Extreme Oncoplastic Breast Surgery in Patients Presented to Ain Shams University Hospital, Initial Experience

Abstract Background Breast cancer, according to national cancer institute, is the most common site of cancer in women in Egypt as it accounts for about 38.8% of total malignancies among Egyptian females; it is an important cause of mortality among women. Objective s: Assess the feasibility of extreme oncoplasty and achievement of negative margins in the enrolled patients. Assess the aesthetic results of the extreme oncoplasty of the enrolled patients. Patients and Methods This is a prospective cohort study to assess the feasibility of extreme oncoplasty and achievement of negative margins in the enrolled patients and the aesthetic results of the extreme oncoplasty. This study was conducted at Ain-Shams University Hospitals. Approval of the Ethical Committee and written informed consent from all participants was obtained. Extreme oncoplasty techniques was proposed for patients in whom inclusion criteria was met. Diagnosis and staging examinations were carried out according to the standard protocol being conducted at Ain Shams University Hospitals. Results We report the oncoplastic outcomes after EO in a single institutional cohort of 20 patients with multifocal/Multicenteric or large tumors (≥50mm).While no major complications were observed after EO procedure, a low rate of minor complications (7.7%) was observed. Conclusion The combination of plastic surgery techniques with breast oncology surgery gives the surgeon a new tool for treatment of breast cancer. The preliminary results of our study indicate that selective patients (with multifocal/Multicenteric or large tumors) who were initially considered for mastectomy can be alternatively treated using Extreme oncoplasty (EO) followed by radiotherapy. EO can be considered as a safe and feasible surgical option for such patients without compromising aesthetic outcomes.

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Dermatography: 10 Years of Applications as an Adjuvant Treatment after Nipple and Areola Reconstruction

The American Journal of Cosmetic Surgery ◽

10.1177/074880680001700106 ◽

2000 ◽

Vol 17 (1) ◽

pp. 23-26 ◽

Cited By ~ 4

Author(s):

Eddy M. Van Der Velden ◽

Brigitte H. I. M. Drost ◽

Otto E. Ijsselmuiden ◽

Abraham M. Baruchin

Keyword(s):

Breast Cancer ◽

Radiation Therapy ◽

Breast Surgery ◽

Total Resection ◽

Refined Method ◽

Aesthetic Results ◽

The Aesthetic ◽

Small Parts ◽

Bilateral Reconstruction ◽

Over Time

Introduction: Nipple and areola reconstruction have recently become in demand because more women are having breast surgery because of breast cancer diagnoses. Many methods for reconstructing the nipple and areola of the breast have been described and several treatment methods have been developed to improve the aesthetic results. The purpose of this paper is to describe one method, dermatography, a refined method of medical tattooing and the results obtained from this method. Materials and Methods: Over 10 years, 112 patients were treated with dermatography for nipple and areola reconstructions. Of these, 89 patients had received a unilateral reconstruction and 23 received a bilateral reconstruction. The first dermatographic treatment was given 8–12 months after the last intervention by the plastic surgeon. The average session lasted 45 minutes. Results were assessed by means of a short questionnaire. Results over time were evaluated by comparing pictures from previous sessions. Dermatography uses a modified tattooing called a dermainjector machine. Keloidectomy is the technique used to reduce keloid in postoperative scars. The needles of the dermainjector are positioned at an angle of 70–90 degrees to the scar surface. Small parts of the keloid are removed. At the same time pigmentation is performed. Results: Patients evaluated their results as satisfactory. Pigmentation over 5 years was judged to be stable with minor loss of pigment in only 6% of the patients, all of whom received radiation therapy for their cancer. Dermatography was well tolerated by the patients. None of the patients required local anesthesia. Discussion: Patients receiving total resection of their breasts are getting younger and perceiving the results as a severe deformation of their bodies. Results of reconstruction are judged very critically. We found that our patients considered the general visual aspect of the nipple and areola shape more important, and most of the patients did not consider reconstruction of the actual nipple mound to be necessary.

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Skin Sparing Mastectomy as an Oncoplastic Surgery Technique for Breast Cancer treatment

QJM ◽

10.1093/qjmed/hcaa050.025 ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Author(s):

A M Alanwar ◽

A G Osman ◽

M A Abdelhamed ◽

A N E Ebrahim

Keyword(s):

Breast Cancer ◽

Breast Surgery ◽

Volume Ratio ◽

Radical Mastectomy ◽

Cosmetic Outcome ◽

University Hospitals ◽

Psychological Outcome ◽

Oncoplastic Breast Surgery ◽

Large Tumor ◽

Oncological Safety

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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Oncoplastic breast surgery techniques - a new look at surgical treatment of breast cancer

Current Issues in Pharmacy and Medical Sciences ◽

10.1515/cipms-2018-0025 ◽

2018 ◽

Vol 31 (3) ◽

pp. 131-134

Author(s):

Krzysztof Kozak ◽

Rafal Wojcik ◽

Maciej Czerwonka ◽

Slawomir Mandziuk ◽

Barbara Madej-Czerwonka

Keyword(s):

Breast Cancer ◽

Surgical Treatment ◽

Statistical Data ◽

Breast Surgery ◽

Point Of View ◽

Oncoplastic Breast Surgery ◽

Reconstruction Surgery ◽

Common Cancer ◽

Breast Centers ◽

The Aesthetic

Abstract Breast cancer is the most common cancer among Polish women [1], thus, the problem of surgical treatment of breasts, especially with regard to conserving and/or reconstruction surgery, is extensively discussed. Currently, in Poland, efforts are made to increase the number of oncologic and reconstructive breast centers which offer specialized treatment of this cancer, the so-called ‘Breast Units’ [1]. This paper analyzes methods of reconstructions, discusses the techniques used in particular types of surgeries and additionally informs the reader of the oncological aspects of the procedures. Based on literature, statistical data of breast reconstructions from Poland and the world are presented. Moreover, complications and psychological aspects of mammary gland surgery are dealt with, and the aesthetic effects of breast reconstructions are discussed. To support of our findings, we also present selected clinical cases from the oncological and reconstructive point of view.

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Aesthetic monitoring-based assessment of oncological safety of oncoplastic management of breast cancer: a multi-center research study

BMC Surgery ◽

10.1186/s12893-021-01410-0 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Selmy Awad ◽

Ahmed Tarabay ◽

Fahad H. Qahtani ◽

Faisal S. Alsulaimani ◽

Mohamed M. Shaat ◽

...

Keyword(s):

Breast Cancer ◽

Research Study ◽

Assessment Method ◽

High Rate ◽

Aesthetic Outcome ◽

University Hospitals ◽

Oncological Safety ◽

Aesthetic Results ◽

The Aesthetic ◽

Center Research

Abstract Background Oncoplastic Breast surgeries (OBS) in breast cancer have evolved to preserve the cancerous breast rather than its amputation to improve postoperative cosmetic results. The lack of evidence to support the oncological safety and benefits of OBS is questionable. In this study, we evaluate various aspects of oncoplastic surgeries with a focused monitoring of aesthetic results and oncological safety. Methods This was a multi-center observational study focused on the statistics of data collected from cases who underwent oncoplastic surgeries from the cohort of breast cancer candidates at Mansoura University Hospitals/Egypt and King Faisal Medical Complex/KSA from January 2015 to June 2018. All data were analyzed carefully using SPSS v-26. Results Eighty cases who underwent different oncoplastic surgeries were included and reviewed for the aesthetic outcome and oncological safety. The recurrence rate was found to be 2.5%. The breast impact treatment scale assessment method was used to analyze the aesthetic outcomes, and average scores were accepted in 90% of patients. Conclusions The oncoplastic breast surgeries are feasible and they had a high rate of oncological safety with the maintenance of good aesthetic outcomes and patient satisfaction.

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Oncoplastic Breast Surgery: A Review of Techniques Quadrant Per Quadrant

Open Medicine Journal ◽

10.2174/1874220301805010093 ◽

2018 ◽

Vol 5 (1) ◽

pp. 93-107 ◽

Cited By ~ 1

Author(s):

Gardani Marco ◽

Bertozzi Nicolò ◽

Grieco Michele Pio ◽

Pesce Marianna ◽

Simonacci Francesco ◽

...

Keyword(s):

Overall Survival ◽

Breast Tissue ◽

Breast Surgery ◽

Early Stage ◽

Breast Conserving Surgery ◽

Lower Pole ◽

Oncoplastic Breast Surgery ◽

Aesthetic Results ◽

The Aesthetic

Breast Conserving Surgery (BCS) has gradually substituted mastectomy in the treatment of early-stage tumors. Indeed it ensures the same overall survival and better aesthetic results when followed post-operative radiotherapy. Nevertheless more than 20% excision of breast tissue, retro-areolar or lower pole cancer, and higer-sized breasts with ptosis, tend to result in aesthetically unpleasant results. Oncoplastic breast surgery finds its route into breast conserving surgery in the attempt to improve the aesthetic results while not compromising the oncologic ones.

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Emotional expectations reported by hospitalized women in southeastern Brazil before being submitted to mastectomy with immediate breast reconstruction: A clinical-qualitative study

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.648 ◽

2017 ◽

Vol 41 (S1) ◽

pp. s507-s507

Author(s):

G.L. Almeida ◽

R.M.C. Sena ◽

V.L.P. Alves ◽

C. Cardoso-Filho ◽

E.R. Turato

Keyword(s):

Breast Cancer ◽

Breast Reconstruction ◽

Immediate Breast Reconstruction ◽

University Hospital ◽

Southeastern Brazil ◽

Immediate Reconstruction ◽

Female Population ◽

Competing Interest ◽

Health Assistant ◽

The Aesthetic

IntroductionBreast cancer is a type that more affects female population in the world. Surgical indication, present in most cases, is a mutilating procedure and mentally traumatic for majority of women subjected. Thus, immediate breast reconstruction, which is the choice to rebuild the breast during the mastectomy surgery, is an alternative to reduce discomforts associated with loss of the breast, in addition to being associated potentially with improved emotional and psychosocial quality of life.ObjectiveTo discuss, from psychological viewpoint, the emotional expectations about surgical results of a planned mastectomy with immediate breast reconstruction, reported by women with breast cancer treated in a university hospital in Campinas, state of São Paulo.MethodQualitative design, particularized in the clinical-qualitative method, adequate to health assistant settings, using the semi-directed interview with open-ended questions in-depth, fully transcribed and after submitted to content clinical-qualitative analysis. Intentional sample closed by criterion of information theoretical saturation with 12 sequential participants.ResultsAmongst the emergent categories from free-floating readings, we have chosen the following to presentation:.–The desire of healing above expectations of the aesthetic aspects;–The perception of the surgical approach predominantly with aesthetic effects;–The desire of a contra-lateral healthy breast withdrawal, too.ConclusionsFace the proposal of mastectomy with immediate reconstruction, days before the surgery, women reported to be well emotionally organized for the procedure, although in different ways. This occurs probably due to emotional meanings built by many experiences from their psychological histories, as well as from values provided by the socio-cultural environments.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Axillary surgery in breast cancer patients treated with breast-conserving surgery at german breast cancer centers within the last 14 years – comparison of a university center and a community hospital

Senologie - Zeitschrift für Mammadiagnostik und -therapie ◽

10.1055/a-0868-8241 ◽

2019 ◽

Vol 16 (01) ◽

pp. 59-66

Author(s):

Amelie de Gregorio ◽

Peter Widschwendter ◽

Susanne Albrecht ◽

Nikolaus de Gregorio ◽

Thomas Friedl ◽

...

Keyword(s):

Breast Cancer ◽

Community Hospital ◽

Breast Conserving Surgery ◽

University Hospital ◽

Axillary Lymph ◽

Breast Cancer Patients ◽

University Hospitals ◽

Cancer Centers ◽

Axillary Surgery ◽

Over Time

Abstract Background Guideline recommendations for axillary surgical approach in breast cancer (BC) treatment changed over the last decade. Methods Data from all invasive BC patients (n = 5344) treated with breast conserving surgery (BCS) at the breast cancer centers of the University Hospital Ulm (U‑BCC) and the community hospital Dachau (D‑BCC) were included into a retrospective analysis for assessing information on axillary surgery between 2003 and 2016 based on the documented cancer registry data. Results The average annual rate of sentinel node biopsy (SNB) was 85.5 % and 87.2 % in Ulm and Dachau, respectively. SNB was performed more precisely at the U‑BCC with a median of 2.4 resected lymph nodes (LN) compared to a median of 3.2 resected LN in Dachau. Median number of resected LN for axillary lymph node dissection (ALNE) showed a statistically significant reduction over time in Ulm (rs = − 0.82; p < 0.001) and Dachau (rs = − 0.76; p = 0.002). The rate of secondary ALNE (after SNB; 2° ALNE) decreased significantly in U‑BCC (rs = − 0.76; p = 0.002) while it remained stable in D‑BCC. The influential publication of the Z0011 study in 2010 resulted in a significant reduction of secondary ALNE (24.1 % pre Z0011 and 14.4 % postZ0011; p < 0.001) in Ulm. Conclusion Changes in axillary surgery over time can be seen in the annual statistics of the reviewed BCCs. With BCS, mostly SNB was performed and numbers of removed LN in ALNE have decreased. In the U‑BCC, the rate of 2° ALNE dropped after the publication of the Z0011 data. The fact that no such decrease for 2° ALNE was found in D‑BCC suggests that university hospitals implement new data and research results into clinical routine earlier than peripheral community hospitals.

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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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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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