Integration of Breast Reconstruction and Postmastectomy Radiotherapy

Shumway, Dean A.; Momoh, Adeyiza O.; Sabel, Michael S.; Jagsi, Reshma

doi:10.1200/jco.19.02850

Cited by 31 publications

(26 citation statements)

References 98 publications

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“…Eighty per cent of patients received 4 cycles AC and 12 cycles paclitaxel. There was a median time interval between completion of NACT to commencement of NART of 21 days (IQR [18][19][20][21][22][23][24][25][26][27]. Approximately 17% of patients did not complete the full course of NACT.…”

Section: Resultsmentioning

confidence: 99%

“…20 Delayed BR is advocated for by a number of groups to decrease risk of poorer surgical outcomes, particularly with regards to longer-term aesthetic results, [5][6][7] although others have found similar complication rates regardless of reconstruction timing, 18 including Billig et al, with use of autologous abdominally based breast reconstruction (complications with immediate 25.9% vs. delayed 26.9% 9 ). Shumway et al 21 published a review article in May 2020 which outlines factors for consideration regarding timing and selection of reconstruction modality which may help guide clinical decision-making.…”

Section: Discussionmentioning

confidence: 99%

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Neoadjuvant radiotherapy for locally advanced and high‐risk breast cancer

et al. 2021

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Introduction: Neoadjuvant radiotherapy (NART) as part of a multi-modality approach for locally advanced breast cancer (LABC) requires further investigation. Importantly, this approach may allow for a single-staged surgical procedure, with mastectomy and immediate autologous reconstruction. Multiple other potential benefits of NART include improved pathological downstaging of breast disease, reduced overall treatment time, elimination of time period with breast tissue deficit and improved patient satisfaction. Methods: This is a retrospective multi-institutional review of patients with LABC and high-risk breast disease undergoing NART. Eligible patients sequentially underwent neoadjuvant chemotherapy (NACT) with or without HER2-targeted therapy, NART, followed by mastectomy with immediate autologous breast reconstruction (BR) 4-to 6 weeks post-completion of radiotherapy. Patient and tumour characteristics were analysed using descriptive statistics. Surgical complications were assessed using the Clavien-Dindo Classification (Ann Surg 2004; 240: 205). Results: From 3/2013 to 9/2019, 153 patients were treated with NART. The median age was 47 years (IQR 42-52), with median body mass index of 27. Eighteen patients experienced Grade 3 acute surgical complications. This included 13 Grade 3B breast-site events and 9 Grade 3B donor-site events, where further surgical intervention was required for management of wound infection, wound dehiscence, flap or mastectomy skin necrosis, haematoma and internal mammary venous anastomotic thrombosis. No autologous flap loss was observed. Conclusion: Neoadjuvant radiotherapy facilitates a single-stage surgical procedure with mastectomy and immediate autologous BR, eliminating the delay to reconstructive surgery and thus shortening a woman's breast cancer journey. The findings of this review support the use of NART, with comparable rates of surgical complications to standard sequencing.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Neoadjuvant radiotherapy for locally advanced and high‐risk breast cancer

et al. 2021

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“…No animation deformity or displacement of the implant is seen with activity. Target volume should be carefully planned for patients with positive or 'close' margins [36]. Prepectoral implant irradiation has been shown to be safe with similar complication rates as subpectoral implant irradiation [37,38].…”

Section: Radiotherapy After Breast Reconstructionmentioning

confidence: 99%

Oncoplastic and Reconstructive Breast Surgery: A Comprehensive Review

Çıtgez¹,

Yiğit²,

Baş³

2022

Cureus

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Most of the approaches that were valid until recently in breast cancer surgery have undergone significant changes with rising awareness, increasing number of patients, and knowledge. It is important to repair the damage caused by surgical treatment performed in accordance with oncological principles and to obtain good cosmetic results. The quality-of-life indexes increase and body image is positively affected by the development of oncoplastic surgery and reconstruction techniques.The oncoplastic techniques are commonly used for the closure of glandular defects. Surgeons must pay attention to the breast volume, tumor location, the amount of breast tissue that would be removed, and the oncoplastic technique that may be required. Oncoplastic breast surgery allows wide local excision of the mass with good cosmetic results. In addition, a contralateral breast lift, breast augmentation or breast reduction may be required to accommodate the conceptually reconstructed breast. The use of oncoplastic breast surgery techniques results in lower mastectomy rates with equivalent local and long-term survival rates as compared with mastectomy and offers women the option of plastic and reconstructive interventions performed at the time of initial surgery. Mastectomy may be needed for large tumors, as breast-conserving surgery may not be possible or may not produce satisfactory cosmetic results. Breast reconstruction methods after mastectomy include autologous or implant-based breast reconstructions, which can be performed at the same time as the breast cancer surgery (immediate reconstruction) or at a later time (delayed reconstruction).Oncoplastic and reconstructive breast surgery minimizes the impact of breast cancer surgery and yields equivalent survival outcomes without psychological morbidity. With advanced techniques, better breast image than before can also be achieved. In this review, the technical details of oncoplastic breast surgery, surgical margin positivity management, reconstruction methods, radiation therapy given after reconstruction surgery, radiologic imaging modalities, and management of complications are discussed.

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“…A parallel trend has been broadening of the indications for post-mastectomy radiation therapy (PMRT) that is often combined with nodal irradiation for low volume nodal disease [ [3] , [4] , [5] , [6] , [7] , [8] ]. Hence, there is dual consideration of both BR and PMRT for many patients who undergo mastectomy for surgical treatment of breast cancer [ 9 , 10 ]. PMRT increases risk of complications and diminishes aesthetic outcomes and quality of life (QoL) following BR, especially when implant-based [ [11] , [12] , [13] ].…”

Section: Introductionmentioning

confidence: 99%