Standard wide local excision or bilateral reduction mammoplasty in large-breasted women with small tumours: Surgical and patient-reported outcomes

Introduction: Oncoplastic breast-conserving surgery (OBCS) is considered a cornerstone in the management of locally invasive breast cancer. We evaluated patient-reported outcomes of OBCS with contralateral balancing breast reduction mammoplasty and reviewed its oncologic outcomes and complications. Methods: This is mixed method study design using retrospective chart review and prospective cohort study. Patient demographics were reviewed. Outcome measures included clinicopathologic characteristics, complications, margin status, local recurrence, tumor histopathologies, duration of follow-up, patient satisfaction, self-esteem, event-related stress, and quality of life. Results: A total of 48 patients were included in this study. Complete excision with negative margins was obtained in 42 (87.5%) patients, positive margins in 6 (12.5%) patients, all who had re-excision with repeat lumpectomy. Thirteen patients developed minor complications, defined as being managed as an outpatient. No patients developed major complications requiring inpatient admission. These complications did not delay commencement of chemotherapy or radiotherapy. Postsurgery BREAST-QTM26 scores demonstrated no statistical difference in satisfaction with breasts, nipples, and sexual well-being. There was high satisfaction with overall outcome with average score of 80.8%. For the Rosenberg self-esteem scale, the results were similar for 3- and 12-month post-operative indicating maintenance of normal self-esteem post-operatively. The Impact of Events Scale showed statistically significant difference at 12-month post-operative (25.1) when compared with preoperative scores indicating that patients had lower event-related stress. There was no significant change in Hospital Anxiety and Depression Scale. Conclusion: Our study has shown that the patient who undergo OBCS have high patient-reported outcomes with acceptable oncologic outcomes and complication rates.

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A 12-year review of patient-reported outcomes after reduction mammoplasty in patients with high body mass index

Medicine ◽

10.1097/md.0000000000016055 ◽

2019 ◽

Vol 98 (25) ◽

pp. e16055 ◽

Cited By ~ 1

Author(s):

Ledibabari M. Ngaage ◽

Jennifer Bai ◽

Selim Gebran ◽

Adekunle Elegbede ◽

Chinezimuzo Ihenatu ◽

...

Keyword(s):

Body Mass Index ◽

Body Mass ◽

Patient Reported Outcomes ◽

High Body Mass Index ◽

Reduction Mammoplasty ◽

High Body ◽

Patient Reported

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392 Magseed-Guided Wide Local Excision During the COVID-19 Pandemic: A Tenable Solution to Barriers in Accessing Elective Breast Cancer Surgery

British Journal of Surgery ◽

10.1093/bjs/znab259.205 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

J J Teh ◽

W Cai ◽

M Kedrzycki ◽

P T R Thiruchelvam ◽

D S Elson ◽

...

Keyword(s):

Breast Cancer ◽

Local Excision ◽

Wide Local Excision ◽

Ductal Carcinoma ◽

Patient Flow ◽

University Hospital ◽

Breast Cancer Surgery ◽

Breast Cancers ◽

Suitable Alternative ◽

Patient Reported

Abstract Introduction Magseed-guided localisation has emerged as a suitable alternative to wire-guided localisation (WGL) for impalpable breast cancers, with advantages including advanced insertion and simpler logistical planning. Given the severe disruption to elective surgeries during the Covid-19 pandemic, a local Magseed pathway was developed enabling safe patient flow. Magseed was inserted well in advance of the operation, enabling time to self-isolate and obtain a negative COVID swab prior to admission to a dedicated COVID -free suite. We present the patient-reported outcomes of the new pathway. Method A prospective service evaluation was conducted in a University hospital. Patients undergoing Magseed-guided wide local excision (WLE) from 01/07/2020 to present were surveyed to detail their experiences on the Magseed pathway. Qualitative data investigating anxiety and comfort post-insertion were reported using 10-fold Likert scales. Quantitative data was collected on patient demographics and tumour specification. Results 41/46 women who underwent Magseed localisation WLE completed the survey, with median age 65 years (IQR 53-72) and median BMI 26.5 kg/m2 (IQR 22.4-30.8). 71% had invasive ductal carcinoma with or without ductal carcinoma in-situ. 10% women found the procedure uncomfortable (<5) and 98% women reported low anxiety (<5) over seed displacement. If given the choice, 98% patients would prefer Magseed over WGL. Conclusions The new Magseed pathway is regarded positively among patients, despite ongoing disruption in elective breast cancer services. Given the progression of the second wave and likelihood of future outbreaks, Magseed localisation could be adopted widely to ensure continuous provision of safe elective surgeries.

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Intralesional Bevacizumab for the Treatment of Recurrent Sinonasal Hemangioma

Annals of Otology Rhinology & Laryngology ◽

10.1177/0003489418802288 ◽

2018 ◽

Vol 127 (12) ◽

pp. 969-973

Author(s):

Michael R. Kinzinger ◽

E. Bradley Strong ◽

Joan Bernard ◽

Toby O. Steele

Keyword(s):

Vascular Endothelial Growth Factor ◽

Growth Factor ◽

Nasal Obstruction ◽

Local Excision ◽

Revision Surgery ◽

Wide Local Excision ◽

Vascular Endothelial ◽

Recurrent Epistaxis ◽

Patient Reported ◽

Endothelial Growth Factor

Introduction: Sinonasal hemangioma is a rare benign tumor of vascular endothelial cells. The pathogenesis is closely linked to abnormalities in the vascular endothelial growth factor signaling pathway. Multiple treatment modalities are available, though wide local excision remains the preferred treatment. Bevacizumab, an anti–vascular endothelial growth factor monoclonal antibody, has known efficacy against hemangiomas, though there are no cases of sinonasal hemangiomas managed with bevacizumab. Methods: Case report. Results: The authors review the case of a 67-year-old man with a left-sided nasal hemangioma originating from the nasal septum. He presented with progressive left nasal obstruction and recurrent epistaxis. At the time of his presentation, the lesion had recurred after 1 excision/polypectomy at an outside institution. He then underwent revision surgery via wide local excision and septoplasty. After tumor recurrence following the revision surgery, the hemangioma was noted to recur on 1 year postoperative surveillance nasal endoscopy. In-office intralesional injection of 50 mg bevacizumab was then performed under endoscopic visualization. No improvement in the tumor size was noted at 2 months after injection, with the tumor measuring 1.5 cm. At the 10-month surveillance clinical visit following injection, the tumor had dramatically involuted to 3 mm in greatest dimension. The patient reported complete resolution of his primary symptoms of epistaxis and nasal obstruction. Conclusions: This report demonstrates the first reported successful treatment of a sinonasal hemangioma with intralesional bevacizumab. Intralesional bevacizumab confers an additional option for adjuvant treatment of sinonasal hemangiomas. Further evaluation of intralesional bevacizumab in the treatment of these tumors is warranted.

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