scholarly journals Enhanced Recovery after Surgery (ERAS) protocols in breast cancer patients undergoing post-mastectomy breast reconstruction with tissue expander

2019 ◽  
Vol 12 (2) ◽  
pp. 14-22
Author(s):  
Maria Bourazani ◽  
Martha Kelesi ◽  
Georgia Fasoi

A lot of women choose the immediate breast reconstruction after mastectomy. The most common method is breast reconstruction using tissue expanders. Women's way of life and the economic crisis have created the need for adopting enhanced recovery after surgery (ERAS) protocols and early hospital discharge. The present study aims at informing perioperative nurses about the ERAS protocols and encouraging their implementation. ERAS protocols in breast cancer patients undergoing immediate post-mastectomy breast reconstruction include a combination of evidence-based interoperative interventions with the participation of surgeons, anesthetists, nurses, physiotherapists, and dietitians as members of the multidisciplinary team. This is a multifactorial approach to postoperative rehabilitation and care of the surgical patient. ERAS protocols are easy to apply, reduce morbidity, perioperative anxiety, postoperative pain, postoperative complications and hospitalization. In addition, they reduce the cost of treatment and hospitalization. The patient's approach to breast cancer following an ERAS protocol is divided into three phases: pre-surgical, intraoperative and post-operative. It starts before the patient’s hospitalization and continues until they are discharged, requiring active participation throughout the process. The total average hospitalization for post-mastectomy rehabilitation decreased from 3.6 days, prior to ERAS implementation, to 0 (discharging the same day) to 1.2 days post-surgery, releasing 30% of the beds. In conclusion, the ERAS protocols, following evidence-based perioperative care, promote the rapid recovery of patients aiming at reducing post-operative stress and its effects.

Author(s):  
Piotr Pluta ◽  
Janusz Piekarski ◽  
Marek Zadrożny

IntroductionA nipple reconstruction complements breast mound restoring in postmastectomy breast cancer patients. It positively affects patients' welfare, both in psycho-social and sexual aspects. An immediate nipple reconstruction is an alternative approach to delayed surgery. We describe an original technique for an immediate nipple reconstruction by the use of a modified rectangular flap.Material and methodsOne hundred seventeen nipple reconstructions in 112 breast cancer patients were performed. This technique was used during skin-sparing mastectomy, including 104 implants (88.9%) and 13 tissue-expander (11.1%) breast reconstructions. Synthetic meshes covered with titanium supported lower breast poles in 72 implantations (61.5%); in remaining cases, (38.5%) muscles covered the entire implant. Preoperative chemotherapy was applied in 18.75% of the patients; adjuvant chemo- and hormonal therapy obtained 29.5% and 74.1% of the patients, respectively. Twenty-four patients (21.4%) were irradiated postoperatively.ResultsIn 5 out of 117 surgeries (4.3%), necrosis of the rectangular flap was observed. Twelve months since surgery, two-loss of projection of reconstructed nipple was reported (1.7%). In the twelfth month of observation, of the subgroup of 102 patients with permanent nipple presentation, 93.1% gave a positive opinion regarding the procedure.ConclusionsThe given immediate nipple reconstruction technique performed during a skin-sparing mastectomy and implant/expander-based breast reconstruction was an effective and safe adjunct curative breast surgery.


BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sung Mi Jung ◽  
Byung-Joon Jeon ◽  
Jinsun Woo ◽  
Jai Min Ryu ◽  
Se Kyung Lee ◽  
...  

Abstract Background Immediate breast reconstruction with tissue expander in breast cancer patients who were expected to receive adjuvant therapy, such as chemotherapy or radiotherapy, has been a topic of debate. Postoperative complications from tissue expander procedures can delay the timing of adjuvant treatment and subsequently increase the probability of recurrence. The purpose of this study was to identify the impact of chemotherapy and radiotherapy on postoperative complications in patients who underwent immediate reconstruction (IR) using tissue expander. Methods We conducted a retrospective study of 1081 breast cancer patients who underwent mastectomy and IR using tissue expander insertion between 2012 and 2017 in Samsung Medical Center. The patients were divided into two groups based on complications (complication group vs. no complication group). Complication group was regarded to have surgical removal or conservative treatment based on clinical findings such as infection, capsular contracture, seroma, hematoma, rupture, malposition, tissue viability, or cosmetic problem. The complication group had 59 patients (5.5%) and the no complication group had 1022 patients (94.5%). Results In univariate analysis, adjuvant radiotherapy and adjuvant chemotherapy were significantly associated with postoperative complications. In multivariate analysis, however, only higher pathologic N stage was significantly associated with postoperative complications (p < 0.001). Chemotherapy (p = 0.775) or radiotherapy (p = 0.825) were not risk factors for postoperative complications. Conclusions IR with tissue expander after mastectomy may be a treatment option even when the patients are expected to receive adjuvant chemotherapy or radiotherapy. These results will aid patients who are concerned about the complications of IR caused by chemotherapy or radiotherapy determine whether or not to have IR. Trial registration Patients were selected and registered retrospectively, and medical records were evaluated.


2018 ◽  
Vol 06 (03) ◽  
pp. 15-25 ◽  
Author(s):  
Tajudeen A. Wahab ◽  
Hanna Uwakwe ◽  
Maher Jumah ◽  
Rilwan Aransi ◽  
Humayun Kabir Khan

Author(s):  
Е. Тимошкина ◽  
E. Timoshkina ◽  
Сергей Ткачев ◽  
Sergey Tkachev ◽  
А. Назаренко ◽  
...  

Purpose: To evaluate the oncological results and late complication rate in breast cancer patients who underwent immediate implant-based breast reconstruction and adjuvant radiotherapy. Material and methods: 32 patients with I–IIIC breast cancer after combined treatment which included immediate implant-based breast reconstruction, chemotherapy and radiotherapy, were reviewed. Results: All 32 patients got skin erythema as an acute adverse effect. 6 (18 %) of them got acute mucositis. Median follow-up was 35 months (range 12–112 months). 2 (6 %) patients had local recurrence after 46 and 31 months since the operation day. Locoregional control rate was 94 %. 9 (28 %) patients presented distant metastases at term 8–71 months since the operation day, and metastases in bones, brain, lungs, liver and non-regional lymph nodes were diagnosed. 2 (6 %) patients died because of disease progression. Late adverse effects of skin and soft tissue in irradiated area were found in 4 (13 %) patients – capsular contracture was diagnosed 1 (n = 1), 2 (n = 2) and 3 (n = 1) stages. In two cases of four, capsular contracture was asymptomatic and found during the second stage of breast reconstruction while changing tissue expander to implant. Capsulotomy was performed, and aesthetic effect was good. In one case capsular contracture was the reason of implant removal, and then second reconstruction using tissue expander was performed. Conclusion: Nowadays immediate implant-based breast reconstruction is an essential part of combined treatment. Breast cancer patients after immediate implant-based breast reconstruction can be treated in adequate manner, and breast reconstruction is not a contraindication for radiotherapy. Low complication rates can still be acquired with the use of state-of-art 3D and 4D radiotherapy techniques and supportive care.


2014 ◽  
Vol 133 (2) ◽  
pp. 234-249 ◽  
Author(s):  
Bernice Tsoi ◽  
Natalia I. Ziolkowski ◽  
Achilleas Thoma ◽  
Kaitryn Campbell ◽  
Daria O’Reilly ◽  
...  

2021 ◽  
Vol 67 (6) ◽  
pp. 785-790
Author(s):  
Georgii Panshin ◽  
Pavel Polushkin ◽  
Aleksei Smyslov ◽  
Timur Izmailov

According to the data for 2019, breast cancer occupies a leading position among malignant neoplasms in the female population in the Russian Federation. Currently, there is an increase in the number of young breast cancer patients. In this regard, the requirements for the quality of life of patients, in particular the aesthetic results of special treatment, are increasing, which contributes to the introduction of methods of reconstructive surgery in oncomammology. The two-stage installation of a silicone breast implant is the most common method of breast reconstruction in oncological practice, in which a tissue expander is installed in patients at the first stage after mastectomy, and at the second stage it is replaced with a permanent implant. At the same time, the issue of radiotherapy in patients who have undergone the surgical stage of breast cancer treatment with reconstructive plastic surgery remains relevant to date. As is known, radiotherapy plays an important role in the combined and complex treatment of breast cancer, increasing, in general, locoregional control in operated patients. On the other hand, it may increase the risk of late complications of breast reconstruction, such as the development of capsular contractures and protrusions. It should also be emphasized that at present, the impact of hypofractive radiotherapy regimes, which are the most promising in clinical development, primarily on endoprostheses in patients during two-stage reconstruction, remains insufficiently studied. This article presents a brief analysis of the physical and dosimetric planning of radiotherapy in patients with breast cancer after the installation of a tissue expander who were treated on the basis of the RNCRR.


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