Single Versus Dual Surgeon Approaches to Oncoplastic Surgery: A Comparison of Outcomes

Karamchandani, Manish; Cruz-Ku, Gabriel De la; Gaffney, Kerry; Wareham, Carly; Persing, Sarah; Homsy, Christopher; Nardello, Salvatore; Chatterjee, Abhishek

doi:10.1016/j.jss.2022.11.067

Cited by 6 publications

(11 citation statements)

References 24 publications

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“…Past studies, however, have demonstrated the oncologic safety of oncoplastic surgery. 12,35 In conclusion, this study adds to the growing body of evidence supporting the safety and efficacy of oncoplastic breast surgery.…”

Section: Discussionmentioning

confidence: 74%

“…Lastly, the NSQIP database did not have cancer‐specific data about oncological outcomes, such as disease‐free, breast cancer‐specific survival, and overall survival. Past studies, however, have demonstrated the oncologic safety of oncoplastic surgery 12,35 …”

Section: Discussionmentioning

confidence: 99%

“…Oncoplastic surgery is a form of breast‐conserving surgery that involves a large partial mastectomy and immediate reconstruction, allowing for improved cosmesis and patient satisfaction, with equivalent oncologic outcomes 6–9 . Oncoplastic surgery is increasing in prevalence as a breast cancer surgery option in the United States 10,11 and its safety has been well documented 12–14 . In general, a higher BMI has been associated with a higher risk of complications in breast cancer operations involving major tissue dissection and reconstruction 15–17 .…”

Section: Introductionmentioning

confidence: 99%

“…[6][7][8][9] Oncoplastic surgery is increasing in prevalence as a breast cancer surgery option in the United States 10,11 and its safety has been well documented. [12][13][14] In general, a higher BMI has been associated with a higher risk of complications in breast cancer operations involving major tissue dissection and reconstruction. [15][16][17] Hence, with a steady rise in both breast cancer and the prevalence of obesity, we sought to evaluate the complication rates in oncoplastic surgery.…”

Section: Introductionmentioning

confidence: 99%

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The impact of body mass index on oncoplastic breast surgery: A multicenter analysis

De La Cruz Ku,

Camarlinghi,

Mallouh

et al. 2023

Journal of Surgical Oncology

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BackgroundObesity has nearly tripled in the last 50 years. During the last decades, oncoplastic breast surgery has become an important choice in the surgical treatment of breast cancer. An association exists between higher body mass index (BMI) and wound complications for major operations, but there is scarce literature on oncoplastic surgery. Hence, our aim was to compare the complication rates among patients who underwent oncoplastic surgery, stratified by BMI.MethodsPatient data were analyzed from the National Surgical Quality Improvement Program database (NSQIP) for oncoplastic breast procedures (2005–2020). Patients were stratified according to World Health Organization obesity classifications. Multivariate logistic regression was performed to assess risk factors for complications (overall, operative, and wound‐related).ResultsFrom a total of 6887 patients who underwent oncoplastic surgery, 4229 patients were nonobese, 1380 had Class 1 obesity (BMI: 30 to <35 kg/m2), 737 Class 2 obesity (BMI: 35 to <40 kg/m2), and 541 Class 3 obesity (BMI: ≥ 40 kg/m2). Greater operative time was found according to higher BMI (p < 0.001). Multivariate analysis adjusted for baseline characteristics showed that patients with obesity Class 2 (odds ratio [OR] = 1.51, 95% confidence interval [CI]: 1.03–2.23, p = 0.037) and 3 (OR = 1.87, 95% CI 1.24–2.83, p = 0.003) had increased risk of overall and wound complications compared with Nonobese patients. Comparing obese with nonobese patients, there were no differences in rates of deep SSI, organ/space SSI, pneumonia, reintubation, pulmonary embolism, deep vein thrombosis, urinary tract infection, stroke, bleeding, postoperative sepsis, length of stay, and readmission.ConclusionsOncoplastic surgery is a safe procedure for most patients. However, caution should be exercised when performing oncoplastic surgery for patients with Class 2 or 3 obesity (BMI ≥ 35 kg/m2), given there was a higher rate of overall and wound‐specific complications, compared with patients who were not obese or had Class 1 obesity.

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Section: Discussionmentioning

confidence: 74%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

The impact of body mass index on oncoplastic breast surgery: A multicenter analysis

De La Cruz Ku,

Camarlinghi,

Mallouh

et al. 2023

Journal of Surgical Oncology

Self Cite

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show abstract

“…A third indication for volume replacement would involve breast cancer patients who have any grade of ptosis with moderate to large breasts whom prefer unilateral surgery. These are patients who are satisfied with their breast form, have no macromastia symptoms but do not want the aesthetic defect that a partial mastectomy alone may create ( 12 ) or want the benefit of a lower positive margin rate that oncoplastic surgery provides over partial mastectomy alone ( 17 , 21 , 22 ). As such, a LICAP or AICAP regional flap affords the patient an ipsilateral oncoplastic reconstruction without operating on the contralateral breast that a level II volume displacement reduction design would require, especially in patients with larger/ptotic breasts.…”

Section: Volume Replacementmentioning

confidence: 99%

Practical oncoplastic surgery techniques needed for practice

Nardello,

Bloom,

Gaffney

et al. 2023

Ann Transl Med

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Oncoplastic breast surgery (OPS) is a form of breast conservation surgery that includes immediate breast reconstruction. OPS has previously been shown to be a safe and effective treatment for breast cancer. In a special series on Breast Reconstruction, we aimed to describe oncoplastic breast reconstruction options and the corresponding technical details. Sections were divided by descriptions of OPS specific preoperative workup, volume displacement techniques, volume replacement techniques, and postoperative considerations. In addition, to sharing expert surgical pearls gained through performing OPS procedures over the years. Innovations in breast reconstruction offer women treatment options that are both oncologically safe and aesthetically preferred. The rise in reconstructive procedures is changing how patients make decisions based on their diagnosis. The ultimate surgical decision should be determined by the patient’s anatomy, patient’s personal preferences, tumor characteristics, and clinical presentation in a shared decision-making fashion with a multidisciplinary team. However, with both volume displacement and volume replacement techniques, women of all breast sizes can achieve an aesthetic outcome without sacrificing oncologic resection.

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Local practice variations and payer differences underlie state‐wide disparities in oncoplastic breast surgery

Yang,

Hyland,

Miller

et al. 2024

Journal of Surgical Oncology

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BackgroundLittle is known about disparities in oncoplastic breast surgery delivery.MethodsThe Massachusetts All‐Payer Claims Database was queried for patients who received lumpectomy for a diagnosis of breast cancer. Oncoplastic surgery was defined as adjacent tissue transfer, complex trunk repair, reduction mammoplasty, mastopexy, flap‐based reconstruction, prosthesis insertion, or unspecified breast reconstruction after lumpectomy.ResultsWe identified 18 748 patients who underwent lumpectomy between 2016 and 2020. Among those, 3140 patients underwent immediate oncoplastic surgery and 436 patients underwent delayed oncoplastic surgery. Eighty‐one percent of patients who underwent oncoplastic surgery did so in the same county as they underwent a lumpectomy. However, the relative frequency of oncoplastic surgery varied significantly among counties. In multivariable regression, public insurance status (odds ratio: 0.87, 95% confidence interval: 0.80–0.95, p = 0.002) was associated with lower odds of undergoing oncoplastic surgery, even after adjusting for macromastia, other comorbidities, and county of lumpectomy. Average payments for lumpectomy with oncoplastic surgery were more than twice as high from private insurers ($840 vs. $1942, p < 0.001).ConclusionDisparities in the receipt of oncoplastic surgery were related to differences in local practice patterns and the type of insurance patients held. Expanding services across counties and considering billing reform may help reduce these disparities.

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Single Versus Dual Surgeon Approaches to Oncoplastic Surgery: A Comparison of Outcomes

Cited by 6 publications

References 24 publications

The impact of body mass index on oncoplastic breast surgery: A multicenter analysis

The impact of body mass index on oncoplastic breast surgery: A multicenter analysis

Practical oncoplastic surgery techniques needed for practice

Local practice variations and payer differences underlie state‐wide disparities in oncoplastic breast surgery

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