Ten-year follow-up of skin-sparing mastectomy followed by immediate breast reconstruction

Romics, László; Chew, Ben K.; Weiler-Mithoff, Eva; Doughty, Julie; Brown, Iain; Stallard, Sheila; Wilson, Christopher R.; Mallon, E.; George, W.D.

doi:10.1002/bjs.8704

Cited by 66 publications

(67 citation statements)

References 91 publications

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“…In contrast to mastectomy, IBR has been shown to provide better cosmetic outcome and superior quality of life, without compromising oncological safety (2)(3)(4)(5)(6)(7)(9)(10)(11)(12)(13)(40)(41)(42)(43)(44).…”

Section: Discussionmentioning

confidence: 99%

“…A study conducted by Al-Ghazal et al showed that patients who underwent IBR showed less psychological distress than patients who underwent delayed breast reconstruction (8). Furthermore, studies have shown that IBR is oncologically safe as local recurrence incidence following IBR is comparable to that after mastectomy (5,(9)(10)(11)(12)(13)(14). This led to increasing IBR in the United (16).…”

Section: Introductionmentioning

confidence: 99%

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Factors influencing the decision to pursue immediate breast reconstruction after mastectomy for breast cancer

et al. 2017

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Background: Immediate breast reconstruction (IBR) after mastectomy has shown to be oncologically safe and to improve quality of life in breast cancer patients. However, most women undergoing mastectomy do not undergo IBR. In this study, we aim to identify breast surgeon-related factors in considering IBR and factors affecting patients' decision to choose for IBR.Methods: Retrospective analysis of the records of breast cancer patients who underwent mastectomy with or without IBR between 2010 and 2013. We documented all information whether or not a patient underwent IBR after mastectomy.Results: Of 437 patients, 97 (22.2%) underwent IBR, 89.8% of which received tissue expanders. Patient who did not undergo IBR had a higher age (62.2 versus 51.9 years, P<0.001) and higher body mass index (BMI) (27.0 versus 24.3, P<0.001). Hundred three patients declined IBR, mainly because considering reconstruction as too much trouble. In 128 cases the breast surgeon did not offer IBR, mostly because of the predicted need for post mastectomy radiation. Approximately 11% of the patients were not informed about IBR.Conclusions: Anticipated radiation therapy, higher age and higher BMI were important breast surgeonrelated factors in refraining from IBR. Almost one third of all patients declined IBR. In almost 10% of all patients, IBR was not discussed.Keywords: Breast neoplasms; breast reconstruction; decision making; mammaplasty; mastectomy Submitted Aug 11, 2016. Accepted for publication Oct 27, 2016Oct 27, . doi: 10.21037/gs.2016 View this article at: http://dx.doi.org/10.21037/gs.2016.11.11 44 Weenk et al. Decision-making process in IBR © Gland Surgery. All rights reserved.Gland Surg 2017;6(1):43-48 gs.amegroups.com States. In 2000, 12.9% of all mastectomies performed in the United States were combined IBR, increasing to 36.3% in 2009 (15). The United Kingdom Association of Breast Surgery recommends that any patient in which IBR is oncologically safe should have the possibility to choose for IBR (16). Dutch guidelines state IBR has a slight preference instead of delayed reconstruction and that every patient considered for mastectomy has to be informed about reconstructive options (17). However, despite the evidence and recommendations, almost two thirds of the mastectomies are still performed without IBR. We asked ourselves if there are elements in the pre-operative process that could facilitate or impede the choice for IBR. The major objective of this study was to investigate the decision-making process on whether or not a patient undergoes immediate reconstruction after mastectomy. In this study we focused on the role of patient as well as the role of the breast surgeon. MethodsWe investigated all electronic patient files of women diagnosed with DCIS or invasive carcinoma between 2010 and 2013, and underwent a mastectomy at the Canisius Wilhelmina Breast Center in Nijmegen, the Netherlands. Patients who underwent prophylactic mastectomy were excluded. IBR is defined as mastectomy and reconstruction performed on the same day. ...

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Factors influencing the decision to pursue immediate breast reconstruction after mastectomy for breast cancer

et al. 2017

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“…Oncological safety and aesthetic outcome have become common goals in breast cancer surgical treatment [1]. Breast conservation surgery is offered to women with relatively large or poorly located cancers and involves specialized plastic surgical techniques in combination with oncological surgery, commonly referred as oncoplastic breast-conserving surgery (OBCS) [2].…”

Section: Introductionmentioning

confidence: 99%

Imaging Results Following Oncoplastic and Standard Breast Conserving Surgery

et al. 2015

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Background: Oncoplastic breast-conserving surgery (OBCS) requires more complex surgical techniques than standard wide local excision (WLE) and the postoperative complication rate may be higher. Since these can have an impact on postoperative imaging, we compared imaging and biopsy results after OBCS and WLE. Methods: Findings for patients undergoing OBCS (n = 83) or standard WLE (n = 128) were compared. Numbers, indications and outcomes of mammograms, breast ultrasounds, magnetic resonance imaging scans and biopsies done within 2 years after surgery were analysed. Results: OBCS was applied for more advanced malignancy. Significantly more patients required breast ultrasound after OBCS than WLE (20/71 vs. 17/116; p = 0.024). Breast Imaging Reporting and Data System (BI-RADS) category 3 or 4 ultrasound results were found only in patients with OBCS (6/29 vs. 0/19; p = 0.034). Significantly more biopsies were required after OBCS (9/71 vs. 3/116; p = 0.006). New lumps or lumpiness were the commonest indications, and pathology confirmed fat necrosis in the majority (7/12). The rate of fat necrosis after OBCS was 18% on clinical examination (13/71), 15% with ultrasound (11/71) and 7% confirmed on pathology (5/71). Conclusion: Patients treated with OBCS require significantly more ultrasound scans and consequent biopsies than patients who underwent WLE. This is mainly due to fat necrosis developing after OBCS in the majority of cases.

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“…A régebbi profilaktikus mastectomia elnevezést fokozatosan átvette a rizikócsökkentő mastectomia, mivel mastectomia után is visszamarad az emlőállomány 3-5%-a, amelynek talaján emlőcarcinoma fejlődhet ki [27]. Habár a mastectomia nem 0%-ra csökkenti az esélyét egy esetleges emlőrák kialakulásának, magas vagy nagyon magas rizikójú egyénekben mastectomia után az emlő-carcinoma kialakulásának esélye az alacsony kockázatú populáció szintje alá csökken [28] (1. táblázat).…”

Section: Rizikócsökkentő Mastectomia éS Salpingo-oophorectomiaunclassified

Az örökletes emlőrák szűrésének, megelőzésének és kezelésének új nemzetközi irányvonalai – hazai vonatkozásokkal

et al. 2016

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Bevezetés: Az örökletes emlőrák szűrése, megelőzése és kezelése összetett, multidiszciplináris feladat. A familiáris emlőrák ellátására új ajánlásokat publikáltak az Egyesült Királyságban. Célkitűzés: A szerzők az angliai és skóciai ajánlá-sokat, azok evidenciáit és az ezzel kapcsolatos magyarországi helyzetet foglalják össze. Módszer: A National Institute for Health and Care Excellence és a Familial Breast Cancer Report (NHS Scotland) ajánlásai és a hazai gyakorlat elemzése. Eredmények: Az új ajánlások jelentősen növelik a genetikai tesztek és az ezzel kapcsolatos genetikai tanács-adások számát. Az új ajánlások alapján lényegesen több mágneses rezonanciás vizsgálat javasolt az emlőszűrésben. Az érintett egyéneknek közepes kockázattól felfelé kemoprevenció ajánlható. Az örökletes emlőrák szisztémás kezelésében új utakat nyithatnak az egyes platinaszármazékokkal és a poli-ADP-ribóz polimeráz inhibitorokkal végzett klinikai vizsgálatok. Az egészségügyi költségvetést számottevően megterhelhetik a jelentősen megnövekedett genetikai tesztvizsgálatok, a genetikai tanácsadások, az emlő mágneses rezonanciás vizsgálatai. Következtetések: A fenti aján-lások bizonyos területeken meg fogják változtatni a familiáris emlőrák ellátásának jelenlegi klinikai gyakorlatát. Orv.

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Ten-year follow-up of skin-sparing mastectomy followed by immediate breast reconstruction

Abstract: Based on these long-term follow-up data, SSM combined with IBR is an oncologically safe treatment option regardless of tumour stage.

Cited by 66 publications

References 91 publications

Factors influencing the decision to pursue immediate breast reconstruction after mastectomy for breast cancer

Factors influencing the decision to pursue immediate breast reconstruction after mastectomy for breast cancer

Imaging Results Following Oncoplastic and Standard Breast Conserving Surgery

Az örökletes emlőrák szűrésének, megelőzésének és kezelésének új nemzetközi irányvonalai – hazai vonatkozásokkal

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