Therapeutic mammaplasty is a safe and effective alternative to mastectomy with or without immediate breast reconstruction

Abstract

Background: Therapeutic mammaplasty (TM) may be an alternative to mastectomy, but few well designed studies have evaluated the success of this approach or compared the short-term outcomes of TM with mastectomy with or without immediate breast reconstruction (IBR). Data from the national iBRA-2 and TeaM studies were combined to compare the safety and short-term outcomes of TM and mastectomy with or without IBR. Methods:The subgroup of patients in the TeaM study who underwent TM to avoid mastectomy were identified, and data on demographics, complications, oncology and adjuvant treatment were compared with those of patients undergoing mastectomy with or without IBR in the iBRA-2 study. The primary outcome was the percentage of successful breast-conserving procedures in the TM group. Secondary outcomes included postoperative complications and time to adjuvant therapy.Results: A total of 2916 patients (TM 376; mastectomy 1532; mastectomy and IBR 1008) were included in the analysis. Patients undergoing TM were more likely to be obese and to have undergone bilateral surgery than those having IBR. However, patients undergoing mastectomy with or without IBR were more likely to experience complications than the TM group (TM: 79, 21⋅0 per cent; mastectomy: 570, 37⋅2 per cent; mastectomy and IBR: 359, 35⋅6 per cent; P < 0⋅001). Breast conservation was possible in 87⋅0 per cent of patients who had TM, and TM did not delay adjuvant treatment.Conclusion: TM may allow high-risk patients who would not be candidates for IBR to avoid mastectomy safely. Further work is needed to explore the comparative patient-reported and cosmetic outcomes of the different approaches, and to establish long-term oncological safety. * Members of the iBRA-2 and TeaM Steering Groups, the Breast Reconstruction Research Collaborative, and the Mammary Fold Academic and Research Collaborative are co-authors of this study and are listed in Appendix S1 (supporting information) Earlier versions of the combined analysis were presented to the

A prospective cohort study of the safety of breast cancer surgery during COVID-19 pandemic in the West of Scotland

“…In terms of surgical techniques more oncoplastic breast conservations were carried out in comparison to our pre-COVID-19 practice due to immediate breast reconstruction not being offered after mastectomy (Table 2.). Oncoplastic breast conservation surgery has been shown as a safe alternative to mastectomy and immediate breast reconstruction in selected patients based on the combined data of iBRA-2 and TeaM studies of 2916 patients (17). Further, the Scottish audits of oncoplastic breast conservations indicate that oncoplastic surgery can widen the indications for breast conservation, and provide good oncological outcome with low complication rates in our hands, hence it can be a reasonable alternative to mastectomy with immediate reconstruction (18)(19)(20)(21).…”

Protocol for a mixed-method study to inform the feasibility of undertaking a large-scale multicentre study comparing the clinical and patient-reported outcomes of oncoplastic breast conservation as an alternative to mastectomy with or without immediate breast reconstruction in women unsuitable for standard breast-conserving surgery (the ANTHEM Feasibility Study)

“…Recent combined analysis of 2540 patients who underwent Mx with or without IBR in the iBRA-2 (immediate breast reconstruction and adjuvant therapy audit)Study 19 and a subgroup of 376 patients who underwent TM to avoid Mx in the TeaM (Therapeutic Mammaplasty) Study 20 suggests that although patients in the TM group were 'higher risk' (ie, older, higher body mass index and more likely to be smokers) than those undergoing IBR, rates of major complications requiring readmission or reoperation were significantly lower in the TM group (2.1% TM vs 14.8% implant-based reconstruction; 16.7% free-flap reconstruction). 21 The tumour characteristics were similar in all groups (median whole tumour size 30 mm and multifocality 31.3%), and TM allowed successful breast conservation in almost 90% of cases. 21 Single-centre case series suggests that patients undergoing TM may report better quality of life than those undergoing Mx and IBR, 22 23 and there is emerging evidence to suggest that TM may be a cost-effective alternative to Mx and immediate implant-based 24 and free-flap reconstruction 25 in a North American setting.…”

“…21 The tumour characteristics were similar in all groups (median whole tumour size 30 mm and multifocality 31.3%), and TM allowed successful breast conservation in almost 90% of cases. 21 Single-centre case series suggests that patients undergoing TM may report better quality of life than those undergoing Mx and IBR, 22 23 and there is emerging evidence to suggest that TM may be a cost-effective alternative to Mx and immediate implant-based 24 and free-flap reconstruction 25 in a North American setting.…”

Therapeutic mammoplasty as a viable surgical approach in Breast Cancer Patients from India: A Single Institutional Audit

“…When negative margins were considered as >2mm, the reported margin positivity rate was 8-16 % (Potter et al 2020). In the TEAM protocol, 79% cases (of reported 385 TM procedures) have clear margins (O'Connell et al 2018).…”

“…TM combines advantages of oncologically safe wide excision of tumor with breast reduction, mastopexy and contralateral symmertrisation techniques (Winters and Bernaudo 2018). This technique increases application of BCS and scope of BCT by facilitating larger tumors excision margins, lower re-excision rates, decreases rates of positive margins and reduction in rate of mastectomies (Macmillan et al 2014;Potter et al 2020). TM has been shown to achieve satisfactory outcomes by reducing the breast size thereby facilitating better delivery and distribution of RT regimens, achieving contralateral breast symmetry and improving the QoL.…”