Annals of breast surgery : an open access journal to bridge breast surgeons across the world最新文献

{"title":"An 11-year retrospective analysis of clinical outcomes after prepectoral implant-based breast reconstruction performed by a single surgeon","authors":"Catherine J. Sinnott, M. Pronovost, C. Hodyl, Melanie Lynch, Freya Young, Sanford Edwards, A. O. Young","doi":"10.21037/abs-21-78","DOIUrl":"https://doi.org/10.21037/abs-21-78","url":null,"abstract":"Background: Prepectoral implant breast reconstruction is being offered to an increasing number of breast cancer patients because it results in less postoperative pain, faster recovery and a lower risk of animation deformity compared to subpectoral reconstruction. However, broad acceptance of this muscle-sparing procedure is still slow secondary to safety concerns, including an increased risk of capsular contracture, implant exposure, implant visibility and delayed detection of breast cancer recurrence. This study aimed to describe clinical outcomes in prepectoral breast reconstruction performed by a single surgeon over an 11-year period. Methods: A retrospective chart review was conducted of all patients who had prepectoral or subpectoral implant breast reconstruction from 2010 to 2021. Demographic, clinical and operative data were assessed. Outcomes were determined by comparing complication rates between prepectoral and subpectoral implant reconstruction, including, mastectomy necrosis, seroma, hematoma, dehiscence and local recurrence. Results: A total of 758 prepectoral reconstructions were performed in 468 patients with a mean age of 52.5±9.9 (± SD) years and mean body mass index (BMI) of 28.8±6.1 kg/m 2 . A total of 163 subpectoral implant reconstructions were performed in 100 patients with a mean age of 46.9±8.8 years and mean BMI of 25.2±5.0 kg/m 2 . Complication rates in prepectoral implant reconstruction patients were low and comparable to subpectoral patients, with regard to major infection (3.4% vs. 1.2%), major necrosis (1.7% vs. 1.2%), capsular contracture (6.5% vs. 9.8%), implant loss (4.1% vs. 4.3%), seroma (0.3% vs. 1.2%), hematoma (0.3% vs. 0%), dehiscence (0.7% vs. 1.2%), local recurrence (1.3% vs. 1.2%) and total complications (22.7% vs. 22.1%; P>0.1462), respectively. Postmastectomy radiation and therapeutic reconstruction were risk factors for a complication in prepectoral implant reconstruction. Conclusions: Prepectoral implant reconstruction is associated with low complication rates comparable to subpectoral implant reconstruction. Rates of capsular contracture, implant exposure and local recurrence were not increased with prepectoral reconstruction. Prepectoral implant reconstruction should be offered to breast cancer patients in settings where there is an experienced team of oncoplastic surgeons because of its decreased invasiveness, postoperative pain and low complication rates.","PeriodicalId":72212,"journal":{"name":"Annals of breast surgery : an open access journal to bridge breast surgeons across the world","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43433240","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence of capsular contracture on irradiated acellular dermal matrices (ADMs)-assisted prepectoral breast reconstructions","authors":"T. Saibene, Claudia Cecconi, M. Toffanin, M. Cagol, Massimo Ferrucci, R. Grigoletto, S. Michieletto","doi":"10.21037/abs-21-141","DOIUrl":"https://doi.org/10.21037/abs-21-141","url":null,"abstract":"","PeriodicalId":72212,"journal":{"name":"Annals of breast surgery : an open access journal to bridge breast surgeons across the world","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46499330","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The propeller thoracodorsal artery perforator flap—designs for breast reconstruction and perspectives","authors":"J. Thomsen, Mikkel Børsen-Rindom, A. Rancati, C. Angrigiani","doi":"10.21037/abs-21-14","DOIUrl":"https://doi.org/10.21037/abs-21-14","url":null,"abstract":"The propeller thoracodorsal artery perforator flap (pTDAP) is a further development and simpler version of the classic TDAP pioneered by Angrigiani C in 1995. The pTDAP can be used for immediate and delayed breast reconstruction in combination with an implant, fat grafting or in combination with other perforator flaps as an alternative to the latissimus dorsi flap. The pTDAP breast reconstruction can be performed and designed in several different ways regarding: (I) flap design, (II) axilla design and (III) breast design. The aim of this paper is to describe and illustrate different pTDAP designs and perspectives. We present the indications for use of the propeller TDAP in delayed as well as immediate breast reconstruction. The TDAP can be harvested from the back in various ways, horizontal and two different oblique techniques, upwards and downwards angled. The flap can be raised as an extended flap to include as much subcutaneous fat adjacent to the skin island as possible, either in the entire length of the flap or as the “Saturn”-design. The location of the dominant perforator(s) is predictable in most cases, but variations due occur and flap harvest can preferably be targeted by color Doppler ultrasonography for perforator identification. The propeller flap pedicle can be tunneled or left visible below/in the axilla. The flap can be augmented by an expander/direct to implant technique or combined with fat grafting or other perforator flaps, an internal mammary perforator flap from the contralateral breast, a superior epigastric artery perforator flap or with a free TDAP as stacked flaps. The pTDAP can and should be designed, targeted and adapted to the individual patient when used for breast reconstruction. This entails the flap size and shape in the back, the choice and use of perforators, the design and rotation in the axilla and the breast reconstruction when using the flap for augmentation, shaping and draping using expanders, implants, fat grafting or in combined with other flaps.","PeriodicalId":72212,"journal":{"name":"Annals of breast surgery : an open access journal to bridge breast surgeons across the world","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48472546","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Financial toxicity and the economic cost of breast cancer therapy","authors":"A. Konski","doi":"10.21037/ABS-20-122","DOIUrl":"https://doi.org/10.21037/ABS-20-122","url":null,"abstract":": Breast cancer. given its natural history, can be present for many years resulting in significant cost to insurers as well as patients with costs not covered by the patients’ insurance plans. Breast cancers tends to be diagnosed in the most productive times of a patient’s life disrupting both family life and employment. Because of the dependence on employment-based insurance coverage, financial toxicity has entered the lexicon of care of patients with breast cancer. Objective measures of toxicity include costs not borne by insurance companies while subjective measures of toxicity include the psychological stress of having to deal with having to deal managing a household budget and determining which bills to pay. Costs not covered by insurance companies such as child care and travel to and from treatment appointments can add to the psychological stress patient’s encounter. Insurance, income and insurance status all play a role in financial toxicity. Unfortunately, financial toxicity is not limited to only those countries without some form of universal health insurance coverage. Financial discussions will need to occur between patients and caregivers in the future as cost of care increases. A switch to a tax-funded universal healthcare system with a universal set of benefits may be needed to decrease the incidence of financial toxicity in women with breast cancer.","PeriodicalId":72212,"journal":{"name":"Annals of breast surgery : an open access journal to bridge breast surgeons across the world","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46729974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An observational study comparing the SPY-Elite® vs. the SPY-PHI QP System in breast reconstructive surgery","authors":"E. Lauritzen, R. Bredgaard, C. Bonde, L. Jensen, T. Damsgaard","doi":"10.21037/abs-21-123","DOIUrl":"https://doi.org/10.21037/abs-21-123","url":null,"abstract":"","PeriodicalId":72212,"journal":{"name":"Annals of breast surgery : an open access journal to bridge breast surgeons across the world","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46320535","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Regional nodal irradiation in the setting of sentinel node biopsy","authors":"C. Seldon, Anna Lee","doi":"10.21037/ABS-20-125","DOIUrl":"https://doi.org/10.21037/ABS-20-125","url":null,"abstract":": The need for axillary lymph node dissection (ALND) in patients with invasive breast cancer (IBC) has been a topic of great debate in the last decade. The role of axillary management in patients with sentinel lymph node biopsy (SLNB) negative or micrometastatic disease is well established after multiple trials demonstrated no survival benefit with the addition of ALND (NSABP B32, IBCSG 23-01, AATRM048); yet, there remains controversy in the management of SLNB positive disease. ALND has traditionally been the standard of care following positive SLNB, however, results from recent studies have identified that further surgical exploration of the axilla may be overtreatment in these patients. In order to de-escalate treatment, non-surgical options such as regional nodal irradiation (RNI) and neoadjuvant chemotherapy (NAC) have been increasingly explored. Trials evaluating the role of RNI following positive SLNB have suggested that RNI is non-inferior to ALND and provides superior outcomes with an improved toxicity profile (AMAROS, MA.20, EORTC 22922). NAC has been explored in the treatment paradigm in patients with locally advanced disease, however, the role of SLNB and RNI in this setting remains unequivocal. This review aims to provide an update on the role of RNI following SLNB in IBC using an evidence-based approach. Ongoing clinical trials will clarify the role of axillary management after NAC in cN1 patients. In the Alliance A011202 trial, the role of ALND versus axillary nodal irradiation is addressed. Patients with clinical T1–3, N1 breast cancer treated with NAC and subsequent positive SLNB are randomized to receive ALND or axillary nodal irradiation along with radiotherapy to the whole breast or chest wall. Both groups will receive radiotherapy to the supraclavicular fossa. Patients in the ALND arm will receive radiotherapy to the undissected axilla. The target accrual is 1,660 patients and the primary study endpoint is invasive breast cancer recurrence-free interval (IBC-RFI) (NCT01901094). The NSABP B-51/RTOG 1304 trial is investigating the role of RNI in the same patient population who achieve pCR at ALND following NAC. Patients who present with clinical T1–3 tumors and N1 disease who achieve pCR post NAC are randomized to receive axillary RNI versus no further axillary treatment. Patients who receive RNI will also receive radiation to the whole breast or chest wall. The target accrual is 1,636 patients with the primary study endpoint of IBC-RFI (NCT01872975).","PeriodicalId":72212,"journal":{"name":"Annals of breast surgery : an open access journal to bridge breast surgeons across the world","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44579200","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adjuvant therapy in older patients with breast cancer","authors":"M. Sawaki","doi":"10.21037/ABS-21-56","DOIUrl":"https://doi.org/10.21037/ABS-21-56","url":null,"abstract":": Older adults suffer the majority of cancer diagnoses and deaths, and also make up the majority of cancer survivors; however, there is little support in the literature for evidence-based clinical management of older patients with breast cancer. This is to a great extent due to the fact that older adults are commonly excluded from most clinical trials. Thus, an appropriate standard of care for older patients has not been established. Treatment needs to be individualized, taking into account patient health status and preference in addition to the anatomical and biological staging. Employing a comprehensive geriatric assessment (CGA) may be advantageous in older patients. This approach formulates a cancer treatment plan after employing a multidisciplinary approach to evaluate patient vulnerability from several different angles. One aim is to predict adverse events of chemotherapy and identify geriatric problems in advance so that extra support and modified treatment can be provided. As well as overtly adverse events, health-related quality of life (HRQoL) is also important in older patients, due to the negative effects of chemotherapy. For decision making about adjuvant treatment in older patients, we should know that older adults differ from their younger counterparts in terms of willingness to trade survival for current HRQoL. Here, current adjuvant therapies in older patients with breast cancer are reviewed and discussed regarding how to approach decision making.","PeriodicalId":72212,"journal":{"name":"Annals of breast surgery : an open access journal to bridge breast surgeons across the world","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45364944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Physician’s comfort level with observing ductal carcinoma in situ of the breast: a survey of breast specialists at accredited breast centers in the United States","authors":"Elizabeth C Poli, Cecilia Chang, R. Bleicher, M. Moran, Jill M. Dietz, T. Sarantou, S. Kurtzman, K. Yao","doi":"10.21037/abs-22-1","DOIUrl":"https://doi.org/10.21037/abs-22-1","url":null,"abstract":"","PeriodicalId":72212,"journal":{"name":"Annals of breast surgery : an open access journal to bridge breast surgeons across the world","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44891890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical management of a giant malignant phyllodes tumour of the breast: a case report","authors":"J. Guevara-Martínez, Irene Osorio, J. Bernar, S. Salido, C. Meliga, Natascha Elsner, R. Pardo","doi":"10.21037/abs-20-150","DOIUrl":"https://doi.org/10.21037/abs-20-150","url":null,"abstract":"Phyllodes tumour (PT) is a rare fibroepithelial neoplasm, being divided into benign, borderline or malignant, and usually presents as large masses with rapid growth. Breast tumours above 4 cm with these characteristics are highly suspicious of PT, and those above 10 cm are considered giant PTs, representing only 20% of these tumours. Prognosis relies on histological type and a mostly on a complete surgical resection with margins above 1 cm. Surgical management of giant PTs can be a technical challenge, and may require advanced breast reconstructive techniques. We present the case of a giant PT, completely resected with a mastectomy and nodal dissection. The patient was discharged without any complications and is currently on follow-up without recurrence. Adequate resection margins should always be the principal aim when providing an optimal surgical treatment of a PT. A multidisciplinary team evaluation by an experienced breast surgeon or a plastic reconstructive surgeon is recommended when planning a proper resection with further reconstruction. Axillary node metastases are rare, and dissection is limited to patients with pathological preoperative findings. Hematogenous dissemination may be present in malignant PTs. Classical adjuvant therapies like chemotherapy, hormonotherapy or radiotherapy are no widely prescribed when treating PT. We strongly emphasize in providing a correct initial resection of the tumour.","PeriodicalId":72212,"journal":{"name":"Annals of breast surgery : an open access journal to bridge breast surgeons across the world","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45287693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"“The perspectives of the patient and her carer” for the upcoming series “Diagnosis and Treatment on Primary Breast Cancer in Older Women”","authors":"S. Turner","doi":"10.21037/abs-21-91","DOIUrl":"https://doi.org/10.21037/abs-21-91","url":null,"abstract":"","PeriodicalId":72212,"journal":{"name":"Annals of breast surgery : an open access journal to bridge breast surgeons across the world","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48432913","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}