The Results of Surveillance Imaging After Breast Conservation Surgery and Partial Breast Reconstruction With Chest Wall Perforator Flaps; A Qualitative Analysis Compared With Standard Breast-Conserving Surgery for Breast Cancer

Hu, Jesse; Cuffolo, Giulio; Parulekar, Vaishali; Chan, Victor; Tenovici, Alexandra; Roy, Pankaj

doi:10.1016/j.clbc.2019.01.010

Cited by 11 publications

(7 citation statements)

References 25 publications

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“… 26 We have already published that the recall and biopsy rates after PBR were similar to that observed after standard breast conserving surgery. 27 …”

Section: Resultsmentioning

confidence: 99%

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Partial Breast Reconstruction with Lateral Chest Wall Perforator Flap to Facilitate Breast Conservation in Breast Cancer: First 100 Cases with Cancer Outcomes at 8 Years Follow-Up and the Lessons Learned

Roy¹,

Mustaţă²,

Hu³

et al. 2021

CMAR

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Background This is a prospective cohort study of partial breast reconstruction (PBR) with a lateral chest wall perforator flap (LCWPF) to facilitate breast conservation surgery (BCS) for women undergoing surgery for breast cancer. The study was undertaken to study the clinical and cancer outcomes. Methods Patients diagnosed with ductal carcinoma in situ (DCIS) or breast cancer who consented to undergo BCS with PBR with LCWPF were included in the study. A prospective database has been maintained to collect information on clinico-pathological features, complications, and follow-up. Patients were asked to complete an anonymised PROM questionnaire over the years. The hospital electronic records were interrogated for women who have completed 5 years follow-up to assess for development of recurrence/events. Results A total of 105 patients underwent PBR with LCWPFs between 2011 and 2018. Of these, 74% underwent cancer resection and PBR as one operation whilst 26% underwent PBR as a two-stage approach. The median tumor size on pre-op imaging was 30 mm for the one-stage approach and 39.5 mm for the two-stage approach ( p -value=0.003). The complication rates were low and the re-operation rate for close margins was 10%, with 4% eventually requiring mastectomy. Good-to-excellent esthetic outcomes were reported in more than 80% of cases by patients and clinicians. The local recurrence rate (LR) was 2%, distant recurrence rate 10.5%, disease free survival (DFS) 86%, distant disease-free survival (DDFS) 89% and overall survival (OS) 94.8% at 4.5 years median follow-up. This procedure provides an effective oncological approach, avoiding mastectomy with a good-to-excellent cosmetic outcome. The follow-up data establishes the safety of this approach. Discussion This is the first published series of recurrence and survival data in patients undergoing PBR. We intend to continue with data collection to assess long-term outcomes beyond 10 years. The authors would recommend consideration of this technique to facilitate BCS and avoid mastectomy. Registration Not applicable.

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“… 26 We have already published that the recall and biopsy rates after PBR were similar to that observed after standard breast conserving surgery. 27 …”

Section: Resultsmentioning

confidence: 99%

“…We have published that the surveillance mammographic follow-up after PBR with CWPF in women undergoing BCS for breast cancer is accurate with low recall (2.2%) biopsy rates and comparable with routine BCS recall rates. 27 …”

Section: Discussionmentioning

confidence: 99%

Partial Breast Reconstruction with Lateral Chest Wall Perforator Flap to Facilitate Breast Conservation in Breast Cancer: First 100 Cases with Cancer Outcomes at 8 Years Follow-Up and the Lessons Learned

Roy¹,

Mustaţă²,

Hu³

et al. 2021

CMAR

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“…Studies have shown minimal effect of chest wall perforator flaps on radiological surveillance. 23,24 Blinded comparison of postoperative mammograms following local flap reconstruction versus standard WLE have shown similar features of calcifications, fat necrosis, volume loss and radiotherapy effect, without an increase in recall or biopsy rates. 23 In a follow-up study, at a median of 3 years, 2% of 102 patients who underwent either latissimus-dorsi mini-flaps or fasciocutaneous perforator flaps were recalled for additional imaging following surveillance mammogram and 1% required needle biopsy.…”

Section: Discussionmentioning

confidence: 99%

“…23,24 Blinded comparison of postoperative mammograms following local flap reconstruction versus standard WLE have shown similar features of calcifications, fat necrosis, volume loss and radiotherapy effect, without an increase in recall or biopsy rates. 23 In a follow-up study, at a median of 3 years, 2% of 102 patients who underwent either latissimus-dorsi mini-flaps or fasciocutaneous perforator flaps were recalled for additional imaging following surveillance mammogram and 1% required needle biopsy. 24 In our study, just four patients (5%) had a subsequent biopsy of the surgical site during follow-upin all cases the diagnosis of the mammographic abnormality was fat necrosis or post-operative change.…”

Section: Discussionmentioning

confidence: 99%

Six-year experience of oncoplastic volume replacement using local perforator flaps

Quinn

Burrah

O’Ceallaigh

et al. 2021

Journal of Plastic, Reconstructive & Aesthetic Surgery

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“…It has been shown that these flaps do not interfere with radiological surveillance, and recall rates for biopsy are low [ 54 , 55 ]. The flap is tunnelled into the defect behind the breast tissue, ensuring that residual breast tissue sits in front of the flap, thus avoiding the potential hindrance from the flap to allow detection of local recurrence in the future.…”

Section: Discussionmentioning

confidence: 99%

Extreme oncoplasty for centrally located breast cancer in small non-ptotic breasts: extending the indications of chest wall perforator flaps with areolar reconstruction

Nigam¹,

Eichholz²,

Bhattacharyya³

et al. 2021

ecancer

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Background Breast cancers located centrally require excision of nipple-areola complex. A simple central wide excision is a safe option but results in suboptimal aesthetic outcome. An oncoplastic option involves therapeutic mammoplasty with or without areolar reconstruction, limited to moderate and large ptotic breasts. For small non-ptotic breasts, most surgeons would resort to mastectomy with/without reconstruction. Methods Lateral chest wall perforator flap (CWPF) is an option for partial breast reconstruction in small to moderate sized, non-ptotic breasts for laterally located tumours. We have extended the application of CWPF for central tumours to avoid mastectomy in selected patients. Results We here present a case series of four patients with small to medium-sized non-ptotic breasts, who had centrally located breast cancer or ductal carcinoma in-situ (DCIS). Three patients had single stage CWPF reconstruction, and one had central excision with immediate reconstruction following a failed attempt at therapeutic mammoplasty. All had the areola reconstructed using flap skin; one patient had simultaneous nipple reconstruction. Conclusions CWPF is an option for treatment of centrally located breast cancers/DCIS needing nipple-areola complex excision for patients wishing to avoid mastectomy. Patients with small to medium-sized non-ptotic breasts are suitable, and need to be carefully selected.

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The Results of Surveillance Imaging After Breast Conservation Surgery and Partial Breast Reconstruction With Chest Wall Perforator Flaps; A Qualitative Analysis Compared With Standard Breast-Conserving Surgery for Breast Cancer

Cited by 11 publications

References 25 publications

Partial Breast Reconstruction with Lateral Chest Wall Perforator Flap to Facilitate Breast Conservation in Breast Cancer: First 100 Cases with Cancer Outcomes at 8 Years Follow-Up and the Lessons Learned

Partial Breast Reconstruction with Lateral Chest Wall Perforator Flap to Facilitate Breast Conservation in Breast Cancer: First 100 Cases with Cancer Outcomes at 8 Years Follow-Up and the Lessons Learned

Six-year experience of oncoplastic volume replacement using local perforator flaps

Extreme oncoplasty for centrally located breast cancer in small non-ptotic breasts: extending the indications of chest wall perforator flaps with areolar reconstruction

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