Introduction: The better survival rates after breast cancer allow for setting of long-term goals, such as Quality of Life (QoL) and aesthetic outcomes following breast reconstruction. Studies find a higher breast-related QoL and greater satisfaction with breasts following autologous breast reconstruction (ABR) compared to implant-based breast reconstruction (IBR). However, aesthetic results from donor sites can influence body image. This concern is little addressed in the literature. Therefore, the aim of this study was to compare the long-term breast-related and body-related QoL of women who underwent ABR to women who underwent IBR. Material and methods: A multicenter, cross-sectional survey was conducted between November and December 2020 among women who underwent postmastectomy breast reconstruction between January 2015 and December 2018. A general questionnaire, the BREAST-Q, and the BODY-Q were used to collect data. Multivariable linear regression was performed to adjust differences in Q-scores for potential confounders. Results: In total, 336 patients were included (112 IBR, 224 ABR). Autologous reconstruction resulted in significantly higher mean scores in all subdomains of the BREAST-Q. On the BODY-Q, IBR scored significantly higher on scars, while ABR scored moderately to significantly higher on all other scales. Despite a lower mean score on Hips & outer thighs in women with Lateral Thigh Perforator (LTP) flap reconstruction, no negative influence on body image was found in these women. Conclusions: Long-term breast-related and body-related outcomes of ABR are superior to IBR. Donor site aesthetic does not adversely affect body image in women who underwent free flap breast reconstruction.
Background Since the number of breast cancer genetic gene testing is increasing, more women opt for bilateral prophylactic mastectomy (BPM) followed by breast reconstruction. However, little is known about the differences in Quality of Life (QoL) after various reconstructive surgeries in this population. In this study, the long-term breast-related, body-related, and health-related QoL between immediate implant-based breast reconstruction (IBBR) and autologous breast reconstruction (ABR) were compared, in women who underwent BPM. Methods In this cross-sectional study, women who underwent postmastectomy breast reconstruction between January 2015 and December 2018 were invited for an online questionnaire, in which the BREAST-Q, the BODY-Q and the SF-36 were included. Women who underwent BPM and immediate breast reconstruction were included for analysis. Multivariable linear regression analysis was performed to adjust mean differences in patient-reported outcomes between IBBR and ABR for potential confounders. Results Of the included women (n = 47), 33 underwent ABR and 14 women underwent IBBR following BPM. BREAST-Q scores were in favor of the ABR group before and after adjustment, with statistically significance on Satisfaction with breasts (mean difference 15.8, p = 0.019) and Physical well-being (mean difference 13.5, p = 0.033). None of the mean differences in BODY-Q and SF-36 scores between groups, before and after adjustment, were statistically significant. Conclusion This study suggests that there is a higher satisfaction with breasts and better physical well-being in women who underwent immediate ABR compared to those who underwent immediate IBBR after BPM. However, these data should be interpreted carefully as a result of selection bias and a small sample size. Level of Evidence: Level III, risk study.
Introduction Neoadjuvant systemic therapy (NST) is increasingly applied in breast cancer to increase breast-conserving surgery (BCS) rates and to improve oncological outcomes. Ductal carcinoma in situ (DCIS) can be present adjacent to invasive breast cancer (IBC), especially in HER2-positive IBC. DCIS was previously considered to be insensitive to NST. Consequently, mastectomy rates are higher in IBC with adjacent DCIS. Recent studies have shown that DCIS can be sensitive to NST, however, only small populations were investigated. Therefore, the aim of this study was to determine the rate of complete response of adjacent DCIS in HER2-positive IBC and to assess the potential influence of clinicopathological variables in a nationwide cohort. Methods All women diagnosed with HER2-positive IBC, treated with NST and surgery between January 2010 and December 2019, were selected from the Netherlands Cancer Registry (NCR). Of these patients, all pre-NST biopsy and postoperative specimen pathology reports were obtained from PALGA, the Dutch Pathology Registry, and assessed for presence of DCIS. Response of DCIS was defined as absence of DCIS in postoperative pathology when a DCIS component was present in the pre-NST biopsy. Clinicopathological factors associated with DCIS response were assessed using logistic regression analyses. Results In total, 5834 patients were included, of whom 1443 (24.7%) had a DCIS component in the pre-NST biopsy. Mastectomy rates were higher in IBC with adjacent DCIS compared to IBC without adjacent DCIS in the pre-NST biopsy (53.6% versus 41.0%, p< 0.001). Of these 1443 patients, 743 (51.5%) showed complete response of the DCIS component. Complete response of DCIS occurred more frequently in patients who also had a complete response of IBC (63.4% versus 33.8%, p< 0.001). Multivariable logistic regression analysis showed ER negative IBC (OR 1.79; 95% CI 1.33-2.42) and treatment with HER2-targeted therapy (OR 5.97; 95% CI 1.82-19.55) to be independently associated with complete response of DCIS. Conclusion More than half of HER2-positive IBC patients with adjacent DCIS in the pre-NST biopsy showed a complete response of the DCIS component to NST. Complete response of DCIS should be considered, especially in ER-negative HER2-positive IBC and in case of complete response of IBC. Future studies should investigate the evaluation of DCIS response by imaging and the possibility of increasing breast-conserving surgery rates. Citation Format: Roxanne Ploumen, Eva Claassens, Loes Kooreman, Kristien Keymeulen, Maartje van Kats, Suzanne Gommers, Sabine Siesling, Thiemo van Nijnatten, Marjolein Smidt. Complete response of ductal carcinoma in situ to neoadjuvant systemic therapy in HER2-positive invasive breast cancer patients: a nationwide analysis [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P4-06-02.
Purpose Ductal carcinoma in situ (DCIS) is present in more than half of HER2-positive invasive breast cancer (IBC). Recent studies show that DCIS accompanying HER2-positive IBC can be completely eradicated by neoadjuvant systemic therapy (NST). Our aim was to determine the percentage of pathologic complete response of the DCIS component in a nationwide cohort and to assess associated clinicopathologic variables. Furthermore, the impact on surgical treatment after NST was investigated. Methods Women diagnosed with HER2-positive IBC, treated with NST and surgery, between 2010-2020, were selected from the Netherlands Cancer Registry. Pre-NST biopsy and postoperative specimen pathology reports were obtained from the Dutch Nationwide Pathology Databank, and assessed for presence of DCIS. Clinicopathologic factors associated with DCIS response were assessed using logistic regression analyses. Results A DCIS component was present in the pre-NST biopsy in 1443 of the 5834 included patients (24.7%). Pathologic complete response of the DCIS component was achieved in 743 (51.5%) of these patients. Complete response of DCIS occurred more frequently in case of complete response of IBC (63.4% versus 33.8%, p<0.001). ER-negative IBC (OR 1.79; 95%CI 1.33-2.42) and treatment with HER2-targeted therapy (OR 5.97; 95%CI 1.82-19.55) were associated with complete response of DCIS. Mastectomy rates were higher in IBC+DCIS compared to IBC (53.6% versus 41.0%, p<0.001). Conclusion Pathologic complete response of DCIS occurred in 51.5% of HER2-positive IBC patients and was associated with ER-negative IBC and complete response of IBC. Future studies should investigate imaging evaluation of DCIS response to improve surgical decision making.
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