Staged approach to partial breast reconstruction to avoid mastectomy in women with breast cancer
Identifieur interne : 009433 ( Ncbi/Merge ); précédent : 009432; suivant : 009434Staged approach to partial breast reconstruction to avoid mastectomy in women with breast cancer
Auteurs : Pankaj G. Roy ; Alexandra A. TenoviciSource :
- Gland Surgery [ 2227-684X ] ; 2017.
Abstract
The lateral chest wall perforator flaps (CWPF) offer an excellent option for partial breast reconstruction (PBR) in women undergoing breast conservation surgery (BCS) for laterally placed tumours in small to moderate non-ptotic breasts.
A total of 20 patients underwent PBR with lateral CWPF over the last 4 years, as two-stage approach. This approach was undertaken for patients with high tumour to breast ratio (>30% predicted resection) in an attempt to avoid mastectomy. The reconstruction was carried out 2–4 weeks after wide local excision in order to ensure clear margins prior to undertaking PBR.
Twenty-three women were selected for attempt at BCS with 2-stage approach. Three patients had extensive disease so they were then counseled for mastectomy after the first surgery and 20 patients had successful BCS. Out of 20 patients, 13 were symptomatic and 7 were screen-detected with mean age of 49 years. The median tumour size on pre-op imaging was 43 mm (23–75 mm). A percentage of 50% women with unifocal cancers undergoing primary surgery had disease overestimated on pre-op imaging. The complication rate was low. Good to excellent aesthetic outcomes were reported in 90% cases. Patients reported high satisfaction scores.
We recommend considering two-stage approach in selected women with high tumour-breast ratio to ensure successful BCS prior to PBR. This approach facilitates BCS and avoids mastectomy in borderline cases, particularly lobular cancers, DCIS, bifocal cancers and post neoadjuvant chemotherapy where pre-operative disease estimation could be challenging. Our small series has shown that this approach results in safe oncological surgery with good aesthetic outcomes in the selected group of women.
Url:
DOI: 10.21037/gs.2017.03.08
PubMed: 28861373
PubMed Central: 5566661
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PMC:5566661Le document en format XML
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<author><name sortKey="Roy, Pankaj G" sort="Roy, Pankaj G" uniqKey="Roy P" first="Pankaj G." last="Roy">Pankaj G. Roy</name>
</author>
<author><name sortKey="Tenovici, Alexandra A" sort="Tenovici, Alexandra A" uniqKey="Tenovici A" first="Alexandra A." last="Tenovici">Alexandra A. Tenovici</name>
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<sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Staged approach to partial breast reconstruction to avoid mastectomy in women with breast cancer</title>
<author><name sortKey="Roy, Pankaj G" sort="Roy, Pankaj G" uniqKey="Roy P" first="Pankaj G." last="Roy">Pankaj G. Roy</name>
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<author><name sortKey="Tenovici, Alexandra A" sort="Tenovici, Alexandra A" uniqKey="Tenovici A" first="Alexandra A." last="Tenovici">Alexandra A. Tenovici</name>
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<series><title level="j">Gland Surgery</title>
<idno type="ISSN">2227-684X</idno>
<idno type="eISSN">2227-8575</idno>
<imprint><date when="2017">2017</date>
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<front><div type="abstract" xml:lang="en"><sec><title>Background</title>
<p>The lateral chest wall perforator flaps (CWPF) offer an excellent option for partial breast reconstruction (PBR) in women undergoing breast conservation surgery (BCS) for laterally placed tumours in small to moderate non-ptotic breasts.</p>
</sec>
<sec><title>Methods</title>
<p>A total of 20 patients underwent PBR with lateral CWPF over the last 4 years, as two-stage approach. This approach was undertaken for patients with high tumour to breast ratio (>30% predicted resection) in an attempt to avoid mastectomy. The reconstruction was carried out 2–4 weeks after wide local excision in order to ensure clear margins prior to undertaking PBR.</p>
</sec>
<sec><title>Results</title>
<p>Twenty-three women were selected for attempt at BCS with 2-stage approach. Three patients had extensive disease so they were then counseled for mastectomy after the first surgery and 20 patients had successful BCS. Out of 20 patients, 13 were symptomatic and 7 were screen-detected with mean age of 49 years. The median tumour size on pre-op imaging was 43 mm (23–75 mm). A percentage of 50% women with unifocal cancers undergoing primary surgery had disease overestimated on pre-op imaging. The complication rate was low. Good to excellent aesthetic outcomes were reported in 90% cases. Patients reported high satisfaction scores.</p>
</sec>
<sec><title>Conclusions</title>
<p>We recommend considering two-stage approach in selected women with high tumour-breast ratio to ensure successful BCS prior to PBR. This approach facilitates BCS and avoids mastectomy in borderline cases, particularly lobular cancers, DCIS, bifocal cancers and post neoadjuvant chemotherapy where pre-operative disease estimation could be challenging. Our small series has shown that this approach results in safe oncological surgery with good aesthetic outcomes in the selected group of women.</p>
</sec>
</div>
</front>
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<pmc article-type="research-article"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Gland Surg</journal-id>
<journal-id journal-id-type="iso-abbrev">Gland Surg</journal-id>
<journal-id journal-id-type="publisher-id">GS</journal-id>
<journal-title-group><journal-title>Gland Surgery</journal-title>
</journal-title-group>
<issn pub-type="ppub">2227-684X</issn>
<issn pub-type="epub">2227-8575</issn>
<publisher><publisher-name>AME Publishing Company</publisher-name>
</publisher>
</journal-meta>
<article-meta><article-id pub-id-type="pmid">28861373</article-id>
<article-id pub-id-type="pmc">5566661</article-id>
<article-id pub-id-type="publisher-id">gs-06-04-336</article-id>
<article-id pub-id-type="doi">10.21037/gs.2017.03.08</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Original Article</subject>
</subj-group>
</article-categories>
<title-group><article-title>Staged approach to partial breast reconstruction to avoid mastectomy in women with breast cancer</article-title>
</title-group>
<contrib-group><contrib contrib-type="author" corresp="yes"><name><surname>Roy</surname>
<given-names>Pankaj G.</given-names>
</name>
</contrib>
<contrib contrib-type="author"><name><surname>Tenovici</surname>
<given-names>Alexandra A.</given-names>
</name>
</contrib>
<aff id="aff1">Department of Breast Surgery, John Radcliffe Hospital,<institution>Oxford University Hospitals NHS foundation Trust</institution>
,<addr-line>Oxford</addr-line>
,<country>UK</country>
</aff>
</contrib-group>
<author-notes><fn id="afn1"><p><italic>Contributions:</italic>
(I) Conception and design: PG Roy; (II) Administrative support: All authors; (III) Provision of study materials or patients: PG Roy; (IV) Collection and assembly of data: AA Tenovici; (V) Data analysis and interpretation: All authors; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors.</p>
</fn>
<corresp id="cor1"><italic>Correspondence to:</italic>
Pankaj G. Roy, FRCS Glasgow, MD, MS. Oncoplastic Breast Surgeon, Department of Breast Surgery, John Radcliffe Hospital, Oxford University Hospitals NHS foundation Trust, Oxford OX3 9DU, UK. Email: <email xlink:href="pankaj.roy@ouh.nhs.uk">pankaj.roy@ouh.nhs.uk</email>
.</corresp>
</author-notes>
<pub-date pub-type="epub-ppub"><month>8</month>
<year>2017</year>
</pub-date>
<pmc-comment>Fake ppub date generated by PMC from publisher
pub-date/@pub-type='epub-ppub' </pmc-comment>
<pub-date pub-type="ppub"><month>8</month>
<year>2017</year>
</pub-date>
<volume>6</volume>
<issue>4</issue>
<fpage>336</fpage>
<lpage>342</lpage>
<history><date date-type="received"><day>11</day>
<month>1</month>
<year>2017</year>
</date>
<date date-type="accepted"><day>21</day>
<month>2</month>
<year>2017</year>
</date>
</history>
<permissions><copyright-statement>2017 Gland Surgery. All rights reserved.</copyright-statement>
<copyright-year>2017</copyright-year>
<copyright-holder>Gland Surgery.</copyright-holder>
</permissions>
<abstract><sec><title>Background</title>
<p>The lateral chest wall perforator flaps (CWPF) offer an excellent option for partial breast reconstruction (PBR) in women undergoing breast conservation surgery (BCS) for laterally placed tumours in small to moderate non-ptotic breasts.</p>
</sec>
<sec><title>Methods</title>
<p>A total of 20 patients underwent PBR with lateral CWPF over the last 4 years, as two-stage approach. This approach was undertaken for patients with high tumour to breast ratio (>30% predicted resection) in an attempt to avoid mastectomy. The reconstruction was carried out 2–4 weeks after wide local excision in order to ensure clear margins prior to undertaking PBR.</p>
</sec>
<sec><title>Results</title>
<p>Twenty-three women were selected for attempt at BCS with 2-stage approach. Three patients had extensive disease so they were then counseled for mastectomy after the first surgery and 20 patients had successful BCS. Out of 20 patients, 13 were symptomatic and 7 were screen-detected with mean age of 49 years. The median tumour size on pre-op imaging was 43 mm (23–75 mm). A percentage of 50% women with unifocal cancers undergoing primary surgery had disease overestimated on pre-op imaging. The complication rate was low. Good to excellent aesthetic outcomes were reported in 90% cases. Patients reported high satisfaction scores.</p>
</sec>
<sec><title>Conclusions</title>
<p>We recommend considering two-stage approach in selected women with high tumour-breast ratio to ensure successful BCS prior to PBR. This approach facilitates BCS and avoids mastectomy in borderline cases, particularly lobular cancers, DCIS, bifocal cancers and post neoadjuvant chemotherapy where pre-operative disease estimation could be challenging. Our small series has shown that this approach results in safe oncological surgery with good aesthetic outcomes in the selected group of women.</p>
</sec>
</abstract>
<kwd-group kwd-group-type="author"><title>Keywords: </title>
<kwd>Partial breast reconstruction (PBR)</kwd>
<kwd>lateral chest wall perforator flap (CWPF)</kwd>
<kwd>lateral intercostal artery perforator (LICAP) flap</kwd>
<kwd>breast conserving surgery</kwd>
<kwd>breast cancer</kwd>
</kwd-group>
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</front>
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<tree><noCountry><name sortKey="Roy, Pankaj G" sort="Roy, Pankaj G" uniqKey="Roy P" first="Pankaj G." last="Roy">Pankaj G. Roy</name>
<name sortKey="Tenovici, Alexandra A" sort="Tenovici, Alexandra A" uniqKey="Tenovici A" first="Alexandra A." last="Tenovici">Alexandra A. Tenovici</name>
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