Breast Volume Measurement As a Predictor of Cosmetic Outcome and Patient Satisfaction Following Oncoplastic Breast Surgery for Breast Cancer

Abstract Background The goal of modern breast surgery is to cure patients with preservation of breast tissue as much as possible with satisfactory physical and psychological outcome. This goal has led to introduction of a new scope of surgery into our clinical practice called oncoplastic breast surgery, with the advantage of combining oncological safety and satisfactory cosmetic outcome. Objective To focus on skin sparing mastectomy as a surgical procedure for treatment of breast cancer and to assess outcomes and benefits versus complications. Patients and Methods It was a retrospective analytical study that included 30 patients aiming to clinically assess the skin sparing mastectomy as an oncoplastic technique regarding oncological safety and patient satisfaction. This study was conducted at Ain-Shams University Hospitals. Approval of the Ethical Committee and written informed consent from all participants was obtained. Results In our study 6 patients underwent SSM and 24 Patients underwent NSM owing to high tumor/breast volume ratio. In our study we were able to conduct an very good cosmetic outcome for a relatively large tumor excisions with 66.7% of the cases (20 patients) falling in excellent and very good score. In our study only one of the patients had malignant recurrence as confirmed by the pathologist in our multidisciplinary team proving that we had performed skin sparring mastectomy technique safely from oncological point of view. The follow up of the malignant recurrence was for the first year as this was the time limitation of our study. Conclusion Skin sparing mastectomy has been proven as an alternate to traditional radical mastectomy with the same oncological safety and better cosmetic outcome.

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From Radical Mastectomy to Breast-Conserving Therapy and Oncoplastic Breast Surgery: A Narrative Review Comparing Oncological Result, Cosmetic Outcome, Quality of Life, and Health Economy

ISRN Oncology ◽

10.1155/2013/742462 ◽

2013 ◽

Vol 2013 ◽

pp. 1-6 ◽

Cited By ~ 7

Author(s):

Ahmad Kaviani ◽

Nassim Sodagari ◽

Sara Sheikhbahaei ◽

Vahid Eslami ◽

Nima Hafezi-Nejad ◽

...

Keyword(s):

Breast Cancer ◽

Breast Surgery ◽

Radical Mastectomy ◽

Breast Conserving Therapy ◽

Cosmetic Outcome ◽

Health Economy ◽

Outcome Quality ◽

Oncoplastic Breast Surgery ◽

Oncological Result

Surgical management of breast cancer has evolved considerably over the last two decades. There has been a major shift toward less-invasive local treatments, from radical mastectomy to breast-conserving therapy (BCT) and oncoplastic breast surgery (OBS). In order to investigate the efficacy of each of the three abovementioned methods, a literature review was conducted for measurable outcomes including local recurrence, survival, cosmetic outcome, quality of life (QOL), and health economy. From the point of view of oncological result, there is no difference between mastectomy and BCT in local recurrence rate and survival. Long-term results for OBS are not available. The items assessed in the QOL sound a better score for OBS in comparison with mastectomy or BCT. OBS is also associated with a better cosmetic outcome. Although having low income seems to be associated with lower BCT and OBS utilization, prognosis of breast cancer is worse in these women as well. Thus, health economy is the matter that should be studied seriously. OBS is an innovative, progressive, and complicated subspeciality that lacks published randomized clinical trials comparing surgical techniques and objective measures of outcome, especially from oncologic and health economy points of view.

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Oncological and Cosmetic outcome of Oncoplastic breast surgery.

The Professional Medical Journal ◽

10.29309/tpmj/2019.26.12.4186 ◽

2019 ◽

Vol 26 (12) ◽

pp. 2222-2230

Author(s):

Saira Saleem ◽

Farhan Javed ◽

Ayesha Rehman ◽

Nazim Hayat ◽

Nadia Bano ◽

...

Keyword(s):

Breast Cancer ◽

Local Recurrence ◽

Distant Metastasis ◽

Breast Surgery ◽

Locally Advanced ◽

Oncological Outcome ◽

Cosmetic Outcome ◽

Breast Size ◽

Axillary Lymph ◽

Oncoplastic Breast Surgery

Objectives: Oncoplastic breast surgery (OBS) is a revolutionary approach for managing breast cancer. This manuscript aimed to assess the oncological and cosmetic outcomes of OBS in breast cancer. Study Design: Descriptive, prospective study. Setting: Department of Surgery, Madina Teaching Hospital, Faisalabad. Period: January 2018 to June 2019. Material & Methods: Females with invasive breast cancer having 5-6 cm tumour size, Locally advanced tumour after chemotherapy, single tumour and patients < 70 years were included; while patients with fixed tumours, high tumour to breast size ratio, multiple axillary lymph nodes, metastatic cancer & patient’s choice for mastectomy were excluded. Oncological outcome was assessed by; Margin involvement, time lag for chemotherapy, local recurrence and distant metastasis. Cosmetic outcome was detected by score given by patient and an independent surgeon. Results: Thirty two female patients underwent OBS. Mean age of patients was 46.56 yr (SD =10.23). Six patients (18.8%) had central tumors. 3 patients were post neoadjuvant chemotherapy. In 28 patients volume displacement (VD) surgery; while in 4 patients volume replacement (VR) using different flaps like LICAP flap were done. Oncological outcome showed positive margin in one case only, in all other cases clear margins were found. Chemotherapy start time varied from 3 to 8 weeks after surgery (Mean=31.3 days). Delayed time was associated with high BMI and diabetes (P<0.05). Local recurrence or distant metastasis was not noticed in any case. Majority of the patients and surgeon (90%) were satisfied with cosmetic outcome. Conclusion: Oncoplastic Breast surgery is a unique approach to conserve breast even in larger tumours without compromise on oncological principles and cosmesis.

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Oncoplastic and reconstructive breast surgery in Canada: breaking new ground in general surgical training

Canadian Journal of Surgery ◽

10.1503/cjs.016717 ◽

2018 ◽

pp. 294-299

Author(s):

Lashan Peiris ◽

David Olson ◽

Kelly Dabbs

Keyword(s):

Breast Cancer ◽

Surgical Training ◽

Breast Surgery ◽

Fellowship Training ◽

Immediate Breast Reconstruction ◽

Oncoplastic Breast Surgery ◽

The Uk

Oncoplastic breast surgery combines certain plastic surgery procedures with a breast cancer resection to minimize the cosmetic penalty. We compared current practices in breast surgery in Canada and the UK, looking at the classification of oncoplastic breast surgery, management of larger tumours that would otherwise mandate a mastectomy, and the breast surgeon’s role in immediate breast reconstruction. Reconstructive breast surgery has always fallen within the domain of the plastic surgeon, but surgical subspecialization and more focused fellowship training have meant that breast surgeons with the appropriate skillset can offer these procedures. This evolution of the breast surgeon has led to the birth of a new field of breast surgery known as oncoplastic and reconstructive breast surgery. Those tasked with developing surgical training programs in Canada must now decide whether to train breast surgeons in these techniques to improve long-term quality of life among Canadian patients with breast cancer.

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Oncoplastic Approaches to Breast Conservation

International Journal of Breast Cancer ◽

10.4061/2011/303879 ◽

2011 ◽

Vol 2011 ◽

pp. 1-16 ◽

Cited By ~ 31

Author(s):

Dennis R. Holmes ◽

Wesley Schooler ◽

Robina Smith

Keyword(s):

Breast Cancer ◽

Multidisciplinary Approach ◽

Breast Surgery ◽

Breast Conservation ◽

Surgical Techniques ◽

Tumor Location ◽

Surgical Approaches ◽

Oncoplastic Breast Surgery ◽

Body Habitus ◽

Skill Sets

When a woman is diagnosed with breast cancer many aspects of her physical, emotional, and sexual wholeness are threatened. The quickly expanding field of oncoplastic breast surgery aims to enhance the physician commitment to restore the patient's image and self-assurance. By combining a multidisciplinary approach to diagnosis and treatment with oncoplastic surgery, successful results in the eyes of the patient and physician are significantly more likely to occur. As a way to aid oncoplastic teams in determining which approach is most suitable for their patient's tumor size, tumor location, body habitus, and desired cosmetic outcome we present a review of several oncoplastic surgical approaches. For resections located anywhere in the breast, theradial ellipse segmentectomy incisionandcircumareolar approach for segmental resectionare discussed. For resections in the upper or central breast,crescent mastopexy, thebatwing incision, thehemibatwing incision,donut mastopexy,B-flap resection, and thecentral quadrantectomyare reviewed. For lesions of the lower breast, thetriangle incision,inframammary incision, andreduction mastopexyare discussed. Surgeons who are interested in adding oncoplastic breast conserving therapies to their skill sets are encouraged to implement these surgical techniques where applicable and to seek out breast fellowships or enhanced training when appropriate.

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Steps to follow in oncoplastic breast surgery to optimise oncological and cosmetic outcome

Annales de Chirurgie Plastique Esthétique ◽

10.1016/j.anplas.2019.03.006 ◽

2019 ◽

Vol 64 (3) ◽

pp. 283-284

Author(s):

G. Franceschini ◽

R. Masetti

Keyword(s):

Breast Surgery ◽

Cosmetic Outcome ◽

Oncoplastic Breast Surgery

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Oncoplastic breast surgery technique for retroareolar breast cancer: a technical modification of the Grisotti flap in patients with short nipple to inferior mammary crease distance

Journal of Surgical Case Reports ◽

10.1093/jscr/rjaa285 ◽

2020 ◽

Vol 2020 (9) ◽

Author(s):

Miguel Johnson ◽

Lorna Cook ◽

Fabio I Rapisarda ◽

Dibendu Betal ◽

Riccardo Bonomi

Keyword(s):

Breast Cancer ◽

Primary Closure ◽

Breast Surgery ◽

Breast Conservation ◽

Original Description ◽

Breast Conservation Surgery ◽

Oncoplastic Breast Surgery ◽

Nipple Areolar Complex ◽

Areolar Complex ◽

Conservation Surgery

ABSTRACT The introduction of breast conservation surgery together with advances in oncoplastic techniques has revolutionized the management of retroareolar breast tumours. Traditionally, cancers in this location were often managed with central excision and primary closure or mastectomy. More recently, oncoplastic breast-conserving techniques such as the Grisotti mammoplasty have been increasingly encouraged as an alternative option as it allows oncological safe margin resections while restoring cosmesis. The use of a Grisotti flap enables safe resection of a retroareolar tumour with concurrent reconstruction of the defect using a local rotational advancement dermoglandular flap allowing a satisfactory cosmetic result in term of contour and projection. This technique is often limited to those patients with sufficient native nipple-inferior mammary fold (IMF) distance to accommodate for some inevitable post-operative reduction in this distance. We describe a modification of the original description, such that satisfactory cosmetic outcome can be achieved, even in patients with a short nipple areolar complex to inframammary fold distance.

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