tumor-to-breast ratios who desire to preserve breast size, those with a paucity of regional breast tissue and patients that wish to avoid chest wall and back scars. Several free flap options for partial breast reconstruction exist, including superficially-based abdominal flaps, medial thigh-based flaps, deep inferior epigastric artery perforator (DIEP) flaps and thoracodorsal artery-based flaps. However, special consideration should be given to preserving donor sites for potential future total autologous breast reconstruction with any flap choice that should be tailored to individual recurrence risk. Aesthetically placed incisions should take recipient vessel access into consideration which include the internal mammary vessels and perforators medially, and then intercostal, serratus branch and thoracodorsal vessels laterally. The utilization of a thin strip of lower abdominal tissue based on the superficial abdominal circulation allows for a well-concealed donor site with minimal morbidity and preservation of the abdominal donor site if future total autologous breast reconstruction is needed. Optimizing outcomes requires a team-based approach to appropriately design recipient and donor-site considerations while individualizing tumor and patient-specific plans.

The Free Superficially Based Low-Abdominal Mini Flap for Oncoplastic Breast Reconstruction.

Volume replacement in oncoplastic breast reconstruction most commonly uses pedicled flaps. In thin patients with small breasts, free-tissue transfer may be better suited to preserve breast size. Evidence on microvascular oncoplastic reconstruction is limited, and reconstruction has often required sacrifice of potential future donor sites. The free superficially based low-abdominal mini (SLAM) flap uses a narrow strip of lower abdominal tissue based on superficial perfusion of the abdominal wall that is anastomosed to chest wall perforators to preserve the ability to perform future abdominally based autologous breast reconstruction. Five patients underwent reconstruction with SLAM flaps for immediate oncoplastic reconstruction. Their mean age was 49.8 years, and their mean body mass index was 23.5. Tumor location was most commonly in the lower outer quadrant (40%). Average lumpectomy weight was 30 g. Two flaps were based on the superficial inferior epigastric artery, and three, on the superficial circumflex iliac artery. Recipient vessels included internal mammary perforators (40%), serratus branch (20%), lateral thoracic vessel branch (20%), and lateral intercostal perforators (20%). All patients underwent radiation therapy without delay and maintained volume, symmetry, and contour at an average period of 11.7 months after surgery. There were no cases of flap loss, fat necrosis, or delayed wound healing. The free SLAM flap allows for immediate oncoplastic breast reconstruction in thin, small-breasted patients with limited regional tissue without sacrificing future potential donor sites for autologous breast reconstruction. Therapeutic, IV.

Enhanced Recovery After Surgery Protocol Allows Safe Same-Day Discharge in Expander Based and Oncoplastic Breast Reconstruction.

Data after enhanced recovery after surgery (ERAS) with same-day discharge in breast reconstruction is limited. This study evaluates early postoperative outcomes after same-day discharge in tissue-expander immediate breast reconstruction (TE-IBR) and oncoplastic breast reconstruction. A single-institution retrospective review of TE-IBR patients from 2017 to 2022 and oncoplastic breast reconstruction patients from 2014 to 2022 was performed. Patients were divided by procedure and recovery pathway: group 1 (TE-IBR, overnight admission), group 2 (TE-IBR, ERAS), group 3 (oncoplastic, overnight admission), and group 4 (oncoplastic, ERAS). Groups 1 and 2 were subdivided by implant location: groups 1a (prepectoral) and 1b (subpectoral), and groups 2a (prepectoral) and 2b (subpectoral). Demographics, comorbidities, complications, and reoperations were analyzed. A total of 160 TE-IBR patients (group 1, 91; group 2, 69) and 60 oncoplastic breast reconstruction patients (group 3, 8; group 4, 52) were included. Of the 160 TE-IBR patients, 73 underwent prepectoral reconstruction (group 1a, 25; group 2a, 48), and 87 underwent subpectoral reconstruction (group 1b, 66; group 2b, 21). There were no differences in demographics and comorbidities between groups 1 and 2. Group 3 had a higher average body mass index than group 4 (37.6 vs 32.2, P = 0.022). There was no significant difference between groups 1a and 2a or between groups 1b and 2b in rates of for rates of infection, hematoma, skin necrosis, wound dehiscence, fat necrosis, implant loss, or reoperations. Group 3 and group 4 showed no significant difference in any complications or in reoperations. Notably, no patients in same-day discharge groups required unplanned hospital admission. Many surgical subspecialities have successfully adopted ERAS protocols into their patient care and have shown both its safety and feasibility. Our research shows that same-day discharge in both TE-IBR and oncoplastic breast reconstruction does not increase risk for major complications or reoperations.

62 (PB-062) Poster - A comparative analysis between vertical rectus abdominis myocutaneous (VRAM) flap and transverse rectus abdominis myocutaneous (TRAM) flap as options for post-mastectomy chest wall reconstruction

Background: Oncoplastic breast reconstruction prevents the chest wall deformities occurring after a mastectomy or occurring after chest irradiation following lumpectomy. It offers lower morbidity, higher quality of life and a more natural aesthetic outcome than traditional breast reconstruction techniques. Free flaps offer great cosmetic results and also prevent donor site morbidity but they require advanced microsurgical techniques that may be difficult in institutions with constraints of resources.

Useful Reduction Mammoplasty Technique in Oncoplastic Breast Surgery and Reconstruction.

A combination of the reduction mammoplasty technique and breast reconstruction allows surgeons to lift ptotic breasts through local flaps and skin reduction during surgery for breast cancer. This study presents a reliable course for the combination of partial and skin or nipple-sparing mastectomy with reduction-reconstruction surgery. Fifty-seven patients underwent a partial mastectomy before reduction mammoplasty of both breasts during the same time period between 2014 and 2021 at our institution and thirteen patients underwent skin or nipple-sparing mastectomy, breast reconstruction with an extended latissimus dorsi flap or silicone implant, and aesthetic reduction mammoplasty of the contralateral breast during the same time period. Additional photos were obtained preoperatively, immediately after the operation, and at one, three, six, and twelve months postoperatively. Patient satisfaction was evaluated preoperatively and postoperatively and postoperative complications were noted. Among the patients who underwent a partial mastectomy, the mean age was 45.18 ± 11.05 years, the mean body mass index (BMI) was 26.74 ± 3.53 kg/m2, and the mean preoperative right and left breast volumes were 663.85 (±28.12) cc and 664.34 (±37.13) cc, respectively, and the mean excised mass weight was 177.74 (±213.93) g. Among the patients who underwent a skin-sparing mastectomy, the mean age was 51.62 ± 8.96 years, the mean BMI was 26.91 ± 4.34 kg/m2, and the mean preoperative right and left breast volumes were 624.17 (±98.52) cc and 562.31 (±80.81) cc, respectively, and the mean excised mass weight was 618.05 (±338.17) g. Four patients (5.3%) in the partial mastectomy group had fat necrosis. The mean patient satisfaction score was higher postoperatively in both groups. Patients with breast cancer and large and/or ptotic breasts can successfully undergo reduction mammoplasty for both breasts immediately following partial mastectomy and nipple or skin-sparing mastectomy.

The no-vertical scar technique for oncoplastic breast reconstruction

Oncoplastic reconstruction can optimize breast conserving therapy. Nipple loss is a concern in patients with significant ptosis and breast hypertrophy particularly with pedicle undermining during tumor resection. The modified Robertson technique (No-Vertical Scar reduction) has been previously described for breast reduction in large, ptotic patients using a wide, bell-shaped inferior pedicle with only inframammary fold and peri‑areolar incisions. The purpose of this study was to evaluate the No-Vertical Scar (NVS) technique applied to oncoplastic reconstruction. Women undergoing oncoplastic breast reduction using a NVS, Wise, or Vertical method were assessed. Predictive variables included patient demographics, comorbidities, and sternal notch to nipple (SNN) distance. Outcome variables were delayed wound healing, surgical site infection, seroma, fat necrosis, nipple necrosis, use of a free nipple graft, and time between surgery and adjuvant radiation. Fifty patients met inclusion criteria using NVS (N=15), Wise (N=16), and Vertical (N=19) methods. The NVS group had a significantly higher BMI (p=.009), greater sternal notch to nipple distance (p=<0.001) and increased resection volume (p=<0.001) as compared to Wise and Vertical groups. There was no significant difference in complications (p=.25). No nipple necrosis occurred, and no free nipple grafts were required. The NVS approach is a useful technique for oncoplastic reconstruction in select patients with macromastia and severe Grade II or Grade III ptosis. The wide, bell-shaped pedicle is versatile for obliterating a lumpectomy cavity and optimizing nipple perfusion if pedicle undermining occurs during resection.

Single unit experience with oncoplastic breast reconstruction using local perforator flaps

Single unit experience with oncoplastic breast reconstruction using local perforator flaps

Oncoplastic breast reconstruction: Principles, current techniques, and future directions.

Oncoplastic breast reconstruction has improved esthetic results after breast-conserving surgery with low complication rates and stable oncologic outcomes. Basic principles can be applied across different volume displacement and replacement techniques including restoration of breast shape and symmetry through esthetic incisions while eliminating dead space. Technique selection is guided by several factors including breast size, resection-to-breast ratio, and patient desires. A surgeon familiar with all techniques will allow individualization of treatment and optimization of outcomes.

Safety and efficacy of anterior intercostal artery perforator flaps in oncoplastic breast reconstruction.

Partial breast reconstruction based on the anterior intercostal artery perforators (AICAP) has been suggested to avoid the unsightly 'bird's beak' deformity for lower pole breast cancers. The aims of this study were to evaluate the initial clinical experience of AICAP flaps in terms of safety and efficacy in oncoplastic breast reconstruction. Between October 2013 and April 2020, AICAP flaps were offered to 30 patients with lower pole breast cancers. Hand-held Acoustic Doppler assessments were undertaken to confirm adequate perforators. Surgical results were evaluated in terms of safety and efficacy. Patients were invited to complete sections of the Breast-Q questionnaire at least 12 months postoperatively to assess patient satisfaction in terms of cosmetic outcome, physical and psychosocial wellbeing. Median operating theatre time for AICAP flap harvesting and positioning was 20 min (range 15-28 min). The median weight of resected breast specimens was 41 g (range 10-127 g). Total tumour size ranged from 7 to 35 mm (median 16 mm; three cases exhibited multifocal disease). Clear radial resection margins were achieved in 29 cases (96.7%). The median post-operative stay was two days (range 2-3 days). There were two postoperative complications comprising delayed wound healing/fat necrosis, which resolved with monitoring and inadine dressings. Based on the Breast-Q results, patients reported high levels of satisfaction with the physical appearance of their reconstructed breast, psychosocial and physical wellbeing. AICAP flaps appear to be safe in restoring breast contour after wide excision of lower pole breast cancers, with high levels of patient satisfaction reported postoperatively.

Advocating for closer collaboration in breast surgery and breast reconstruction: a narrative review

: In the surgical treatment for breast cancer patients, preference for breast conservation and oncoplastic breast reconstruction is increasing across the world. This current treatment modality demands a holistic understanding of breast cancer treatment and oncoplastic procedures and requires comprehensive surgical skills. China has the world’s largest population which has specific characteristics and relies on a medical care system that is different from most Western countries. Studies on this specific population can provide valuable information in guiding clinical practices for physicians. A MEDLINE (PubMed) search using a combination of keywords, “breast reconstruction”, “breast surgery”, “breast cancer”, and “China” or “Chinese”, from January 2001 to April 2020 yielded 40 clinical studies on the mainland Chinese population and a trend towards increased publication in the past 5 years. Due to the multifaceted nature of breast reconstruction post breast surgery and a paucity of clinical studies concerning the aspect of oncological resection in Chinese patients, the authors aimed to write this narrative review from an oncological perspective (including incision design, mastectomy flap perfusion, preservation of collateral vessels, timing of radiation and reconstruction, reconstruction plane). It is hoped this discussion can facilitate the collaboration between surgeons of different specialties and improve surgical outcomes. Establishment of oncoplastic teams is strongly advocated in Chinese medical centers to maximize the quality of multidisciplinary care to breast cancer patients.

P055. The effects of the COVID-19 pandemic on breast cancer services at a Tertiary University Hospital

Introduction: The COVID-19 pandemic significantly impacted the treatment of breast cancer. Management deviated from standard practice. The Association of Breast Surgery (ABS) advised - aim for day case surgery with priority given to: estrogen receptor (ER)-ve, HER2+ve, and pre-menopausal ER+ve patients. Neoadjuvant chemotherapy was advised for inoperable disease only. Oncoplastic procedures and breast reconstruction was not advised. ER+ves were to be considered for bridging endocrine treatment. We audited this change in practice.

The role of thoracodorsal artery perforator flap after breast conserving surgery

Background: The emergence of thoracodorsal artery perforator flap combined with radiotherapy as new techniques in breast reconstruction has resulted in greater focus on oncoplastic breast surgery. In this study, were to study the role of thoracodorsal artery perforator flap after breast conserving surgery.Methods: This study included 40 patients of stage I and II breast cancer at Menoufia University hospital from July 2018 to February 2019. Every patient accepted to be enrolled in thus study with curative intent by having breast conservative surgery and immediate reconstruction by TDAP flap.Results: The mean operative time was 145 min. Seroma is the commonest complication following TDAP flap reconstruction and occurred in four cases (20%) and was treated by repeated aspiration. The cosmetic outcome was acceptable with 90% of patients rating their outcome as either pleased or satisfied. The subjectively assessed functional outcome showed a mean time of 10 days postoperative for patients to regain their full range of shoulder movements.Conclusions: Thoracodorsal artery perforator flap can play a significant role in oncoplastic surgery and breast reconstruction with acceptable cosmetic and functional outcome.

Oncoplastic reconstruction of central lumpectomy defects using the medial pillar island flap

This report presents the medial pillar island flap technique of oncoplastic breast reconstruction of central defects that involve the nipple-areola complex. The procedure was performed in patients who presented with inferior pole redundancy using a vertical mammaplasty pattern. The flap was designed utilizing the territory of the lower pole as an island flap pedicled by the internal mammary artery perforators surrounded by the soft tissue of the medial pillar. Eight patients underwent the procedure with a mean age of 57.6 years. Median breast cup size was D (range: from C to DDD). The mean body mass index was 37.3 kg/m2 (range: from 32.1 to 41.5). The size of the defect ranged from 64 to 150 cm3 (mean, 97.2). Concomitant opposite breast vertical reduction was performed in 6 cases. Flap survival was uneventful. Nipple reconstruction was performed 6 months after radiation treatment in 4 patients. No major complications were encountered. Two patients developed minor wound breakdown after nipple reconstruction. The medial pillar island flap is presented as a safe and reliable option for the reconstruction of central partial mastectomy defects in patients with macromastia or breast ptosis. Internal mammary system provides predictable and robust flap viability while complete separation from the inframammary fold allows for unrestricted mobility. The procedure is designed with vertical scar mammaplasty, which results in a smooth contour to the lower pole. The flap allows for nipple reconstruction using well-vascularized skin paddle. The technique is offered as an alternative oncoplasty option for neoareolar reconstruction.