Mastectomy with immediate breast reconstruction: Results of a mono-centric 4-years cohort

Quilichini, Olivia; Barrou, Julien; Bannier, Marie; Rua, Sandrine; Troy, Aurore Van; Sabiani, Laura; Lambaudie, Éric; Cohen, Monique; Houvenaeghel, Gilles

doi:10.1016/j.amsu.2020.12.033

Cited by 7 publications

(8 citation statements)

References 70 publications

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“…Studies have reported that BMI is one of the risk factors (Table 5 ) for nipple and areola necrosis [ 38 ]. BMI is an index of obesity and is highly correlated with breast mastectomy specimen weight.…”

Section: Discussionmentioning

confidence: 99%

Nipple-areolar complex (NAC) or skin flap ischemia necrosis post nipple-sparing mastectomy (NSM)—analysis of clinicopathologic factors and breast magnetic resonance imaging (MRI) features

et al. 2023

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Background The purpose of this study is to identify clinicopathologic factors and/or preoperative MRI vascular patterns in the prediction of ischemia necrosis of the nipple-areola complex (NAC) or skin flap post nipple-sparing mastectomy (NSM). Methods We performed a retrospective analysis of 441 NSM procedures from January 2011 to September 2021 from the breast cancer database at our institution. The ischemia necrosis of NAC or skin flap was evaluated in correlation with clinicopathologic factors and types of skin incision. Patients who received NSM with preoperative MRI evaluation were further evaluated for the relationship between vascular pattern and the impact on ischemia necrosis of NAC or skin flap. Results A total of 441 cases with NSM were enrolled in the current study, and the mean age of the cases was 49.1 ± 9.8 years old. A total of 41 (9.3%) NSM procedures were found to have NAC ischemia/necrosis. Risk factors were evaluated of which old age, large mastectomy specimen weight (> 450 g), and peri-areola incision were identified as predictors of NAC necrosis. Two-hundred seventy NSM procedures also received preoperative MRI, and the blood supply pattern was 18% single-vessel type and 82% double-vessel pattern. There were no correlations between MRI blood supply patterns or types of skin flap incisions with ischemia necrosis of NAC. There were also no correlations between blood loss and the pattern or size of the blood vessel. Conclusion Factors such as the type of skin incision, age, and size of mastectomy weight played an important role in determining ischemia necrosis of NAC; however, MRI vascular (single or dual vessel supply) pattern was not a significant predictive factor.

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Section: Discussionmentioning

confidence: 99%

Nipple-areolar complex (NAC) or skin flap ischemia necrosis post nipple-sparing mastectomy (NSM)—analysis of clinicopathologic factors and breast magnetic resonance imaging (MRI) features

et al. 2023

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“…Most surgical literature strongly supports the negative association of long-term preoperative smoking and increased complications rates in both gastrointestinal (GI) and non-GI surgery [5][6][7][8][9][10][11][12][13]. These studies are consistent in demonstrating higher rates of post-operative morbidity such as wound infections, pulmonary complications and increased anastomotic leaks (ALs).…”

Section: Introductionmentioning

confidence: 90%

Impact of preoperative smoking on patients undergoing right hemicolectomies for colon cancer

Badiani

Diab

Woodford

et al. 2022

Langenbecks Arch Surg

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Purpose The tobacco epidemic is one of the biggest global public health issues impacting quality of life and surgical outcomes. Although 30% of colon cancers warrant a right hemicolectomy (RH), there is no specific data on the influence of smoking on postoperative complications following RH for cancer. The aim of this study was to determine its effect on post-surgical outcomes. Methods Patients who underwent elective RH for colon cancer between 2016 and 2019 were identified from the ACS-NSQIP database. Propensity score matching (PSM) was used with a maximum absolute difference of 0.05 between propensity scores. Primary outcome was to assess the 30-day complication risk profile between smokers and non-smokers. Secondary outcomes included smoking impact on wound and major medico-surgical complication rates, as well as risk of anastomotic leak (AL) using multivariable logistic regression models. Results Following PSM, 5652 patients underwent RH for colon cancer with 1,884 (33.3%) identified as smokers. Smokers demonstrated a higher rate of organ space infection (4.1% vs 3.1%, p = 0.034), unplanned return to theatre (4.8% vs 3.7%, p = 0.045) and risk of AL (3.5% vs 2.1%, p = 0.005). Smoking was found to be an independent risk factor for wound complications (OR 1.32, 95% CI 1.03–1.71, p = 0.032), primary pulmonary complications (OR 1.50, 95% CI 1.06–2.13, p = 0.024) and AL (OR 1.66, 95% CI 1.19–2.31, p = 0.003). Conclusion Smokers have increased risk of developing major post-operative complications compared to non-smokers. Clinicians and surgeons must inform smokers of these surgical risks and potential benefit of smoking cessation prior to undergoing major colonic resection.

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“…This choice may also have evolved with the increased possibilities and proposals for immediate reconstruction. However, patients must be informed of the aesthetic limitations of immediate or delayed reconstruction [ 39 ], postoperative complications [ 40 ], and of the risks of altering the aesthetic results in the event of post-mastectomy radiotherapy. As expected, pCR rates following NAC were significantly different according to tumor subtypes, being higher in HER2+ and triple-negative BC.…”

Section: Discussionmentioning

confidence: 99%

Neoadjuvant Chemotherapy for Breast Cancer: Evolution of Clinical Practice in a French Cancer Center Over 16 Years and Pathologic Response Rates According to Tumor Subtypes and Clinical Tumor Size: Retrospective Cohort Study

Houvenaeghel¹,

Nonneville²,

Cohen³

et al. 2022

J Surg Res

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We examined characteristics trends in early breast cancer patients receiving neoadjuvant chemotherapy (NAC) over a 16-year period. Our primary objective was to analyze variations in tumor stage and subtype over time. Secondary objectives included analyses of type of surgery and pathological response, from January 2005 to May 2021, 1623 patients receiving NAC were identified. Three periods were determined: 2005-2009 (P1), 2010-2014 (P2), 2015-2021 (P3). Correlations between periods and patient features with cT stage, pathological breast and axillary node response, pathological complete response (pCR), and type of surgery were assessed in univariate and multivariate analyses. We observed a significant increase in cT0-1 and N0 stages with periods (from 6.8% at P1 to 21.2% at P3, and from 43.2% at P1 to 55.9% at P3, respectively) and in the proportion of HER2+ and triple negative (TN) subtypes. In a multivariate analysis, a decrease of cT2-3-4 tumors during P3 was observed for HER2+ (OR:0.174; p=0.004) and TN tumors (OR:0.287; p=0.042). In-breast pCR and pCR were observed in 40.8% and 34.4% of all patients, respectively, with strong association with tumor subtypes, but not with tumor size in multivariate analysis (37.0% pCR for cT0-1 tumors, 36.4% for cT2 tumors, 29.1% for cT3 tumors (cT0-1 versus cT≥2; p=0.222)). pCR was negatively associated with cN1 stage (OR:1.499; p<0.001 for cN1 patients compared to cN0). We observed an increase in the proportion of small cT0-1 and N0 stages treated with NAC, especially in HER2+ and TN subtypes. No significant impact of tumor size on pCR rates was found.

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Mastectomy with immediate breast reconstruction: Results of a mono-centric 4-years cohort

Cited by 7 publications

References 70 publications

Nipple-areolar complex (NAC) or skin flap ischemia necrosis post nipple-sparing mastectomy (NSM)—analysis of clinicopathologic factors and breast magnetic resonance imaging (MRI) features

Nipple-areolar complex (NAC) or skin flap ischemia necrosis post nipple-sparing mastectomy (NSM)—analysis of clinicopathologic factors and breast magnetic resonance imaging (MRI) features

Impact of preoperative smoking on patients undergoing right hemicolectomies for colon cancer

Neoadjuvant Chemotherapy for Breast Cancer: Evolution of Clinical Practice in a French Cancer Center Over 16 Years and Pathologic Response Rates According to Tumor Subtypes and Clinical Tumor Size: Retrospective Cohort Study

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