Symmetrization reduction mammaplasty combined with sentinel node biopsy in patients operated for contralateral breast cancer

Schrenk, Peter; Wölfl, S; Bogner, S; Huemer, Georg M.; Wayand, W.

doi:10.1002/jso.20542

Cited by 17 publications

(8 citation statements)

References 43 publications

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“…Of these studies, the data of 1 study 16 were updated by McLaughlin and colleagues 17 in 2008, and 1 study 18 was prospective, leaving 6 studies for inclusion in our analysis. The data were extracted from these 6 studies 17,[19][20][21][22][23] (Fig. 1).…”

Section: Resultsmentioning

confidence: 99%

“…In the trial by Wilke and colleagues, 29 8.6% of patients had axillary paresthesias, 3.8% had a decreased upper extremity range of motion and 6.9% demonstrated proximal upper extremity lymphedema at 6 months. Other complications related to SLNB at the time of prophylactic mastectomy, such as axillary seroma, 20 blue hives and axillary hematomas, 19 have been reported. Considering that most patients will be exposed to the risk of complications of SLNB and few patients will benefit from the procedure being performed at the time of prophylactic mastectomy, we conclude that performing SLNB at this time may not be suitable for all patients.…”

Section: Discussionmentioning

confidence: 99%

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Meta-analysis of sentinel lymph node biopsy at the time of prophylactic mastectomy of the breast

Zhou

Dai

et al. 2011

Can J Surg

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Background: Prophylactic mastectomy is performed to decrease the risk of breast cancer in women at high risk for the disease. The benefit of sentinel lymph node biopsy (SLNB) at the time of prophylactic mastectomy is controversial, and we performed a meta-analysis of the reported data to assess that benefit. Methods:We searched MEDLINE, EMBASE and the Cochrane Library databases from January 1993 to December 2009 for studies on patients who underwent SLNB at the time of prophylactic mastectomy. Two reviewers independently evaluated all the identified papers, and only retrospective studies were included. We used a mixedeffect model to combine data. Results:We included 6 studies in this review, comprising a total study population of 1251 patients who underwent 1343 prophylactic mastectomies. Of these 1343 pooled prophylactic mastectomies, the rate of occult invasive cancer (21 cases) was 1.7% (95% confidence interval [CI] 1.1%-2.5%), and the rate of positive SLNs (23 cases) was 1.9% (95% CI 1.2%-2.6%). In all, 36 cases (2.8%, 95% CI 2.0%-3.8%) led to a significant change in surgical management as a result of SLNB at the time of prophylactic mastectomy. In 17 cases, patients with negative SLNs were found to have invasive cancer at the time of prophylactic mastectomy and avoided axillary lymph node dissection (ALND). In 19 cases, patients with positive SLNBs were found not to have invasive cancer at the time of prophylactic mastectomy and needed a subsequent ALND. Of the 23 cases with positive SLNs, about half the patients had locally advanced disease in the contralateral breast. Conclusion:Sentinel lymph node biopsy is not suitable for all patients undergoing prophylactic mastectomy, but it may be suitable for patients with contralateral, locally advanced breast cancer.Contexte : La mastectomie prophylactique vise à réduire le risque de cancer du sein chez les femmes à risque élevé. L'avantage de la biopsie du ganglion lymphatique sentinelle (BGLS) au moment de la mastectomie prophylactique suscite la controverse et nous avons procédé à une méta-analyse des données qui ont fait l'objet de rapports afin d'évaluer l'avantage en question. Méthodes :Nous avons cherché dans les bases de données MEDLINE, EMBASE et la Bibliothèque Cochrane, de janvier 1993 à décembre 2009, des études portant sur des patientes qui ont subi une BGLS au moment de la mastectomie prophylactique. Deux examinateurs ont évalué indépendamment toutes les études repérées et nous avons inclus seulement les études rétrospectives. Nous avons utilisé un modèle à effets mixtes pour combiner les données.Résultats : Nous avons inclus dans cette analyse 6 études regroupant une population totale de 1251 patientes qui ont subi 1343 mastectomies prophylactiques. Parmi ces 1343 mastectomies prophylactiques regroupées, le taux de cancer envahissant occulte (21 cas) s'est établi à 1,7 % (intervalle de confiance [IC] à 95 %, 1,1 %-2,5 %) et le taux de GLS positifs (23 cas) a atteint 1,9 % (IC à 95 %, 1,2 %-2,6 %). Au total, les constatations dans 36 cas (2,8 %, IC ...

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Meta-analysis of sentinel lymph node biopsy at the time of prophylactic mastectomy of the breast

Zhou

Dai

et al. 2011

Can J Surg

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“…16 Associated complications have become more apparent as experience with SLND has increased. These complications have been quantified in recent prospective studies.…”

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confidence: 99%

Decision analysis to assess the efficacy of routine sentinel lymphadenectomy in patients undergoing prophylactic mastectomy

Boughey

Cormier

Xing

et al. 2007

Cancer

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The polyimide HFPE‐II‐52 was developed at NASA Glenn Research Center for use as a matrix in high temperature composite materials. The unique properties of such composites stem largely from the performance of the matrix at high temperature. Thus, as part of a larger effort to study high temperature composite materials, the linear viscoelastic properties of HFPE are measured and a mathematical model of the properties is developed. In particular, storage, loss, and stress relaxation moduli were obtained from cyclic and transient loading experiments. A Prony series was fit to the relaxation modulus data. As a cross check, the fit to the relaxation modulus was converted to storage and loss moduli and compared with those measured directly. Effects of postcuring and of moisture on the properties are investigated as well. These results provide researchers with a constitutive model for HFPE‐II‐52 and provide some insight into the performance of HFPE matrix composites at high temperatures. © 2006 Wiley Periodicals, Inc. J Appl Polym Sci 100: 3255–3263, 2006

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“…As part of a study [20] we routinely perform sentinel node biopsy in case a reduction mammaplasty is done to the contralateral breast for symmetrization. This approach spares patients with occult cancers in the contralateral (non tumor) breast a secondary axillary lymph node dissection for sentinel node biopsy may no longer be feasible in these patients due to disrupted lymphatics or is associated with low identification rates.…”

Section: Discussionmentioning

confidence: 99%

“…This approach spared all patients with occult cancers in the contralateral (non tumor) breast a secondary axillary lymph node dissection or sentinel node biopsy [20].…”

Section: Detection Of Occult Cancermentioning

confidence: 99%

Tumor quadrantectomy combined with reduction mammaplasty for the treatment of breast cancer

Schrenk¹,

Huemer²,

Sir³

et al. 2006

Eur Surg

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Brusterhaltende Operationen im Rahmen einer Reduktionsplastik zur chirurgischen Therapie des Mammakarzinoms Zusammenfassung. Grundlagen: Der Einsatz von Reduktionstechniken im Rahmen der brusterhaltenden Therapie des Mammakarzinoms kann bei ungünstiger Brustgröße/Tumorrelation die Rate an brusterhaltenden Operationen erhöhen und gleichzeitig das kosmetische Ergebnis verbessern. Methodik: 121 Patientinnen mit 125 Karzinomen (114 invasive Karzinome, 11 DCIS) wurden brusterhaltend im Rahmen einer Reduktionsplastik operiert. Ergebnisse: Die Eingriffe wurden einseitig (n = 4/121) oder beidseits (n = 117/121) durchgeführt. In 3/125 der Tumorresektate fanden sich kein freier Tumorrand (alle DCIS), bei 2/125 ein multizentrisches Tumorgeschehen, die eine sekundäre Mastektomie mit Sofortrekonstruktion nötig machten. Bei 4/117 Patientinnen fand die endgültige histologische Aufarbeitung ein okkultes kontralaterales invasives Karzinom. Nach einer medianen Nachbeobachtungszeit von 32 Monaten (11-106 Monate) fand sich kein lokales oder axilläres Rezidiv, 3 mal eine systemische Metastasierung. 97/121 Patientinnen (80 %) beurteilten ihr kosmetisches Ergebnis als ausgezeichnet, 24/121 (20 %) als gut. Schlussfolgerungen: Onkologische Reduktionstechniken zeigen ein den alleinigen Quadrantektomien vergleichbares onkologisches Ergebnis, jedoch mit einem besseren kosmetischen Ergebnis. Schlüsselwörter: Mammakarzinom, Reduktionsplastik, onkoplastische Chirurgie, brusterhaltende Chirurgie.Summary. Background: Tumor quadrantectomy combined with reduction mammaplasty allows resection of breast cancer with wider free margins and an improved cosmetic result.Methods: 121 women with 125 breast cancers (114 invasive cancers, 11 high grade DCIS) underwent tumor quadrantectomy combined with a reduction mammaplasty. The oncological and cosmetic outcome is evaluated.Results: Reduction mammaplasties were performed unilaterally (n = 4/121) or bilaterally (n = 117/121). Mean free surgical margins were 11.8 mm in patients with invasive cancer and 18.6 mm in patients with high grade DCIS. 3 of 125 resection specimen revealed positive margins (all were DCIS), in 2 of 125 specimens multicentric invasive cancer was found and the 5 patients underwent secondary mastectomy with immediate reconstruction. In 4 of 117 patients an occult invasive cancer was found in the histological specimen of the contralateral breast. After a median follow-up of 32 months (range 11-106 months) there were no local recurrences in the breast or axilla, three patients developed distant metastases. The postoperative cosmetic result evaluated by the patients was rated as excellent in 97 of 121 patients (80%) and good in 24 of 121 patients (20%) with no poor result.Conclusions: Tumor quadrantectomy combined with reduction mammaplasty allows wide tumor resection with adequate cosmetic result.

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Symmetrization reduction mammaplasty combined with sentinel node biopsy in patients operated for contralateral breast cancer

Abstract: The small number of patients with occult contralateral cancers may not warrant routine SN mapping in patients scheduled for contralateral reduction mammaplasty.

Cited by 17 publications

References 43 publications

Meta-analysis of sentinel lymph node biopsy at the time of prophylactic mastectomy of the breast

Meta-analysis of sentinel lymph node biopsy at the time of prophylactic mastectomy of the breast

Decision analysis to assess the efficacy of routine sentinel lymphadenectomy in patients undergoing prophylactic mastectomy

Tumor quadrantectomy combined with reduction mammaplasty for the treatment of breast cancer

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