Oncoplastic Reduction Mammoplasty Research Articles

Oncologic Safety of Immediate Oncoplastic Surgery Compared with Standard Breast-Conserving Surgery for Patients with Invasive Lobular Carcinoma.

Invasive lobular carcinoma (ILC) of the breast grows in a diffuse pattern, resulting in a high risk of positive margins at surgical resection. Oncoplastic approaches have been shown to reduce this risk, but concerns persist around the safety of immediate oncoplastic surgery for those with ILC. This study evaluated the short- and long-term oncologic outcomes of immediate oncoplastic surgery for patients with ILC. This study retrospectively analyzed an institutional database of stages I to III ILC patients who underwent breast-conserving surgery (BCS) with or without immediate oncoplastic surgery (oncoplastic closure or oncoplastic reduction mammoplasty [ORM]). The study compared positive margin rates, rates of successful BCS, and recurrence-free survival (RFS) by type of surgery. For 494 patients the findings showed that the use of immediate ORM was associated with significantly lower odds of positive margins (odds ratio [OR], 0.34; 95 % confidence interval [CI], 0.17-0.66; p = 0.002). Both lumpectomy with oncoplastic closure and ORM were significantly associated with higher rates of successful BCS than standard lumpectomy (94.2 %, 87.8 %, and 73.9 %, respectively; p < 0.001). No difference in RFS was observed between those undergoing immediate oncoplastic surgery and those undergoing standard lumpectomy alone. The patients with stages I to III ILC who underwent immediate oncoplastic surgery had significant benefits including lower odds of positive margins and higher rates of successful BCS, with both types of immediate oncoplastic surgery showing similar RFS compared with lumpectomy alone. This supports the oncologic safety of immediate oncoplastic surgery for diffusely growing tumors such as ILC, providing it an ideal option for patients desiring BCS.

ASO Visual Abstract: Effect of Delayed Oncoplastic Reduction Mammoplasty on Radiation Treatment Delay Following Breast-Conserving Surgery for Breast Cancer.

ASO Visual Abstract: Effect of Delayed Oncoplastic Reduction Mammoplasty on Radiation Treatment Delay Following Breast-Conserving Surgery for Breast Cancer.

ASO Author Reflections: Oncoplastic Reduction Mammoplasty Appears Safe for Patients with Early-Stage Breast Cancer Albeit with Delays > 8 Weeks to Adjuvant Radiation.

ASO Author Reflections: Oncoplastic Reduction Mammoplasty Appears Safe for Patients with Early-Stage Breast Cancer Albeit with Delays > 8 Weeks to Adjuvant Radiation.

Effect of Delayed Oncoplastic Reduction Mammoplasty on Radiation Treatment Delay Following Breast-Conserving Surgery for Breast Cancer.

The purpose of this study was to evaluate the delay in initiating adjuvant radiation therapy (RT) after breast-conserving surgery (BCS) in patients with early-stage breast cancer who underwent oncoplastic reduction mammoplasty (ORM) following BCS compared with a matched cohort of patients who did not undergo ORM between BCS and RT. Medical records of 112 women (56 ORMs and 56 matched non-ORMs) with carcinoma in situ or early-stage breast cancer treated with BCS were reviewed. ORM was performed in a delayed manner following BCS, allowing confirmation of negative surgical margins. Time to RT was defined as time from last oncologic surgery to start of RT. The median follow-up time was 6.8 years for the ORM cohort and 6.7 years for the control non-ORM cohort. Patients who underwent ORM following BCS experienced a significant delay in initiating RT (>8 weeks) than matched patients not undergoing ORM (66% vs. 34%; p<0.001). Wound complications occurred in 44.6% (n=25) of patients in the ORM cohort, which were mostly minor, including delayed wound healing and/or infection (39%). There was no significant difference in local recurrence between patients in the non-ORM and ORM cohorts (p=0.32). This study demonstrates that ORM following BCS has the potential to delay RT >8 weeks, largely as a result of increased risk of wound complications; however, this delay did not impact local control. ORM can be safely considered for appropriately selected patients with breast cancer.

The Modified Fragility Index Predicts Major Complications in Oncoplastic Reduction Mammoplasty (OCR)

The Modified Fragility Index Predicts Major Complications in Oncoplastic Reduction Mammoplasty (OCR)

Oncoplastic reduction mammoplasty in patients with breast cancer and macromasty: review of the literature and case report

El cáncer de mama es la patología maligna más frecuente en la población femenina, su tratamiento ha evolucionado progresivamente en dirección a la conservación del seno a través del desarrollo de la cirugía Oncoplástica de seno, que consiste en manejo conservador con mastectomía parcial y reconstrucción inmediata. Las pacientes que presentan de manera concomitante cáncer de seno y macromastia, representan un reto mayor en el tratamiento debido a la dificultad de generar simetría con el seno contralateral y que además presentan sintomatología específica relacionada con la macromastia que disminuye su calidad de vida. El objetivo de este artículo es reportar el caso de una paciente que se maneja de manera exitosa y simultánea el cáncer de seno y macromastia, mediante cirugía oncoplástica de seno derecho y en el mismo tiempo quirúrgico, mamoplastia de reducción bilateral, obteniendo adecuado control oncológico y mejoría significativa en su calidad de vida medida por cuestionario BREAST-Q. MÉD.UIS.2021;34(3): 93-101.

Secondary Surgeries After Oncoplastic Reduction Mammoplasty.

The oncoplastic reduction approach is a popular option for women with breast cancer and macromastia. Although the benefits of this approach are numerous, data on the need for secondary surgeries are limited. We evaluated the need for all secondary surgeries after oncoplastic reduction in an attempt to understand the incidence and indications. All patients with breast cancer who underwent an oncoplastic breast reduction at the time of the tumor resection were queried from a prospectively maintained database from 1998 to 2020 (n = 547) at a single institution. Secondary surgical procedures were defined as any unplanned return to the operating room. Demographic and clinical variables were analyzed, and secondary surgeries were classified and evaluated. The timing and rates of secondary surgery were evaluated and compared with clinical variables. There were 547 patients included in this series with a mean age of 55 years and body mass index of 33.5. Mean duration of follow-up was 3.8 years. One hundred and seventeen (21%) patients underwent 235 secondary surgeries, with an average of 1.4 operations until stable reconstruction was obtained. The reason for the secondary surgery was involved margins (7.5%), major complications (8.6%), aesthetic improvement (13.3%), and completion mastectomy (5.3%). Age 65 years and younger age was associated with any subsequent procedure (P = 0.023) and revision for cosmesis (P = 0.006). Patients with body mass index greater than 35 had increased secondary surgeries for operative complications (P = 0.026). Secondary surgeries after oncoplastic breast reduction procedures are common. Management of margins and complications, such as hematoma and infection, are early indications, with aesthetic improvement, wound healing complications, fat necrosis, and recurrence being late reasons. The most common reason for reoperation is aesthetic improvement, especially in younger patients. Attention to surgical technique and patient selection will help minimize secondary surgeries for the nononcological reasons.

Abstract PS1-49: The effect of oncoplastic reduction on the incidence of post-operative breast lymphedema in breast cancer patients undergoing lumpectomy

Abstract Purpose / Objectives: In patients with macromastia, breast conservation surgery (BCS) followed by radiation therapy (RT) for the treatment of breast cancer may be associated with a different complication profile than those without macromastia. General complications of BCS followed by RT includes seroma, infection, wound complications, cosmetic deformity, asymmetry, acute versus long term arm and/or breast lymphedema. Oncoplastic reduction mammoplasty (ORM) aims to reduce breast volume while excising the tumor bed and its margins. Since breast volume was found to be a risk factor for chronic breast lymphedema, this study was performed to determine the impact of ORM on chronic breast lymphedema as well as other complications compared to BCS without ORM. Materials / Methods: We performed a retrospective chart review on patients who underwent lumpectomy with RT from 2014 to 2018. Chronic breast lymphedema (CBL) was defined as swelling that persisted &amp;gt;1 year post-RT. Breast volumes (BV) were determined by contoured breast volumes or, if unavailable, estimated by the 95% isodose volumes from the RT treatment planning system. Univariate analysis was used to evaluate various patient factors and treatment outcomes in women with BV ≥1300 cc compared to &amp;lt;1300 cc. These same factors were compared in women who underwent ORM vs. BCS alone. Multivariate regression analysis was used to evaluate factors associated with ≥1 complication. Logistic regression was performed to identify factors associated with the development of CBL. Results: The total population included 1173 patients, of which 51 (4.3%) underwent ORM and 1122 (95.7%) underwent BCS. 440 (37.5%) patients had BV ≥1300 cc and 733 (62.5%) patients had a BV &amp;lt;1300 cc. Multivariate regression analysis demonstrated that patients with BV ≥1300 cc had a higher BMI (OR=1.200, P&amp;lt;0.001), decreased risk of grade 2 radiation dermatitis (OR=0.457, P=0.002), and increased risk of CBL (OR=2.127, P=0.024) compared to patients with BV &amp;lt;1300 cc. However, oncoplastic reduction was associated with an increased risk of hematoma (OR=5.934, P&amp;lt;0.001), increased risk of wound dehiscence (OR=12.433, P&amp;lt;0.001), and decreased risk of seroma (OR=0.201, P&amp;lt;0.001) compared to BCS patients. Conclusions: Our data demonstrates that patients with breast volume &amp;gt; 1300 cc are at increased risk for developing several complications regardless of the presence of ORM. Those who had ORM experienced an increase in wound complications but having undergone ORM appeared to eliminate the increased risk of CBL associated with macromastia. This suggests that ORM should be considered at the time of BCS to reduce their future risk of CBL as there is no cure for this disease. Citation Format: Jenna Nicole Luker, Cara Canella, Sanjay Rama, Kelley Park, Renee Barry, Saheli Ghosh, Simeng Zhu, Yalei Chen, Jessica Bensenhaver, Eleanor Walker, Kenneth Levin, Maristella Evangelista, Dunya Atisha. The effect of oncoplastic reduction on the incidence of post-operative breast lymphedema in breast cancer patients undergoing lumpectomy [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS1-49.

Abstract PS1-37: Reduction mammoplasty in the setting of neoadjuvant chemotherapy

Abstract Background: Oncoplastic reduction mammoplasty is an accepted method of breast conserving surgery that also allows for potentially improved symmetry and aesthetics compared to other techniques and allows for larger tissue volumes to be removed with acceptable cosmetic outcomes. Neoadjuvant systemic chemotherapy (NAC) is increasingly used for the treatment of patients with breast cancer. While there is some data that oncoplastic reduction may delay timing of adjuvant radiation, we sought to examine this in our patients, and specifically to compare complications and time to radiation in patients who received NAC to those that didn’t. Methods: A retrospective analysis was done of all patients with DCIS or invasive cancer who underwent a reduction mammoplasty and received adjuvant radiation at our single institution from 2009-2018. Patients who received NAC were compared to those that did not. Results: A total of 114 patients underwent reduction mammoplasty as part of their oncologic surgery and received adjuvant radiation at our institution. Of those, 40.4% received neoadjuvant chemotherapy and 49.1% received no neoadjuvant treatment. A total of 38 patients (33.3%) had some postoperative complication with 8.8% having a serious complication that required intervention. Adjuvant radiation started after 8 weeks in 74.6% of patients and after 12 weeks in 38.6% of patients, with the majority of these delays due to non-clinical factors. A total of 29.4% of patients had a delay due to wound healing issues. There was no association between NAC and delayed radiation due to wound healing (p=0.18). Discussion: Oncoplastic reduction mammoplasty is a safe option for breast-conserving surgery in patients who have received NAC. The receipt of NAC in itself does not delay timing of adjuvant radiation or lead to increases in delayed wound healing. We are additionally examining other factors and their possible interaction with NAC, including diabetes, smoking, BMI and breast reduction size. In those with larger tumors receiving NAC who would otherwise not be candidates for breast conserving surgery, oncoplastic reduction should be considered as an appropriate option for surgical management. Reduction also allows for wider excision which may mitigate the impact of the longer time from surgery to radiation. Citation Format: Kelly Hewitt, Susan Wu, Laura Barnes, Joanna Yang, Merisa Piper. Reduction mammoplasty in the setting of neoadjuvant chemotherapy [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS1-37.

The Effect of Oncoplastic Reduction on The Incidence of Post-Operative Lymphedema in Breast Cancer Patients Undergoing Lumpectomy

In patients with macromastia, breast conservation surgery (BCS) followed by radiation therapy (RT) may be associated with increased radiation exposure and a different complication profile than those without macromastia. The oncoplastic reduction mammoplasty (ORM) procedure includes breast reduction at the time of BCS. The purpose of this study is to determine if women with macromastia who undergo ORM have a different complication profile compared to those who undergo BCS followed by RT. We performed a retrospective chart review on patients who underwent lumpectomy with RT from 2014 to 2017. Chronic breast lymphedema (CBL) was defined as swelling that persisted >1-year post-RT. Breast volumes (BV) were determined by contoured breast volumes or, if unavailable, estimated by the 95% isodose volumes from the RT treatment planning system. Univariate analysis was used to evaluate various patient factors and treatment outcomes in women with BV ≥1300 cc compared to <1300 cc. These same factors were compared in women who underwent ORM vs. BCS. Multivariate regression analysis was used to evaluate factors associated with ≥1 complication. Logistic regression was performed to identify factors associated with the development of CBL. The total population included 785 patients, of which 28 (3.6%) underwent ORM and 757 (96.4%) underwent BCS. The total population was stratified into two groups, in which 289 (36.8%) patients had BV ≥1300 cc and 496 (63.2%) patients had a BV <1300 cc. Compared to patients with BV<1300 cc, those with BV ≥1300 cc had a higher percentage of African Americans (52.6% vs. 41.5%, P = 0.002), higher median BMI (34.96 vs. 27.87, P<0.001), higher incidence of diabetes (39.8% vs. 27.2%, P<0.001), higher incidence of hypertension (75.4% vs. 63.1%, P<0.001), and higher incidence of CBL (12.5% vs. 4.2%, P<0.001). Compared to BCS patients, ORM patients with BV ≥1300 cc had increased incidence of CBL (36.4% vs. 11.5%, P = 0.035). Logistic regression showed that the incidence of ≥1 complication was associated with BMI, presence of SLNB, and the number of lymph nodes removed in either SLNB or ALND. However, factors such as ORM and BV were not associated with an increased risk of ≥1 complication. Logistic regression demonstrated that having a BV ≥1300 cc was associated with 2.5 times increased odds of CBL compared to those with BV <1300 cc. Even though those who underwent ORM did not change the risk for CBL for the entire cohort, ORM patients with BV ≥1300 had a higher risk of CBL. Ultimately, logistic regression demonstrates that ORM does not increase the risk of CBL when adjusting for BV. In conclusion, axillary surgery contributed most significantly to the incidence of having ≥1 complication. However, BV was associated with an increased risk of CBL, regardless of the presence of ORM. Therefore, women with BV ≥1300 cc should be offered ORM at the time of lumpectomy in order to reduce their future risk of CBL.

A Cost-Utility Analysis Comparing Immediate Oncoplastic Surgery with Delayed Oncoplastic Surgery in Smoking Breast Cancer Patients.

Oncoplastic reduction mammoplasty for smoking breast cancer patients committed to smoking cessation may be performed immediately (increasing smoking-related risk) or in a delayed fashion (increasing radiation-related risk). Our aim was to examine the cost utility of immediate versus delayed oncoplastic reconstruction when operating on a smoking patient with breast cancer and macromastia with a long-term commitment to smoking cessation. A literature review determined the probabilities and outcomes for the treatment of unilateral breast cancer with immediate or delayed oncoplastic surgery. Reported utility scores were used to estimate quality-adjusted life-years (QALYs) for varying health states. A decision analysis tree was constructed with rollback analysis to highlight the more cost-effective strategy, and an incremental cost-utility ratio (ICUR) was calculated. Sensitivity analyses were performed to validate the robustness of the results. Immediate oncoplastic surgery is associated with a higher clinical effectiveness (QALY) of 33.3 compared with delayed oncoplastic surgery (33.26), with a higher increment of clinical effectiveness of 0.07 and relative cost reduction of $3458.11. This resulted in a negative ICUR of -50,194, which favored immediate reconstruction, indicating a dominant strategy. In one-way sensitivity analyses, delayed reconstruction was the more cost-effective strategy if the probability of successful immediate reconstruction falls below 29% or its cost exceeds $29,611. Monte-Carlo analysis showed a confidence of 99% that immediate oncoplastic surgery is more cost effective. Despite the risk of postoperative complications associated with smoking, immediate oncoplastic surgery is more cost effective compared with delayed oncoplastic surgery in which reconstructive surgery would occur after radiation.

MODIFIED DOUGHNUT TECHNIQUE IN REDUCTION MAMMOPLASTY FOR BREAST CANCER

Background: Breast cancer is the commonest malignancy in women and comprises 18% of all female cancers. The goal of modern breast surgery is to cure patients with preservation and reconstruction of breast tissue leading to satisfactory physical and psychological outcome. Aim of the Work: to evaluate modification of Dougnut technique in reduction mamoplasty as part of oncoplastic breast surgery for breast cancer. Patients and Methods: This prospective study included 20 female patients diagnosed with breast cancer suitable for management with the modified doughnut breast oncoplastic reduction mammoplasty surgery the age of the patients varied from 22 and 60 years old. The mean age for our study was 46.5. Results: From the 20 patients, the most common were of cup size C and D with the later being the mean and accounting for more than half (55%). The mean tumor size was 3.37  1.01 with a mean distance from NAC of 2.86  0.85. The location was 60% paraaereolar and 40% in the lower half of the breast. 13 (65%) patients underwent operation unilateral and 7 (35%) patients underwent bilaterally. The most common tumor pathology was IDC (70%). Regarding our patients' cosmetic satisfaction, the overall mean score of our study was 4.35 which falls between very good and excellent Conclusion: The modification of oncoplastic surgical techniques allows combining of several benefits, as here the modified doughnut technique benefiting from combining the round block and superior medial techniques giving better access of tumors and oncological control around the breast and reduction mammoplasty in large breast of cup C, D and more, with safe NAC and good aesthetic outcome. That technique showed good adoption bilaterally which is a key forsymmetrization in oncoplastic surgeries.

Abstract P2-12-16: The use of oncoplastic surgical techniques to increase successful breast conservation in invasive lobular carcinoma of the breast

Abstract Background: Invasive lobular carcinoma (ILC) of the breast differs from invasive ductal carcinoma in its non-cohesive growth pattern. These diffuse tumors pose challenges for accurate size assessment as well as surgical resection. Patients with ILC have higher rates of positive margins and lower rates of successful breast conservation surgery. Oncoplastic surgical techniques such as oncoplastic reduction mammoplasty and lumpectomy with oncoplastic closure can allow for removal of larger areas of breast tissue than lumpectomy alone. Whether or not these techniques improve the success of breast conservation in patients with ILC is unknown. Methods: We queried a prospectively maintained surgical database and identified 384 women treated for ILC at UCSF between 1992 and April 2017. We reviewed pathology and operative reports, and clinical outcomes data, and identified 199 women who had an initial attempt at breast conservation. Data were analyzed in Stata 14.2. Results: Average age was 61 years (range 39-84), and 69% of patients underwent lumpectomy, 16% had lumpectomy with oncoplastic closure, and 15% had oncoplastic reduction mammoplasty. The majority of tumors were hormone receptor positive, Her2 negative, grade 2, T1 or T2, and 28% were node positive. A total of 156 women (78%) had successful breast conservation; of these, 34% had one re-excision, and 1 patient had two re-excisions. Positive margins were seen in 40% of patients overall, and were significantly lower in the lumpectomy with oncoplastic closure group and those who had shave margins taken. Among the patients who underwent lumpectomy only, obtaining shave margins was significantly associated with final negative margins (71% versus 53%, p = 0.033). Patients with oncoplastic reduction mammoplasty had significantly larger average tumor size (4.1 cm), and significantly more tissue removed (167 cm3). LumpectomyLumpectomy with oncoplastic closureOncoplastic reduction mammoplastyP valueTumor size (mean)2.4 cm2.1 cm4.1 cm&amp;lt;0.001Volume tissue excised65 cm383 cm3167 cm3&amp;lt;0.001Positive margins42%19%50%0.022Shave margins50%69%79%0.005Successful breast conservation75%97%77%0.021Re-excision rate among those with successful breast conservation33%26%39%0.571 Conclusions: Tailoring the surgical treatment to tumor size can increase the rate of successful breast conservation surgery for these diffuse, often non-palpable lobular cancers. For the women with the largest tumors, oncoplastic reduction mammoplasty was often recommended. This group likely represents women who were borderline candidates for breast conservation; despite this, oncoplastic reduction mammoplasty allowed 77% to ultimately have successful breast conservation. For the women with smaller tumors, removing additional tissue with shave margins and using oncoplastic techniques for closure when necessary clearly reduced positive margin rates. Surgeons should routinely obtain shave margins when performing partial mastectomy for women with ILC. Citation Format: Wong JM, Piper ML, Ewing C, Alvarado M, Esserman LJ, Sbitany H, Foster RD, Mukhtar RA. The use of oncoplastic surgical techniques to increase successful breast conservation in invasive lobular carcinoma of the breast [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P2-12-16.

Outcomes Following Oncoplastic Reduction Mammoplasty: A Systematic Review.

Reconstruction of partial mastectomy defects with oncoplastic approaches has become increasingly popular as a strategy for improving aesthetic outcomes and extending the option of breast conservation therapy. However, interpretation of reported oncologic outcomes and postoperative complications has been challenging because of limited data and significant variability in surgical technique and degree of tissue rearrangement. Studies describing oncoplastic mammoplasty or partial mastectomy reconstruction were identified from the MEDLINE and Cochrane databases. Only studies reporting the use of oncoplastic reduction mammoplasty techniques with significant breast parenchymal rearrangement were included for analysis. Primary outcomes assessed were postoperative complications and oncologic outcomes, including local recurrence rates and need for re-excision or completion mastectomy. Seventeen articles met the inclusion criteria, representing 1324 oncoplastic cases. Reported follow-up ranged from 20 to 73 months. Of the 12 studies with at least 2 years' mean/median follow-up, the pooled local-regional recurrence rate was 3.1%. Fifteen articles reported re-excision and completion mastectomy rates (3.5% and 3.7%, respectively). Twelve articles reported postoperative complications. Overall, 4.6% of patients had wound dehiscence, 4.3% developed fat necrosis, 2.8% developed an infection, 0.9% had either partial or total nipple necrosis, and 0.6% had seromas. Partial mastectomy reconstruction with oncoplastic reduction techniques is associated with high rates of successful breast conservation and low rates of required re-excisions, likely due to the ability to take wide tumor margins without compromising aesthetic outcome. Future studies should consistently report complications, recurrences, and patient-reported outcomes to improve our ability to evaluate the use of this technique.

Six-year follow-up of patients treated with oncoplastic reduction mammoplasty: A cohort study

BackgroundCurrent evidence for the oncological safety of oncoplastic breast conservation is poor as it is based mostly on short-term follow-up data. Hence, we report long-term recurrence rates in patients treated with oncoplastic reduction mammoplasty (ORM). MethodsA prospectively maintained database was searched to identify patients who underwent ORM between 2005 and 2010. A retrospective review of medical records was carried out, including patients with ductal carcinoma in situ and invasive breast cancer. ResultsFollow-up data from 65 consecutive patients with ORM were reviewed, of which 50 patients were eligible to measure long-term recurrence rates. The average weight of the resected tissue was 272 g altogether. The mean preoperative tumour size was 2.95 cm on imaging. 64% of patients had stage II – III cancers. Incomplete excision rate after ORM was 16.1%, completion mastectomy rate was 10.7%. During a median follow-up of 72 months, 2% local, 6% distant recurrence rates were detected. The breast cancer-specific survival rate was 96% per cent. ConclusionsBased on these long-term follow-up data, ORM is an oncologically safe treatment option.

Oncoplastic reduction mammoplasty for breast cancer in women with macromastia: long term aesthetic, functional and satisfaction outcomes.

Aim of the studyDespite the increase in studies concerning oncoplastic reduction mammoplasty (ORM), data showing long-term aesthetic and patient satisfaction for ORM in patients with macromastia remain limited. Therefore, this study evaluated the long-term results of tumorectomy and concomitant bilateral ORM for early-stage breast cancer patients with macromastia in terms of cosmesis, patient satisfaction, and functional outcomes.Material and methodsRetrospective data of patients with macromastia undergoing ORM for breast cancer between 1996 and 2011 were examined and evaluated regarding the aesthetic results, patient satisfaction, and functional outcomes.ResultsThe median age of the 82 patients was 50 years. The median follow-up was 120 months (range: 28–212 months). The median breast volume was 1402 cm3, and the median weight of the excised breast material was 679 g. A good or excellent evaluation of the cosmetic outcome was as follows: self-evaluation: 84.1% at the early-stage, 80.3% at the later stage; panel evaluation: 75.4% at the late-stage. Median patient satisfaction rates were 9.1% for early-stage disease and 8.8% for late-stage disease. Reduced mobility and intertrigo improved by three-fold during the post-operative period.ConclusionsORM for early-stage breast cancer in women with macromastia results in good cosmesis in both the early-stage and long-term, and is quite acceptable for use in patients. Patients reacted favorably to the prospect of having their breast cancer and macromastia treated in a single session, and positive results continued over the long-term.

Oncoplastic reduction mammoplasty for breast cancer in women with macromastia: Oncological long-term outcomes

To evaluate the long-term results of tumorectomy and concomitant bilateral oncoplastic reduction mammoplasty (ORM) for early stage breast cancer patients with macromastia in terms of local disease control and long-term oncological results. Data of 82 patients with macromastia undergoing ORM for breast cancer between 1996 and 2011 were retrospectively examined and evaluated with regard to oncological results. The median age was 50 years. The median follow-up was 121 months (range 28-212 months). The median breast volume was 1402cm3 and the median weight of excised breast material was 679g. The median surgical margin was 16mm. Ten-year local recurrence rate was 8.7%. The 10-year overall survival rate was 82.2% and the disease-free survival rate was 73.2%. Early and late complication rates were 12.2% and 14.6%, respectively. From the standpoint of local disease control and long-term observation, ORM can be considered a very safe and acceptable treatment for early stage breast cancer in women with macromastia.

Oncoplastic reduction mammoplasty for breast cancer in woman with macromastia: Oncological long-term outcomes.

e12057 Background: Despite the increase in studies of ORM, data showing long-term oncological results, aesthetic and patient satisfaction for ORM in patients with macromastia is still limited. Ther...

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.

Essential elements of the preoperative breast reconstruction evaluation.

A plethora of options exist for breast reconstruction and preoperative evaluation must be thorough to lead to a successful outcome. We review multiple components of the preoperative assessment including the patient's history, goals, imaging, and key elements of the physical exam. Consideration for tumor biology, staging, need or response to chemotherapy or radiation therapy is important in deciding on immediate versus delayed reconstruction. It is also important to consider the patient's anatomy, breast size and whether the reconstruction will be unilateral or bilateral. The reconstructive surgeon must accommodate all these factors to consider partial or complete mastectomy defects and guide the patient to the most appropriate reconstructive technique whether it be an oncoplastic reduction mammoplasty, expander-based reconstruction, immediate implant reconstruction, or immediate versus delayed autologous tissue reconstruction such as the deep inferior epigastric artery perforator (DIEP)/transverse rectus abdominis muscle (TRAM), latissimus, transverse upper gracilis (TUG)/profunda femoris artery perforator (PAP), or gluteal artery perforator (GAP) flaps.