Breast Conservation Surgery: State of the Art

White, Jonathan; Achuthan, Raj; Turton, Philip; Lansdown, Mark

doi:10.4061/2011/107981

Cited by 17 publications

(12 citation statements)

References 77 publications

(79 reference statements)

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“…This finding supports the approach to offer contralateral surgery in the primary setting only in selected cases, and otherwise as a secondary procedure after individual assessment. Since PRT can cause unpredictable changes to the breast [17, 18], it might be better to wait until the 1-year follow-up visit to see if contralateral surgery is needed. Achieving a better long-term symmetrical appearance when the “template,” in form of the cancer-treated breast, has reached its final outcome could be easier than trying to predict the change over time and compensate for this in the primary setting.…”

Section: Discussionmentioning

confidence: 99%

“…After operation with a volume displacement technique, a slight asymmetry can be expected regarding size and ptosis of the breast, although the shape of the breast and centralization of the nipple is preserved [13]. As symmetry is presented to be of great importance for patient satisfaction [14, 17, 21], many breast centers also operate on the contralateral breast in the primary setting to ensure postoperative symmetry. However, there are no firm guidelines specifying in which cases contralateral surgery should be performed, and a recent interview study showed that patients accept a slight asymmetry due to concerns regarding risks with surgery and the will to preserve the untouched contralateral, healthy breast [22].…”

Section: Introductionmentioning

confidence: 99%

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Patient satisfaction after unilateral oncoplastic volume displacement surgery for breast cancer, evaluated with the BREAST-Q™

2019

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Background Oncoplastic breast-conserving surgery allows larger resections in unfavorable locations, with an improved chance of preserving esthetics. Indications and timing for potential contralateral surgery to obtain symmetry are not clear. The aim of this study was to evaluate patient satisfaction after unilateral oncoplastic volume displacement surgery, to investigate potential risk factors for lower patient satisfaction and to assess patient wish for contralateral surgery. Method A cohort of 144 women, consecutively treated for breast cancer with unilateral breast-conserving oncoplastic volume displacement surgery, followed by radiotherapy and with an unoperated contralateral breast, was sent the BREAST-Q™ breast-conserving therapy (BCT) and a study-specific questionnaire. In all, 120 women (83%) responded. For these women, the median value for resected specimen weight was 92 g (range 14–345) and for the estimated percentage of the breast volume excised 15% (range 3–35%). Results The median patient-reported score for “Satisfaction with breast” (BREAST-Q™ BCT) was 74/100. Factors associated with a score below median value in a simple logistic regression model adjusted for age and BMI were axillary clearance (OR 2.46, 95% CI 1.09–5.56), neoadjuvant chemotherapy (OR 3.26, 95% CI 1.15–9.24), and low breast density (OR 2.32 95% CI 1.02–5.29). Thirteen women (11%) were interested in contralateral surgery. Conclusion Most patients in this study cohort, who had undergone breast-conserving therapy with oncoplastic volume displacement techniques, were satisfied with their breasts without surgery to the contralateral breast. This indicates that contralateral surgery to achieve symmetry only should be performed after individual evaluation and as a delayed procedure.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Patient satisfaction after unilateral oncoplastic volume displacement surgery for breast cancer, evaluated with the BREAST-Q™

2019

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“…Differently from volume displacement techniques, symmetrization of the contralateral breast is usually not required in cases of volume replacement techniques. 6 , 12 , 13 Standardized algorithms are not available, but many articles have been published in the attempt to provide a guide to help oncoplastic breast surgeons decide the best surgical procedure to apply to each single case. In a recent review, 9 the indication for either volume displacement or volume replacement techniques was essentially based on the expected percentage of breast volume excised: up to 10%, the result is considered satisfactory using simple wide local excisions, in cases between 10% and 20% of breast volume loss the use of volume displacement techniques should be favored, finally, for resections above 20% more complex approaches using tissue transfer and volume replacement are indicated.…”

Section: Discussionmentioning

confidence: 99%

“…The 2 different approaches (volume displacement and volume replacement) are differently indicated depending on tumor size, location, and breast characteristics. 6 , 12 , 13 On the one hand, volume displacement applies different surgical techniques to reshape the breast and to correct the defect created during lumpectomy or quadrantectomy with dermo-glandular flaps of breast tissue; on the other hand, volume replacement procedures employ autologous reconstruction techniques like the use of local flaps where volume is missing. Volume replacement procedures have evolved over time from the use of the entire latissimus dorsi (LD) muscle to the use of pedicled perforator flaps available in the thoracic region such as the thoracodorsal artery perforator (TDAP) flap, the intercostal artery perforator flaps, the lateral thoracic artery perforator flap, and the serratus anterior artery perforator flap.…”

Section: Introductionmentioning

confidence: 99%

Thoracodorsal Artery Perforator Flap in Partial Breast Reconstruction: A Systematic Review

Mangialardi

Baldelli

Salgarello

et al. 2020

Plastic and Reconstructive Surgery - Global Open

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Introduction: Breast conserving surgery followed by radiation therapy represents the standard of care for early stage breast cancer. Oncoplastic breast surgery includes several reconstructive techniques essentially summarized in 2 categories: volume displacement and volume replacement procedures. These latest procedures have evolved over time from the use of the entire latissimus dorsi muscle to the use of pedicled perforator flaps, namely the thoracodorsal artery perforator (TDAP) flap. The aim of this article is to provide a comprehensive review of the literature regarding the use of the TDAP flap in partial breast defects. Methods: A literature search was performed via PubMed, Medline, and Cochrane. Studies reporting the use of the TDAP flap after breast conserving surgery were included. Patient characteristics, topography and size of breast defect, flap size and design, number of perforators, and operative time were analyzed. Moreover, aesthetic and functional (shoulder morbidity) results, patient satisfaction, postoperative complications, and donor site morbidity were registered. Results: Twelve articles fulfilled inclusion criteria, and 337 patients were included. All articles except 1 described the use of the TDAP flap for defects in every breast quadrant. The mean weight of resected breast tissue was 97.28 g, and patients with over 20% of volume deficiency were considered eligible for TDAP flap volume replacement. The ellipse-shaped skin paddle (oriented oblique downward, transversal or oblique upward in most cases) was extended over the anterior border of the latissimus dorsi muscle to include possible septocutaneous perforator vessels. Most authors began the dissection from the anterior and caudal border of the flap to reserve the possibility to convert the TDAP to a musculocutaneous flap and check for septocutaneous perforators. Flap size ranged from 4 × 12 to 21 × 9 cm. The mean procedure time was 192.21 minutes. Mean follow-up was 17.42 months. Evaluation by way of a 5-point Likert scale reported overall mean values of over 4 points. Satisfactory outcomes were reported in 92.85%–100% of cases. Patient satisfaction ranged from 80% to 94% of cases. The incidence of seroma (1 case) and “shoulder-related” donor site morbidity was very low. Conclusions: Despite the heterogeneity of the evaluation methods, our review suggested that the use of the TDAP flap in oncoplastic surgery allows for satisfactory aesthetic outcomes and quite high levels of patient satisfaction. The TDAP flap represents an effective and versatile tool that amplifies the oncoplastic surgeon’s arsenal, which allows for satisfactory outcomes.

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“…However, studies in the 1970s showed that radical mastectomy has no benefit over less aggressive surgeries in terms of either disease recurrence or overall survival [11,13]. Later, less aggressive breast conservation surgery became more common for local therapy combined with a wide variety of systemic adjuvant therapies [14]. Adjuvant therapies given systemically are aimed at eradicating disseminated cancer cells in order to minimize the probability of metastatic growth [15].…”

Section: Current Therapiesmentioning

confidence: 99%

Viroimmunotherapy for breast cancer: promises, problems and future directions

Chaurasiya

Fong

2020

Cancer Gene Ther

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Virotherapy, a strategy to use live viruses as therapeutics, is a relatively novel field in the treatment of cancer. With the advancements in molecular biology and virology, there has been a huge increase in research on cancer virotherapy. For the treatment of cancer, viruses could be used either as vectors in gene therapy or as oncolytic agents. A variety of viruses have been studied for their potential usage in gene therapy or oncolytic therapy. In this review, we discuss virotherapy with a special focus on breast cancer. Breast cancer is the most common cancer and the leading cause of cancer-related deaths in women worldwide. Current treatments are insufficient to cure metastatic breast cancer and are often associated with severe side effects that further deteriorates patients' quality of life. Therefore, novel therapeutic approaches such as virotherapy need to be developed for the treatment of breast cancer. Here we summarize the current treatments for breast cancer and the potential use of virotherapy in the treatment of the disease. Furthermore, we discuss the use of oncolytic viruses as immunotherapeutics and the rational combination of oncolytic viruses with other therapeutics for optimal treatment of breast cancer. Finally, we outline the progress made in virotherapy for breast cancer and the shortcomings that need to be addressed for this novel therapy to move to the clinic for better treatment of breast cancer.

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Breast Conservation Surgery: State of the Art

Cited by 17 publications

References 77 publications

Patient satisfaction after unilateral oncoplastic volume displacement surgery for breast cancer, evaluated with the BREAST-Q™

Patient satisfaction after unilateral oncoplastic volume displacement surgery for breast cancer, evaluated with the BREAST-Q™

Thoracodorsal Artery Perforator Flap in Partial Breast Reconstruction: A Systematic Review

Viroimmunotherapy for breast cancer: promises, problems and future directions

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