Age-dependent Characteristics in Women with Breast Cancer: Mastectomy and Reconstructive Trends at an Urban Academic Institution

Breast reconstruction is an important aspect of treatment after breast cancer. Postmastectomy reconstruction bears a significant impact on a woman's postsurgical confidence, sexuality, and overall well-being. Previous studies have inferred that women under age 40 years have unique characteristics that distinguish them from an older cohort. Identifying age-dependent trends will assist with counseling women on mastectomy and reconstruction. To identify age-dependent trends, 100 consecutive women were sampled from a prospectively maintained breast reconstruction database at an urban academic institution from June 2010 through June 2013. Women were placed into two cohorts <40 and ≥40 as well cohorts by decade (20s, 30s, 40s, 50s, and 60s). Statistical trends were reported as odds of risk per year of increasing age using logistic regression; linear regression, χ2, and Fischer's exact were used to compare <40 and ≥40 and split cohorts for comparison. Comorbidities, tumor staging, oncologic treatment including chemotherapy and radiation, disease characteristics and genetics, and mastectomy, reconstructive and symmetry procedures were evaluated. Statistical analysis was performed using SAS software. In 100 patients of the sample study cohort, 151 reconstructions were performed. Increasing age was associated with one or more comorbidities [odds ratio (OR) = 1.07, P = 0.005], whereas younger age was associated with metastatic disease (OR = 0.88, P = 0.006), chemotherapy (OR = 0.94, P = 0.01), and radiation (OR = 0.94, P = 0.006); split cohorts demonstrated similar trends ( P < 0.005). Mastectomy and reconstructive characteristics associated with younger age included bilateral mastectomy (OR = 0.94, P = 0.004), tissue expander (versus autologous flap) (OR = 0.94, P = 0.009), extra high implant type (OR = 0.94, P = 0.049), whereas increasing use of autologous flaps and contralateral mastopexy symmetry procedures (OR = 1.09, P = 0.02) were associated with an aging cohort. Increasing age was not associated with an increasing likelihood of complications ( P = 0.75). Age-related factors play a role in the treatment of patients with breast cancer. Younger women typically present with more aggressive features requiring oncologic treatment including chemotherapy and radiation. Mastectomy and reconstructive choices also demonstrate age-dependent characteristics. Women in younger age groups are more likely to pursue risk-reduction procedures and implant-based strategies, whereas older women had a higher propensity for abdominal-based autologous reconstruction. In addition, preferential reconstructive strategies correlate with age-dependent archetypical features of the breast (higher profile implants in younger patients; autologous reconstruction on affected side mimicking natural ptosis, and contralateral mastopexy in older patients). These trends seem to be consistent with each increasing year of age. Age-related preferences and expectations, age-dependent body habitus and breast shape, and lifetime risk play a role in the choices pursued for mastectomy and reconstruction.

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Secondary Angiosarcoma With C-MYC Amplification Following Prophylactic Bilateral Mastectomy and Autologous Breast Reconstruction: Report of a Case and Review of the Literature

International Journal of Surgical Pathology ◽

10.1177/1066896920930100 ◽

2020 ◽

pp. 106689692093010

Author(s):

Chrisopher Webb ◽

Natalia Partain ◽

Prasad Koduru ◽

Helena Hwang ◽

Venetia R. Sarode

Keyword(s):

Breast Cancer ◽

Brca1 Gene ◽

Tumor Infiltrating Lymphocytes ◽

Lymphatic Drainage ◽

Bilateral Mastectomy ◽

Prior History ◽

Autologous Reconstruction ◽

Variant Of Uncertain Significance ◽

History Of ◽

Secondary Angiosarcoma

In this article, we report a very rare case of secondary angiosarcoma in a young woman with no prior history of breast cancer who had bilateral prophylactic mastectomies with autologous reconstruction due to a strong family history of breast cancer and BRCA1 gene variant of uncertain significance. The surgery was complicated by recurrent fat necrosis requiring several excisions and additional reconstruction followed by the development of localized lymphedema and subsequent angiosarcoma in the reconstructed breast 10 years later. The angiosarcoma was high grade with prominent epithelioid features associated with abundant tumor-infiltrating lymphocytes. Amplification of C-MYC locus 8q21.24 was demonstrated by fluorescence in situ hybridization study. We postulate that chronic trauma from several surgeries including tissue hypoxia and impaired lymphatic drainage may have provided a milieu for angiogenesis and mutagenic transformation. Amplification of C-MYC locus 8q21.24 was most likely a strong oncogenic driver of angiosarcoma. To the best of our knowledge, this is the first report of its kind in the literature.

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Psychosocial outcomes following surgery in women with unilateral, nonhereditary breast cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.570 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. 570-570

Author(s):

David Wai Lim ◽

Helene Retrouvey ◽

Isabel Kerrebijn ◽

Kate Butler ◽

Anne C O'Neill ◽

...

Keyword(s):

Breast Cancer ◽

Regression Model ◽

Surgical Procedure ◽

Psychosocial Outcomes ◽

Well Being ◽

Bilateral Mastectomy ◽

Change Over Time ◽

Younger Age ◽

Unilateral Mastectomy ◽

Over Time

570 Background: Rates of bilateral mastectomy continue to rise in average-risk women with unilateral breast cancer. We aim to characterize psychosocial predictors of surgical procedure and how psychosocial outcomes change over time after surgery for breast cancer. Methods: A prospective cohort of women with unilateral, nonhereditary breast cancer were recruited at University Health Network in Toronto, Canada between 2014-2017. Women completed validated psychosocial questionnaires (BREAST-Q) pre-operatively, and 6 and 12 months after surgery. Outcomes were assessed between three surgical groups (unilateral lumpectomy, unilateral mastectomy, bilateral mastectomy). Predictors of surgical procedure were identified using a multinomial logistic regression model. Change in psychosocial scores over time according to procedure was assessed using linear mixed models. All models control for age, stage, reconstruction and treatment. P values < .05 were considered statistically significant. Results: 506 women underwent surgery as follows: 216 unilateral lumpectomy (43%), 181 unilateral mastectomy (36%) and 109 bilateral mastectomy (22%). In the multinomial regression model, younger age (p < .01), and lower chest physical (p = .03) and sexual well-being (p = .02) predicted having bilateral mastectomy over unilateral lumpectomy while younger age (p < .01) and lower disease stage (p = .02) predicted bilateral mastectomy over unilateral mastectomy. The mixed model demonstrates that breast satisfaction follows a non-linear pattern of change over time, with 6- but not 12-month scores being significantly different from baseline (p = .015). Procedure predicts baseline satisfaction (p = .016), with bilateral mastectomy having worse satisfaction than unilateral lumpectomy. Procedure also predicts change in satisfaction, with unilateral and bilateral mastectomy having lower scores across time than lumpectomy. While a significant improvement in psychological well-being is detected by 12 months (p = .02), those with unilateral and bilateral mastectomy have worse psychological well-being over time compared to lumpectomy. Women having mastectomy start with worse physical well-being than those in the lumpectomy group, but their physical well-being does not decline as much as the lumpectomy group over time (p < .01). Conclusions: Definitive surgical procedure affects the trajectory of psychosocial functioning over time. This emerging data may be used to further facilitate surgical decision-making in women considering contralateral prophylactic mastectomy.

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Systematic and continuous collection of patient-reported outcomes and experience in women with cancer undergoing mastectomy and immediate breast reconstruction: a study protocol for the Tuscany Region (Italy)

BMJ Open ◽

10.1136/bmjopen-2020-042235 ◽

2021 ◽

Vol 11 (1) ◽

pp. e042235

Author(s):

Francesca Ferrè ◽

Sabina De Rosis ◽

Anna Maria Murante ◽

Kendall Jamieson Gilmore ◽

Matteo Ghilli ◽

...

Keyword(s):

Breast Cancer ◽

Breast Reconstruction ◽

Patient Reported Outcomes ◽

Care Pathway ◽

Ethics Committees ◽

Immediate Breast Reconstruction ◽

Care Process ◽

Autologous Reconstruction ◽

Patient Reported ◽

Dissemination Of Results

IntroductionMonitoring how patients feel and what they experience during the care process gives health professionals data to improve the quality of care, and gives health systems information to better design and implement care pathways. To gain new insights about specific gaps and/or strengths in breast cancer care, we measure patient-reported outcomes (PROs) and patient-reported experiences (PREs) for women receiving immediate breast reconstruction (iBR).Methods and analysisProspective, multicentre, cohort study with continuous and systematic web-based data collection from women diagnosed with breast cancer, who have an indication for iBR after mastectomy treated at any Breast Unit (BU) in Tuscany Region (Italy). Patients are classified into one of two groups under conditions of routine clinical practice, based on the type of iBR planned (implant and autologous reconstruction). Patient-reported information are obtained prior to and after surgery (at 3-month and 12-month follow-up). We estimate that there are around 700 annual eligible patients.Descriptive analyses are used to assess trends in PROs over time and differences between types of iBR in PROs and PREs. Additionally, econometric models are used to analyse patient and BU characteristics associated with outcomes and experiences. PREs are evaluated to assess aspects of integrated care along the care pathway.Ethics and disseminationThe study has been reviewed and obtained a nihil obstat from the Tuscan Ethics Committees of the three Area Vasta in 2017. Dissemination of results will be via periodic report, journal articles and conference presentations.

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Breast Reconstruction and Post Mastectomy Radiotherapy: A Primer for Members of a Multidisciplinary Team

Archives of Breast Cancer ◽

10.32768/abc.20218280-87 ◽

2021 ◽

pp. 80-87

Author(s):

Aska Arnautovic ◽

Sigurast Olafsson ◽

Julia Wong ◽

Shailesh Agarwal ◽

Justin Broyles

Keyword(s):

Breast Cancer ◽

Breast Reconstruction ◽

Treatment Plan ◽

Tissue Expander ◽

Autologous Reconstruction ◽

Reconstructive Procedures ◽

Radiation Delivery ◽

Permanent Implant ◽

Staged Reconstruction ◽

Timely Administration

Background: Post-mastectomy radiation therapy (PMRT) is a key component in managing breast cancer with increased potential for locoregional recurrence. Breast reconstruction has evolved to include various techniques that can be categorized according to the type of reconstruction (implant-based versus autologous reconstruction), and the timing of reconstruction (one versus two-step techniques). Methods/Results: This review article aims to provide a digestible summary of PMRT in the context of breast reconstruction by summarizing salient existing literature with a focus on considerations of the plastic surgeon. The main findings summarized in this review include the technique and timing of breast reconstruction, how breast reconstruction can affect radiation delivery, and the type of reconstruction. Within implant-based reconstruction, existing data on the location of the implant in the context of PMRT and PMRT delivery to the tissue expander versus permanent implant are reviewed. Each consideration may alter the probability of successful reconstruction and patient satisfaction.Conclusion: It is essential for the multidisciplinary breast cancer team to have knowledge of the various reconstructive options, and to understand the safety and comparative effectiveness of staged reconstruction in the setting of PMRT. Additionally, one must consider that reconstructive procedures may have implications on the timely administration of PMRT. This review serves as a reference for members of the oncologic care team when discussing reconstructive options with patients who will receive PMRT as part of their treatment plan.

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Management of early breast cancer during the COVID-19 pandemic in Brazil

10.21203/rs.3.rs-41941/v1 ◽

2020 ◽

Cited By ~ 1

Author(s):

Francisco Pimentel Cavalcante ◽

Guilherme Garcia Novita ◽

Eduardo Camargo Millen ◽

Felipe Pereira Zerwes ◽

Vilmar Marques de Oliveira ◽

...

Keyword(s):

Breast Cancer ◽

Breast Reconstruction ◽

Early Breast Cancer ◽

Hormone Receptor ◽

Premenopausal Women ◽

Management Approach ◽

Autologous Reconstruction ◽

Hormone Receptor Positive ◽

Neoadjuvant Systemic Therapy ◽

The Impact

Abstract Purpose: The COVID-19 pandemic has impacted early breast cancer (EBC) treatment worldwide. This study analyzed how Brazilian breast specialists are managing EBC. Methods: An electronic survey was conducted with members of the Brazilian Society of Breast Specialists between April 30 and May 11, 2020. Bivariate analysis was used to describe changes in how specialists managed EBC at the beginning and during the pandemic, according to molecular subtype and oncoplastic surgery. Results: The response rate was 34.4% (503/1,462 specialists). At the beginning of the pandemic, 43% changed their management approach. As the outbreak progressed, this proportion increased to 69.8% (p<0.001). For hormone receptor-positive tumors with the best prognosis (Ki67<20%), 47.9% and 17.7% of specialists would recommend neoadjuvant endocrine therapy for postmenopausal and premenopausal women, respectively. For tumors with poorer prognosis (Ki67>30%), 34% and 10.9% would recommend it for postmenopausal and premenopausal women, respectively. Menopausal status significantly affected whether the specialists changed their approach (p<0.00001). For tumors ≥1.0 cm, 42.9% of respondents would recommend neoadjuvant systemic therapy for triple-negative tumors and 39.6% for HER2+ tumors. Overall, 63.4% would recommend immediate total breast reconstruction, while only 3.4% would recommend autologous reconstruction. In breast-conserving surgery, 75% would recommend partial breast reconstruction; however, 54.1% would contraindicate mammoplasty. Furthermore, 84.9% of respondents would not recommend prophylactic mastectomy in cases of BRCA mutation.Conclusions: Important changes occurred in EBC treatment, particularly for hormone receptor-positive tumors, as the outbreak progressed in each region. Systematic monitoring could assure appropriate breast cancer treatment, mitigating the impact of the pandemic.

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Type of surgery for early breast cancer and predictive factors an institutional review: A regression model.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.e12016 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. e12016-e12016

Author(s):

Mahvish Muzaffar ◽

Iman Mohamed ◽

Colette Gaba ◽

Sadik Khuder

Keyword(s):

Breast Cancer ◽

Early Breast Cancer ◽

Cancer Registry ◽

Academic Institution ◽

Stage I ◽

Stage Ii ◽

Bilateral Mastectomy ◽

Tumor Characteristics ◽

Local Surgery ◽

Type Of Surgery

e12016 Background: Breast conserving surgery (BCS) is the preferred surgical management for most early-stage breast cancer, given the equivalent survival after BCS plus radiation and mastectomy (M). Clinical reports of an increasing trend in mastectomy from some institutional reviews have been published. The aim of this study was to assess correlation of type of surgery with different factors in our cancer registry database. Methods: We retrospectively reviewed the cancer registry data at UTMC for early breast cancer stage I/II from 2006-2010. Patient demographics, tumor characteristics, institution of surgery, academic versus private surgeon were identified and compared. We used univariate analysis to select factors for entry into a multivariate analysis. Multinomial logistic regression analysis was performed to predict the type of surgery (cancer side mastectomy (CSM) versus BCS, bilateral mastectomy (BM) versus BCS based on the above variables. A p-value of < 0.05 was significant and comparisons were two tailed. Results: We identified 506 eligible patients with stage I/II breast cancer. 306(60.5%) had undergone breast conservative surgery (BCS), 91 (18%) patients had cancer side mastectomy (CSM) and 109 (21.5%) patients had bilateral mastectomy (BM). 298 (59%) patients were stage I and 208 (41%) had stage II, 218 (42%) had undergone surgery at academic center versus 298 (58%) at nonacademic institution. Predictors o CSM were stage II (p =0.0193), high-grade tumor (p=0.015), surgeon from academic institution (p=0.64), age (p=0.61). Predictors of BM were surgeon from academic institution (p=0.060), age (p=0.07). Conclusions: This study confirms some known factors like stage, surgeon expertise, as influencing factors in type of local surgery, while at the same time did not show impact of race and other tumor characteristics. Further research of these factors need to confirm the influence on decision making prospectively.

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Postmastectomy Radiation of Latissimus Dorsi Myocutaneous Flap Reconstruction is Well Tolerated in Women with Breast Cancer

The American Surgeon ◽

10.1177/000313481207801025 ◽

2012 ◽

Vol 78 (10) ◽

pp. 1122-1127 ◽

Cited By ~ 2

Author(s):

Brandice Durkan ◽

Farin Amersi ◽

Edward H. Phillips ◽

Randy Sherman ◽

Catherine M. Dang

Keyword(s):

Breast Cancer ◽

Breast Reconstruction ◽

Chest Wall ◽

Latissimus Dorsi ◽

Myocutaneous Flap ◽

Immediate Breast Reconstruction ◽

Bilateral Mastectomy ◽

Wound Complications ◽

Postmastectomy Radiation ◽

Latissimus Dorsi Myocutaneous Flap

Chest wall irradiation decreases locoregional recurrence and breast cancer-related mortality in women at high risk for recurrence after mastectomy. Many women undergoing mastectomy desire immediate breast reconstruction. Postmastectomy radiation therapy (PMRT), however, increases the risk of surgical complications and may adversely affect the reconstructed breast. We compared outcomes of immediate latissimus dorsi myocutaneous flap (Lat Flap) versus tissue expander/implant (EI) reconstruction after mastectomy followed by PMRT in 29 women with invasive breast cancer treated at a single institution between 2009 and 2011. Although patients undergoing EI reconstruction were slightly younger and more frequently underwent bilateral mastectomy, there were no major differences between the groups with respect to patient or tumor characteristics. With a median follow-up of 11 months (Lat Flap) and 13 months (EI) after completion of PMRT, there was a trend toward more wound complications requiring reoperation, including expander/implant loss (n = 3), in the EI group. Capsular contracture was the most common sequela of PMRT in the Lat Flap group (67%) but this was easily treated with capsulotomy at the time of nipple– areola reconstruction. Immediate breast reconstruction with a latissimus dorsi myocutaneous flap is a viable option for women undergoing mastectomy who are likely to require chest wall irradiation.

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Two-Stage Tissue-Expander Breast Reconstruction: A Focus on the Surgical Technique

BioMed Research International ◽

10.1155/2017/1791546 ◽

2017 ◽

Vol 2017 ◽

pp. 1-8 ◽

Cited By ~ 1

Author(s):

Elisa Bellini ◽

Marianna Pesce ◽

PierLuigi Santi ◽

Edoardo Raposio

Keyword(s):

Breast Cancer ◽

Body Image ◽

Surgical Technique ◽

Breast Reconstruction ◽

Tissue Expander ◽

Psychological Trauma ◽

Cancer Tissue ◽

Autologous Reconstruction ◽

Two Stage ◽

Aesthetic Result

Objective. Breast cancer, the most common malignancy in women, comprises 18% of all female cancers. Mastectomy is an essential intervention to save lives, but it can destroy one’s body image, causing both physical and psychological trauma. Reconstruction is an important step in restoring patient quality of life after the mutilating treatment. Material and Methods. Tissue expanders and implants are now commonly used in breast reconstruction. Autologous reconstruction allows a better aesthetic result; however, many patients prefer implant reconstruction due to the shorter operation time and lack of donor site morbidity. Moreover, this reconstruction strategy is safe and can be performed in patients with multiple health problems. Tissue-expander reconstruction is conventionally performed as a two-stage procedure starting immediately after mammary gland removal. Results. Mastectomy is a destructive but essential intervention for women with breast cancer. Tissue expansion breast reconstruction is a safe, reliable, and efficacious procedure with considerable psychological benefits since it provides a healthy body image. Conclusion. This article focuses on this surgical technique and how to achieve the best reconstruction possible.

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Breast Cancer beyond the Age of Mutation

Gerontology ◽

10.1159/000441030 ◽

2015 ◽

Vol 62 (4) ◽

pp. 434-442 ◽

Cited By ~ 22

Author(s):

Mark A. LaBarge ◽

E. Lorena Mora-Blanco ◽

Susan Samson ◽

Masaru Miyano

Keyword(s):

Breast Cancer ◽

Cancer Incidence ◽

Breast Tissue ◽

Breast Cancer Incidence ◽

Epigenetic Changes ◽

Breast Cancers ◽

Age Related ◽

Age Dependent ◽

Tissue Changes ◽

Cellular Phenotypes

Age is the greatest risk factor for breast cancer, but the reasons underlying this association are unclear. While there is undeniably a genetic component to all cancers, the accumulation of mutations with age is insufficient to explain the age-dependent increase in breast cancer incidence. In this viewpoint, we propose a multilevel framework to better understand the respective roles played by somatic mutation, microenvironment, and epigenetics making women more susceptible to breast cancer with age. The process of aging is associated with gradual breast tissue changes that not only corrupt the tumor-suppressive activity of normal tissue but also impose age-specific epigenetic changes that alter gene expression, thus reinforcing cellular phenotypes that are associated with a continuum of age-related tissue microenvironments. The evidence discussed here suggests that while the riddle of whether epigenetics drives microenvironmental changes, or whether changes in the microenvironment alter heritable cellular memory has not been solved, a path has been cleared enabling functional analysis leading to the prediction of key nodes in the network that link the microenvironment with the epigenome. The hypothesis that the accumulation of somatic mutations with age drives the age-related increase in breast cancer incidence, if correct, has a somewhat nihilistic conclusion, namely that cancers will be impossible to avoid. Alternatively, if microenvironment-driven epigenetic changes are the key to explaining susceptibility to age-related breast cancers, then there is hope that primary prevention is possible because epigenomes are relatively malleable.

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Trends in bilateral mastectomy for cases of unilateral breast cancer in a Brazilian institute over a 10-year period

Mastology ◽

10.29289/2594539420210030 ◽

2021 ◽

Vol 31 ◽

Author(s):

Francisco Pimentel Cavalcante ◽

Paulo Goberlâneo de Barros Silva ◽

Marcos Venicio Alves Lima

Keyword(s):

Breast Cancer ◽

Breast Reconstruction ◽

Immediate Breast Reconstruction ◽

Bilateral Mastectomy ◽

Contributing Factors ◽

Unilateral Breast Cancer ◽

Nipple Sparing Mastectomy ◽

Nipple Sparing ◽

Unilateral Mastectomy ◽

Type Of Surgery

Introduction: There has been a substantial increase worldwide in the number of women with unilateral breast cancer who undergo bilateral mastectomy. Possible contributing factors include the advent of nipple-sparing mastectomy (NSM) and an improvement in breast reconstruction techniques. This study evaluated the trend in bilateral mastectomy at the Ceará Cancer Institute in Brazil. Methods: Patients with unilateral breast cancer who underwent mastectomy and immediate breast reconstruction were evaluated retrospectively between 2009 and 2018. Clinical, pathological and surgical factors were analyzed to determine their possible effects on the type of surgery performed. Results: Of 121 patients, 77 (63.6%) were submitted to unilateral mastectomy, while 44 (36.4%) underwent bilateral mastectomy. Most were treated with NSM (n = 66; 54.5%), with this technique being significantly associated with bilateral mastectomy (p < 0.001). Bilateral mastectomy increased significantly over the period (p = 0.009; r2 = 0.592), but unilateral mastectomy did not (p = 0.417; r2 = 0.084). Age < 45 years (p = 0.007) and negative axilla (p = 0.003) were also associated with bilateral mastectomy, while axillary dissection was associated with unilateral mastectomy (p = 0.028). Multivariate analysis showed the 2016-2018 period to be an independent factor associated with bilateral mastectomy. Conclusions: These results corroborate the international literature. From 2010 onwards, there was a trend towards an increase in bilateral mastectomy with breast reconstruction. These data may contribute to multidisciplinary debates, facilitating the establishment of guidelines. Further studies are required to improve understanding of this phenomenon in Brazil.

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