Oncoplastic Reduction Mammaplasty Research Articles

Comparison between breast conserving therapy and oncoplastic reduction mammaplasty: a retrospective study

Comparison between breast conserving therapy and oncoplastic reduction mammaplasty: a retrospective study

Oncoplastic reduction mammaplasty, an effective and safe method of breast conservation

INTRODUCTIONOncoplastic breast conserving surgery (BCS) can enhance both cosmetic and oncologic breast cancer outcomes. This study evaluates the outcomes and complications associated with oncoplastic reduction mammaplasty performed by surgical breast oncologists. METHODSA single institution retrospective chart review of patients undergoing oncoplastic reduction mammaplasty by a surgical breast oncologist for the treatment of breast cancer. RESULTSSeventy-one patients were identified. The average patient age was 59.6 years (range 37–77 years). Average lesion span was 31.4 mm (range 3–166 mm). Six (8.5%) patients required additional surgery to obtain adequate margins. One (1.4%) patient developed recurrent disease during the follow-up interval. No major surgical complications were observed. CONCLUSIONOncoplastic reduction mammaplasty is associated with low rates of re-excision and complications and can be safely and effectively performed by appropriately trained surgical breast oncologists.

Discussion of “Oncoplastic reduction mammaplasty, an effective and safe method of breast conservation”

The development of the field of Oncoplastic breast surgery has expanded the number of patients eligible for breast conserving therapy for breast cancer. Studies have demonstrated equivalent survival and locoregional control to conventional lumpectomy and mastectomy 1 Clough K. van la Parra R. Thygesen H. et al. Long-term results after oncoplastic surgery for breast cancer. A 10 year follow-up. Ann Surg. 2017 Apr 26; ([Epub ahead of print])https://doi.org/10.1097/SLA.0000000000002255 Crossref PubMed Scopus (92) Google Scholar and oncoplastics has developed as the third pathway for surgical treatment of breast cancer. In Canada only 7% of patients have immediate breast reconstruction with mastectomy often a result of challenges coordinating combined procedures and concerns about effects of radiation on reconstruction. Following the publication of the MA20 study 2 Whelan T. Olivotto I. Parulekar W. et al. Regional Nodal irradiation in early stage breast cancer. NEJM. 2015; 373: 307-316 Crossref PubMed Scopus (606) Google Scholar most patients with nodal metastasis are being offered radiation at our center. This makes oncoplastic procedures an attractive option for many patients. Oncoplastic reduction mammaplasty, an effective and safe method of breast conservationThe American Journal of SurgeryVol. 215Issue 5PreviewOncoplastic breast conserving surgery (BCS) can enhance both cosmetic and oncologic breast cancer outcomes. This study evaluates the outcomes and complications associated with oncoplastic reduction mammaplasty performed by surgical breast oncologists. Full-Text PDF

Abstract P3-01-04: Mammographic changes after oncoplastic reduction mammoplasty

Abstract BACKGROUND: Reconstruction of partial lumpectomy defects with reduction mammaplasty techniques can improve aesthetic outcomes. However, the impact of the significant tissue rearrangement on post-operative mammographic findings and subsequent recommendations for biopsy has not been well-studied. METHODS: A retrospective review of 50 patients who underwent partial mastectomy with immediate oncoplastic reduction mammaplasty reconstruction from 2001 to 2008 was performed. Mammography reports at 6 months, 1 year, 2 years, and 3 years post-operatively were reviewed for Breast Imaging Reporting and Data System (BI-RADS) scores, predominant findings, and recommendations for subsequent imaging or biopsy. RESULTS: At six months post-operatively, 49 patients (98%) had benign findings of post-surgical changes, while one patient had microcalcifications and underwent subsequent surgical re-excision with residual DCIS on pathologic analysis. At one year, 94% of patients continued to have benign mammograms; of these mammograms, 94% reported only post-surgical scarring, while 6% described benign-appearing scattered or dystrophic calcifications. Of the three patients with suspicious mammograms at one year, all underwent core biopsies with benign results. At two years, rates of fat necrosis (2%) and scattered or dystrophic calcifications (10%) increased, though all mammographic findings were considered benign and none required additional imaging or biopsies. By three years post-operatively, an additional two patients (4%) developed suspicious findings and underwent biopsies confirming local recurrence (one invasive, one in situ). The remaining 96% continued to have benign mammographic findings and were subsequently followed with routine biannual mammographic surveillance. Overall, 88% of patients required no additional intervention in the three-year period following oncoplastic reduction mammaplasty. Of patients recommended for biopsy, malignancy was discovered in 50%, including two local recurrences (4% of total patients). This data is similar to a previously published large study (1841 women) of mammographic surveillance after partial mastectomy without oncoplastic reconstruction at our institution, which found a 6% malignancy rate at 5 years. CONCLUSIONS: Although substantial tissue rearrangement is performed at the time of oncoplastic reduction mammaplasty, our results demonstrate low rates of abnormal post-operative mammograms and subsequent biopsies over the first three years following the procedure. These findings support the use of oncoplastic reduction mammaplasty as a strategy for improving reconstructive outcomes in patients undergoing partial mastectomy. Citation Format: Anne Warren Peled, Merisa Piper, Laura J Esserman, Robert D Foster, Hani Sbitany, Elissa R Price. Mammographic changes after oncoplastic reduction mammoplasty [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P3-01-04.

Une technique originale de réduction mammaire oncoplastique adaptée aux cancers du sein à risque d’exérèse incomplète

Oncoplastic reduction mammaplasty (ORM), like breast-conserving treatments for cancer, has a risk of incomplete excision, and sometimes requires complementary mastectomy. In that case difficulties may occur due to skin shortness induced by recent surgery. Review of bibliography brings evidence that some factors are predictive of incomplete excision. When a patient has one or more of these factors, surgeon should anticipate complementary mastectomy. Horizontal ORM should be reminded for they allow secondary mastectomy in a horizontal way to be performed. An adaptation of the inverted T pattern is proposed, also permitting mastectomy in a horizontal way. These solutions allow neither to alter skin healing nor to compromise the future breast reconstruction.

Mammographic Changes after Oncoplastic Reduction Mammaplasty

INTRODUCTION: Reconstruction of partial lumpectomy defects with reduction mammaplasty techniques can improve aesthetic outcomes. However, the impact of the significant tissue rearrangement on post-operative mammographic findings and subsequent recommendations for biopsy has not been well-studied. METHODS: A retrospective review of 50 patients who underwent partial mastectomy with immediate oncoplastic reduction mammaplasty reconstruction from 2001 to 2008 was performed. Mammography reports at 6 months, 1 year, 2 years, and 3 years post-operatively were reviewed for Breast Imaging Reporting and Data System (BI-RADS) scores, predominant findings, and recommendations for subsequent imaging or biopsy. RESULTS: At six months post-operatively, 49 patients (98%) had benign findings of post-surgical changes, while one patient had microcalcifications and underwent subsequent surgical re-excision with residual DCIS on pathologic analysis. At one year, 94% of patients continued to have benign mammograms; of these mammograms, 94% reported only post-surgical scarring, while 6% described benign-appearing scattered or dystrophic calcifications. Of the three patients with suspicious mammograms at one year, all underwent core biopsies with benign results. At two years, rates of fat necrosis (2%) and scattered or dystrophic calcifications (10%) increased, though all mammographic findings were considered benign and none required additional imaging or biopsies. By three years post-operatively, an additional two patients (4%) developed suspicious findings and underwent biopsies confirming local recurrence (one invasive, one in situ). The remaining 96% continued to have benign mammographic findings and were subsequently followed with routine biannual mammographic surveillance. Overall, 88% of patients required no additional intervention in the three-year period following oncoplastic reduction mammaplasty. Of patients recommended for biopsy, malignancy was discovered in 50%, including two local recurrences (4% of total patients). This data is similar to a previously published large study (1841 women) of mammographic surveillance after partial mastectomy without oncoplastic reconstruction at our institution, which found a 6% malignancy rate at 5 years.1 CONCLUSION: Although substantial tissue rearrangement is performed at the time of oncoplastic reduction mammaplasty, our results demonstrate low rates of abnormal post-operative mammograms and subsequent biopsies over the first three years following the procedure. These findings support the use of oncoplastic reduction mammaplasty as a strategy for improving reconstructive outcomes in patients undergoing partial mastectomy.

Local Recurrence Patterns in Breast Cancer Patients Treated with Oncoplastic Reduction Mammaplasty and Radiotherapy

The purpose of this study was to describe the incidence and location of ipsilateral breast tumor recurrence (IBTR) among breast cancer patients treated with oncoplastic reduction mammoplasty (ORM) and radiotherapy (RT). The medical records of 86 consecutive women with ductal carcinoma in situ (DCIS) (n = 11) or invasive carcinoma of the breast (n = 75) treated with ORM at Emory University between January 1994 and December 2010 were reviewed. Following ORM, prolonged wound healing or surgical complications led to delay of adjuvant chemotherapy or RT in 11 patients. Surgical clips were found outside the primary tumor breast quadrant in 43 % of the patients with available RT planning CT images. When the clips were found outside the primary tumor quadrant, the RT boost was more frequently delivered outside versus inside the primary tumor quadrant (67 vs. 33 %, p < 0.001). After a median follow-up period of 4.5 years (range 0.1-17.9), 6 patients developed an IBTR and only 1 IBTR occurred outside the primary tumor quadrant. The 5-year ipsilateral breast tumor control rates were 91 % (95 % CI 0.82-0.99) and 93 % (95 % CI 0.90-0.97) for patients with DCIS and invasive carcinoma, respectively. The use of ORM yields acceptable rates of IBTR. ORM may displace breast tissue and surgical clips to breast quadrants outside of the original tumor location, but the majority of IBTRs still occur in the original tumor quadrant. This area remains at highest risk of in-breast recurrence in women treated with ORM irrespective of surgical clip location.

Long-term Outcomes Following Oncoplastic Reduction Mammaplasty: Implications for Radiation Therapy

A relatively recent advancement in oncoplastic breast reconstruction is oncoplastic reduction mammaplasty (ORM). Increasingly used in women with macromastia or lower quadrant breast tumors, ORM involves the manipulation of breast tissue to fill and replace the lumpectomy cavity, reduce breast deformity and improve cosmesis following breast conserving surgery. The purpose of this study was to evaluate the impact of ORM on radiation therapy (RT) treatment and to determine long-term rates of ipsilateral breast tumor recurrence (IBTR) among breast cancer patients following ORM and RT.

A Head-to-Head Comparison of Quality of Life and Aesthetic Outcomes following Immediate, Staged-Immediate, and Delayed Oncoplastic Reduction Mammaplasty

A Head-to-Head Comparison of Quality of Life and Aesthetic Outcomes following Immediate, Staged-Immediate, and Delayed Oncoplastic Reduction Mammaplasty

The Use of Immediate, Delayed-Immediate and Delayed Oncoplastic Reduction Mammaplasty Techniques following Breast Conserving Surgery

Purpose: Oncoplastic surgical techniques are nowadays the gold standard in breast conservation therapy and following the right timing is mandatory in order to obtain a more than average cosmetic and functional result. Materials and methods: The goal of the study is to consider the timing of oncoplastic reduction mammaplasty relative to the radiation by drawing a retrospective study that encompassed 19 consecutive patients who had oncoplastic reduction mammaplasty with patients classified into 3 groups: patients having breast conservation and reduction mammaplasty before radiotherapy, patients having reduction mammaplasty within the time interval between lumpectomy and radiation therapy, and patients having reduction mammaplasty after both lumpectomy and radiation therapy. A questionnaire has been used to assess quality of life and patient satisfaction following reduction mammoplasty. Results: Nine patients had reduction mammoplasty immediately following partial mastectomy, four had reduction surgery in the delayed-immediate period, and six had delayed reduction mammoplasty. Patient satisfaction was very high among the immediate and delayed-immediate groups. Aesthetic assessment for the delayed group was lower but did not reach any significance when compared against the other groups. Conclusion: Ninety percent of patients reported that they would have elected to undergo the procedure again based on their experience and aesthetic outcome. Complications are more frequent in the delayed setting. Clinical implications: Oncoplastic surgery increases the oncological safety of BCT as larger breast volume can be excised resulting in larger respective specimens than with partial mastectomy alone. A contralateral reduction mammaplasty can be performed to obtain symmetry and balance, with consequent “surgical screening” of the contralateral breast.

Reply

Sir:FigureWe would like to congratulate Dr. Pusic and colleagues for their significant contribution in developing the BREAST-Q. This is a valuable and welcome tool to the expanding field related to plastic surgery of the breast. The BREAST-Q has the potential to become the criterion standard in evaluating patients who have undergone plastic surgery of the breast, especially in light of the increasing demands on providing patient-centered outcomes. Each of the three modules has been developed to analyze different patient populations and include those women who have undergone breast augmentation, reduction, or reconstruction. In our recently published study, we attempted to analyze patient-centered functional outcomes and satisfaction in a cohort of patients who had undergone oncoplastic reduction mammaplasty.1 Having no prior experience using the BREAST-Q, we decided to use it for this study. Given that our patients had oncoplastic procedures, there were elements that required evaluation of the aesthetic and oncologic components that were related to the reduction and reconstruction modules. As such, certain parameters that were felt to be relevant to our cohort were included and those that were not were excluded. Dr. Pusic and colleagues have politely brought to our attention that certain errors were committed in the execution of the BREAST-Q. It is true that the term “adapted” may have been used incorrectly. Our intent was to use the reduction mammaplasty module for oncoplastic reduction outcomes because this module most closely fit the parameters that we were seeking; however, it did not completely fit. As such, some scales were included and others were excluded. All questions in our analysis are those found in the BREAST-Q. In terms of the scoring and analysis of data, there are various methods for analyzing Likert-type scales, and the choice of method depends on the distribution of the data. Our study used a method that was felt to be appropriate for the data collected. In addition, presenting the values outlined in the tables would provide readers a better understanding of the data. With all new procedures, there is a learning curve. In our attempt to provide patient-centered outcomes in this evolving field of oncoplastic surgery, the BREAST-Q has allowed us to evaluate oncoplastic reduction mammaplasty patients in a way we believed was meaningful. It was not our intention to violate the validity of the BREAST-Q but rather to find relevant aspects of it that would assist in our evaluation. We feel that our first experience with the BREAST-Q was positive, and we will continue to use it in the future; however, it will only be used as it was originally intended, to preserve the integrity and validity of the modules. Maurice Y. Nahabedian, M.D. Ketan Patel, M.D. Margaret Gatti, M.P.H. Department of Plastic Surgery, Georgetown University Hospital, and, Georgetown University School of Medicine, Washington, D.C. DISCLOSURE The authors have no financial interest in any of the products or devices mentioned in this communication.

A Head-to-Head Comparison of Quality of Life and Aesthetic Outcomes following Immediate, Staged-Immediate, and Delayed Oncoplastic Reduction Mammaplasty [Outcomes Article

Oncoplastic reduction mammaplasty offers patients breast conservation with the added benefit of functional improvement in symptoms related to macromastia. The reduction can be performed in the immediate setting with the lumpectomy, in a staged-immediate fashion after final pathology has been confirmed or in a delayed fashion after completion of both lumpectomy and radiation. This study compared quality of life and aesthetic outcomes for these different cohorts. A retrospective review was carried out on 16 consecutive patients who had oncoplastic reduction mammaplasty by the senior author (M.Y.N.) between 2003 and 2009. Demographics, oncologic treatment and timing, and reduction techniques were recorded. Patients were asked to complete a questionnaire to assess quality of life and satisfaction. Preoperative and postoperative photographs were evaluated by 15 reviewers. Over a 7-year period, five patients had immediate, six had staged-immediate, and five had delayed reduction mammaplasty. Mean patient age was 52.5 years, and mean body mass index was 31.5. The average timing of reduction was 0, 49, and 734 days for the three groups. Positive margins occurred in two patients, leading to completion mastectomy. In addition, one patient in the staged-immediate group had a recurrence that led to completion mastectomy. Complications occurred in seven (44 percent) of 16 patients. Questionnaire response was 75 percent (12 of 16), showing positive scores in all groups but no statistical significance. Objective aesthetic evaluation also revealed significant improvements within groups comparing various preoperative to postoperative parameters. Importantly, aesthetic scores for the delayed group were consistently lower across all aspects but did not reach significance. Oncoplastic reduction mammaplasty can be safe and effective in carefully selected patients in the immediate, staged-immediate, and delayed settings.