Analysis of risk factors for complications in expander/implant breast reconstruction by stage of reconstruction

Analysis of risk factors for complications in expander/implant breast reconstruction by stage of reconstruction. Plastic and Reconstructive Surgery, Nov 2014, Vol. 134(5), p.692e-699e

Hirsch, E.M., et al.

http://journals.lww.com/plasreconsurg/Fulltext/2014/11000/Analysis_of_Risk_Factors_for_Complications_in.7.aspx

Expander/implant breast reconstruction is a common approach to breast reconstruction. Although several studies evaluate risk factors for complications during the overall reconstructive process, no studies currently evaluate risk factors by stage of reconstruction. This information is important, as it can help guide physician and patient decision making.

Postmastectomy radiotherapy in patients with breast cancer

Postmastectomy radiotherapy in patients with breast cancer - author's reply. The Lancet, Nov 2014, Vol. 384(9957), p.1846-47

Early Breast Cancer Trialists' Collaborative Group 

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)62240-6/fulltext?rss=yes#bib1

Our meta-analysis of individual patient data from trials in women given mastectomy and axillary clearance to at least level ll showed that radiotherapy reduced mortality from breast cancer by 20% in women with one to three positive lymph nodes (rate ratio [RR], irradiated vs not, 0·80, 95% CI 0·67—0·95; 2p=0·01) and by 13% in women with at least four positive lymph nodes (RR 0·87, 95% CI 0·77—0·99; 2p=0·04). Little reason of how radiotherapy works exists to think that this treatment for breast cancer has any appreciable abscopal effect and so, as Ismail Jatoi suggests, these results showed that a proportion of the deaths avoided by radiotherapy would have arisen from cells localised within the areas targeted by radiotherapy (ie, the chest wall and, for most trials, the regional lymph nodes).

Fertility advice

Breast cancer women 'not offered fertility advice'.  BBC News, Nov 2014

http://www.bbc.co.uk/news/health-30129324

Most young women diagnosed with breast cancer do not receive fertility advice, despite the fact their treatment could leave them unable to have children.

Chemotherapy can stop the ovaries working for a while or may bring on an early menopause.

Charity Breast Cancer Care, which surveyed 170 women under 45, wants all younger women to be referred to a fertility expert at diagnosis.

Treatment patterns and duration in post-menopausal women with HR+/HER2

Treatment patterns and duration in post-menopausal women with HR+/HER2 - metastatic breast cancer in the US: a retrospective chart review in community oncology practices.Current Medical Research and Opinion, Nov. 2014.

Macalalad, A.R., et al.

http://informahealthcare.com/doi/abs/10.1185/03007995.2014.980885

Clinical guidelines prefer endocrine therapy (ET) as initial treatment for post-menopausal women with hormone receptor positive (HR+)/human epidermal growth factor receptor 2 negative (HER2−) metastatic breast cancer (mBC). Chemotherapy (CT) should be reserved for patients who develop symptomatic visceral disease or have no clinical benefit after three sequential ET regimens. It is unclear if real-world clinical practice reflects these guidelines.

Breast reconstruction using free posterior medial thigh perforator flaps

Breast reconstruction using free posterior medial thigh perforator flaps: Intraoperative anatomical study and clinical results. Plastic and Reconstructive Surgery, Nov 2014, Vol. 134(5), p.880-91.

Satake, T., et al.

http://journals.lww.com/plasreconsurg/Abstract/2014/11000/Breast_Reconstruction_Using_Free_Posterior_Medial.5.aspx

The free posterior medial thigh perforator flap is a fasciocutaneous flap on the posterior and medial thigh, based on perforators from the deep femoral vessels. In this study, the authors evaluated the anatomical basis of posterior and medial thigh perforators from the deep femoral vessels.

The impact of postmastectomy radiotherapy on two-stage implant breast reconstruction

The impact of postmastectomy radiotherapy on two-stage implant breast reconstruction: An analysis of long-term surgical outcomes, aesthetic results and satisfaction over 13 years. Plastic and Reconstructive Surgery, October 2014, Vol. 134(4), p.588-95.

Cordeiro, P.G., et al.

http://journals.lww.com/plasreconsurg/Abstract/2014/10000/The_Impact_of_Postmastectomy_Radiotherapy_on.4.aspx

Postmastectomy radiation therapy is increasingly indicated in patients with node-positive breast cancer. The authors prospectively evaluated long-term outcomes in patients with two-stage implant-based reconstruction and postmastectomy radiation therapy to the permanent implant.

Invisible risks, emotional choices

Invisible risks, emotional choices: Mammography and medical decision making. NEJM, 2014; 371: 1549-52.

Rosenbaum, L.

http://www.nejm.org/doi/full/10.1056/NEJMms1409003?af=R&rss=currentIssue

Putting it all together: Managing pain in autologous and implant-based breast reconstruction

Putting it all together: Managing pain in autologous and implant-based breast reconstruction. Plastic and Reconstructive Surgery, October 2014, Vol. 134 (4S-2), p. 120S-125S.

Wilson, A.J., et al.

http://journals.lww.com/plasreconsurg/Fulltext/2014/10002/Putting_It_All_Together___Managing_Pain_in.19.aspx

Appropriate pain management in breast reconstruction improves outcomes and patient satisfaction. The purpose of this study is to review the current methodology and paradigms in pain management following breast reconstruction. Methods: A review of the scientific literature was performed. The protocols used at our institution were further examined and contrasted in the context of this published literature. Results: Pain following breast reconstruction is multifactorial and patient specific. Pain can originate from the mastectomy alone, from the donor site, or from tissue expansion. Counseling a patient is of upmost importance. The armamentarium to address pain includes narcotic analgesics, nonnarcotic analgesics, local anesthesia, and other nontraditional regimens. Each of these methods has an evidence-based efficacy and patient selection factors for application. Conclusions: The data contained herein provide a review of perioperative pain management following autologous and implant-based breast reconstruction.

Patient activated controlled expansion for breast reconstruction using controlled carbon dioxide inflation

Patient activated controlled expansion for breast reconstruction using controlled carbon dioxide inflation: Confirmation of a feasibility study. Plastic and Reconstructive Surgery, October 2014, Vol. 134(4), p.503e-511e.

Connell, T.

http://journals.lww.com/plasreconsurg/Fulltext/2014/10000/Patient_Activated_Controlled_Expansion_for_Breast.2.aspx

Women with breast cancer or those at high risk of developing breast cancer because of familial history of the disease or genetic mutations are frequently indicated for therapeutic or prophylactic mastectomy. Prosthetic reconstruction of the breast with placement of tissue expanders followed by implants offers favorable aesthetic and psychological results while adding only minimal additional surgical intervention. This study describes the confirmatory phase of an earlier feasibility trial that involved seven women who successfully underwent patient-activated controlled expansion for breast reconstruction with 10 AeroForm patient-controlled tissue expanders.

Methods: A prospective, open-label, single-arm, single-surgeon confirmatory study in Perth, Australia, evaluated outcomes of two-stage breast reconstruction using the investigational device. Each subject administered a preset 10-cc dose of carbon dioxide gas using a remote dosage controller, three times each day, with a 3-hour lockout between doses until full expansion was achieved.

Results: Thirty-three women with breast cancer, family history, or predisposition because of the BRCA1 or BRCA2 gene mutation underwent pedicled latissimus dorsi flap procedures with placement of 61 carbon dioxide–based tissue expanders. The mean number of days for subjects to achieve desired expansion was 17 ± 5. Operating the dosage controller was described by the surgeon as very easy in 94 percent of the cases and by 97 percent of the subjects. No serious adverse events were reported.

Conclusion: This study confirms that the AeroForm breast tissue expander has demonstrated the ability to provide, relative to saline expanders, a needle-free, patient-controlled, convenient, and time-saving method of tissue expansion.

Skirt size ups breast cancer risk

Skirt size ups breast cancer risk [UK study].  Health news from NHS Choices

http://feedly.com/#subscription%2Ffeed%2Fhttp%3A%2F%2Ffeeds.feedburner.com%2FNhsChoicesBehindTheHeadlines%3Fformat%3Dxml

The study was carried out by researchers from the Universities of London and Manchester, and was funded by the Medical Research Council, Cancer Research UK and the National Institute of Health Research, as well as the Eve Appeal.

The study was published in the peer-reviewed medical journal BMJ Open. As the name suggests, this is an open-access journal, so the study can be read for free online.

The paper was widely covered in the UK media. Coverage was fair, if uncritical.

Several headlines gave the impression that going up a single skirt size would raise breast cancer risk by 33%. Such a rise in risk would only be expected if a person went up a dress size every decade from their mid-twenties to when they were over 50 years old – the youngest age of the women recruited to the study.

Several media sources included useful comments from independent experts.

Current status of hormone therapy in patients with hormone receptor positive advanced breast cancer

Current status of hormone therapy in patients with hormone receptor positive (HR+) advanced breast cancer. The Breast, October 2014 [in press]

Dalmau, E., et al.

http://www.thebreastonline.com/article/S0960-9776(14)00171-4/abstract?rss=yes

The natural history of HR+ breast cancer tends to be different from hormone receptor-negative disease in terms of time to recurrence, site of recurrence and overall aggressiveness of the disease.

Nipple-sparing mastectomy in patients with prior breast irradiation

Nipple-sparing mastectomy in patients with prior breast irradiation: Are patients at higher risk for reconstructive complications? Plastic and Reconstructive Surgery Aug 2014, Vol. 134(2), p.202e-206e.

Alperovich, M., et al.

http://journals.lww.com/plasreconsurg/Abstract/2014/08000/Nipple_Sparing_Mastectomy_in_Patients_with_Prior.6.aspx

Reconstruction in the setting of prior breast irradiation is conventionally considered a higher-risk procedure. Limited data exist regarding nipple-sparing mastectomy in irradiated breasts, a higher-risk procedure in higher-risk patients.

Individual risk of surgical site infection

Individual risk of surgical site infection: An application of the breast reconstruction risk assessment score. Plastic and Reconstructive Surgery Sept 2014, Vol. 134(3), p.351e-362e.

Kim, J.Y.S., et al.

http://journals.lww.com/plasreconsurg/Fulltext/2014/09000/Individualized_Risk_of_Surgical_Site_Infection__.1.aspx

Risk factors for surgical-site infection following breast reconstruction have been thoroughly investigated at a population level. However, traditional population-based measures may not always capture the nuances of individual patients. The authors aimed to develop a validated breast reconstruction risk assessment calculator for surgical-site infection that informs risk at an individual level.

No reduction in death rate is seen with bilateral mastectomy

No reduction in death rate is seen with bilateral mastectomy. BMJ 2014; 349.

McCarthy, M.

http://www.bmj.com/content/349/bmj.g5402?rss=1&variant=short&hwoasp=authn%3A1409906788%3A4044144%3A3266341273%3A0%3A0%3A6BZxAKWi6ImzkhkTN57Ukg%3D%3D

Increasing numbers of US women with breast cancer are opting for double mastectomies, but the procedure is not associated with a lower 10 year mortality than breast conserving surgery with radiation, a study has found. The study was reported in the 3 September issue of JAMA. Allison W Kurian, of Stanford University School of Medicine in California, and colleagues, accessed data that had been collected from 1998 to 2011 on 189 734 women who had new diagnoses of early, unilateral breast cancer at stages 0-III. The data came from the California Cancer Registry—a population based registry that captures information on about 99% of the state’s breast cancer cases—and the median length of follow-up for patients was 89.1 months.

An algorithmic approach for selective acellular dermal matrix use in immediate two-stage breast reconstruction

An algorithmic approach for selective acellular dermal matrix use in immediate two-stage breast reconstruction: Indications and outcomes. Plastic and Reconstructive Surgery Aug 2014, Vol. 134(2), p.178-88.

Jordan, S.W., et al.

http://journals.lww.com/plasreconsurg/Fulltext/2014/08000/An_Algorithmic_Approach_for_Selective_Acellular.4.aspx

Acellular dermal matrix use has gained widespread acceptance—despite higher material costs—because of its ease of use and potential for enhanced cosmesis. The authors developed a resource-sensitive algorithm for selective acellular dermal matrix use with indications and contraindications based on body mass index, breast size, radiation therapy, flap vascularity, and pectoralis anatomy. Methods: The algorithm incorporates preoperative and intraoperative decision points. Complication rates and aesthetic scores were compared for procedures performed before and after adoption of the algorithm. Multiple logistic regression was used to determine the independent influence of the algorithm on postoperative outcomes.

Breast reconstruction with tissue expanders

Breast reconstruction with tissue expanders: Implementation of a standardized best practices protocol to reduce infection rates. Plastic and Reconstructive Surgery July 2014, Vol. 134(1), p.11-18.

Khansa, I., et al.

http://journals.lww.com/plasreconsurg/Abstract/2014/07000/Breast_Reconstruction_with_Tissue_Expanders__.4.aspx

Periprosthetic infection remains a frustrating and costly complication of breast reconstruction with tissue expanders. Although some specific steps have been previously shown to reduce periprosthetic infections, no comprehensive protocol addressing all aspects of preoperative, intraoperative, and postoperative patient management has been evaluated in the literature. The authors’ goal was to evaluate the effectiveness of their protocol at reducing periprosthetic infections.

Silicone gel breast implants: Science and testing

Silicone gel breast implants: Science and testing. Plastic and Reconstructive Surgery, July 2014, Vol.134 (1s).

Kinney, B.M., et al.

http://journals.lww.com/plasreconsurg/Fulltext/2014/07001/Silicone_Gel_Breast_Implants___Science_and_Testing.9.aspx

Since the first generation of breast implants, major design innovations, including consistency of the gel, palpability and thickness of the shell, and barrier materials in the shell, have been introduced. Surgeons have not had metrics to assess and compare available implants.

Methods: Research at independent laboratories included 4 tests: gel elasticity (the gel’s ability to retain its shape), gel compression fracture (the resistance to permanent gel deformation), gel-shell peel (the integration of the gel with shell as a cohesive unit), and morphological analysis.

Breast embryology and the double-bubble deformity

Breast embryology and the double-bubble deformity. Plastic and Reconstructive Surgery, July 2014, Vol. 134(1), p.161e-162e.

Gigliofiorito, P., et al.

http://journals.lww.com/plasreconsurg/Fulltext/2014/07000/Breast_Embryology_and_the_Double_Bubble_Deformity.42.aspx

Breast surgery remains one of the most popular branches of plastic surgery. More than 286,000 breast implants were placed in 2012 in the United States, and these numbers will probably increase in the next decade. The double-bubble deformity can be a disappointing complication during breast surgery, and patients often relate to it as a surgical mistake. However, as the author stated, it can also be a consequence of a patient’s own susceptibility.

NEJM Audio Summary: Breast cancer

NEJM Audio Summary: Breast cancer risk. Aug 2014 [podcast]

Breast-cancer risk and mutations in PALB2

http://podcast.nejm.org/summaries/nejm_2014.371.issue-6.summary.mp3

Postmastectomy radiation therapy after immediate two-stage tissue expander/implant breast reconstruction

Postmastectomy radiation therapy after immediate two-stage tissue expander/implant breast reconstruction: A University of British Columbia perspective. Plastic and Reconstructive Surgery, July 2014, Vol. 134(1), p.1e-10e.

Ho, A.L., et al.

http://journals.lww.com/plasreconsurg/Fulltext/2014/07000/Postmastectomy_Radiation_Therapy_after_Immediate.2.aspx

 An increasing number of women who undergo immediate two-stage tissue expander/implant breast reconstruction will require postmastectomy radiation therapy. An important variable is the timing of radiotherapy relative to surgery. The authors report their experience treating a large consecutive series of patients who underwent postmastectomy radiation therapy to the tissue expander before exchange for a permanent implant.

Screening an asymptomatic person for genetic risk

Screening an asymptomatic person for genetic risk. NEJM, June 2014, 370: 2442-45 [Clinical Decisons]

Department of Bioethics and Humanities, University of Washington, Seattle

http://www.nejm.org/doi/pdf/10.1056/NEJMclde1311959

Case Study: Jim Mathis is a 45-year-old health-conscious man who has been a patient in an internal medicine–primary care practice for several years. At today’s visit, he talks about the family tree that he has sketched out and his discovery that three of his relatives had cancer — one had breast cancer, one ovarian cancer, and one prostate cancer.

Postmastectomy radiation in breast cancer with one to three involved lymph nodes

Postmastectomy radiation in breast cancer with one to three involved lymph nodes: ending the debate. The Lancet, June 2014, Vol. 383(9935), p.2104-06.

Poortmans, P.

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)60192-6/fulltext?rss=yes

Many trials in breast cancer have investigated various aspects of locoregional and systemic treatments. Combination of the results of these trials in a meticulous meta-analysis, as has been done several times by the Early Breast Cancer Trialists' Collaborative Group (EBCTCG), fills the gaps in evidence and knowledge by conclusively showing significant trends and differences.

Adjuvant exemestane with ovarian suppression in premenopausal breast cancer

Adjuvant exemestane with ovarian suppression in premenopausal breast cancer. NEJM, June 2014 [online]

Pagani, O., et al.

http://www.nejm.org/doi/pdf/10.1056/NEJMoa1404037

The most effective adjuvant endocrine therapy for premenopausal women with hormone-receptor (estrogen, progesterone, or both)–positive breast cancer is uncertain. Tamoxifen for at least 5 years is a standard of care. Adjuvant suppression of ovarian function (hereafter, ovarian suppression) may be recommended in addition. For postmenopausal women, adjuvant therapy with an aromatase inhibitor, as compared with tamoxifen, improves outcomes.

Portrait, treatment choices and management of breast cancer in nonagenarians

Portrait, treatment choices and management of breast cancer in nonagenarians: An ongoing challenge. The Breast, June 2014, Vol. 23(3), p.221-5.

Merv, B., et al.

http://www.thebreastonline.com/article/S0960-9776(14)00050-2/abstract?rss=yes?rss=yes

There are only scarce data on the management of nonagenarians with breast cancer, and more particularly on the place of radiation therapy (RT). We report a retrospective study on patients aged 90 years old or older, with breast cancer, receiving RT. Records from RT departments from five institutions were reviewed to identify patients 90 years old of age and older undergoing RT over past decade for breast cancer. Tumors' characteristics were examined, as well treatment specificities and treatment intent. 

44 patients receiving RT courses were identified, mean age 92 years. Treatment was given with curative and palliative intent in 72.7% and 27.3% respectively. Factors associated with a curative treatment were performance status (PS), place of life, previous surgery, and tumor stage. Median total prescribed dose was 40 Gy (23–66). Hypo fractionation was used in 77%. Most toxicities were mild to moderate. RT could not be completed in 1 patient (2.3%). No long-term toxicity was reported. Among 31 patients analyzable for effectiveness, 24 patients (77.4%) had their diseased controlled until last follow-up, including 17 patients (54.8%) experiencing complete response. At last follow-up, 4 patients (12.9%) were deceased, cancer being cause of death for two of them.

The study shows that breast/chest RT is feasible in nonagenarians. Although the definitive benefit of RT could not be addressed here, hypofractionated therapy allowed a good local control with acceptable side effects.

Effect of radiotherapy after mastectomy and axillary surgery on 10-year recurrence and 20-year breast cancer mortality

Effect of radiotherapy after mastectomy and axillary survey on 10-year recurrence and 20-year breast cancer mortality: meta-analysis of individual patient data for 8135 women in 22 randomised trials. The Lancet, June 2014, Vol. 383(9935), p.2127-35.

Early Breast Cancer Trialists' Collaborative Group

http://download.thelancet.com/pdfs/journals/lancet/PIIS0140673614604888.pdf?id=baafQEJCKe7tA85F7c8Bu

Postmastectomy radiotherapy was shown in previous meta-analyses to reduce the risks of both recurrence and breast cancer mortality in all women with node-positive disease considered together. However, the benefit in women with only one to three positive lymph nodes is uncertain. We aimed to assess the effect of radiotherapy in these women after mastectomy and axillary dissection.

Breast cancer drug hope for leukaemia

Breast cancer drug hope for leukaemia. [online]. BBC News [Health]. June 2014

http://www.bbc.co.uk/news/health-28044146

Leukaemia research may lead to new drugs for difficult-to-treat breast cancers, say scientists.

These types of tumours cannot be treated with the targeted drugs which have hugely improved survival.

A team in Glasgow says a faulty piece of DNA which causes leukaemia also has a role in some tumours and could help in research for new drugs. 

Meanwhile, other researchers say they have taken tentative steps towards a blood test for breast cancer.

Three-dimensional nipple-areola tattooing

Three-dimensional nipple-areola tattooing: A new technique with superior results. Plastic and Reconstructive Surgery, May 2014, Vol. 133(5), p.1073-75.

Halvorson, E.G., et al.

http://journals.lww.com/plasreconsurg/Fulltext/2014/05000/Three_Dimensional_Nipple_Areola_Tattooing___A_New.4.aspx

Traditional coloring techniques for nipple-areola tattooing ignore the artistic principles of light and shadow to create depth on a two-dimensional surface. The method presented in this article is essentially the inverse of traditional technique and results in a more realistic and three-dimensional reconstruction that can appear better than surgical methods. The application of three-dimensional techniques or “realism” in tattoo artistry has significant potential to improve the aesthetic outcomes of reconstructive surgery.

Quality-of-life outcomes between mastectomy alone and breast reconstruction

Quality-of-life outcomes between mastectomy alone and breast reconstruction: Comparison of patient-reported BREAST-Q and other health-related quality-of-life measures. Plastic and Reconstructive Surgery, April 2014, Vol. 133(4), p.594(e)-595(e).

Cagli, B.M.D., et al.

file://mscl-users/Users/ecnt/L&D%20Services/CKeeling/Downloads/Quality_of_Life_Outcomes_between_Mastectomy_Alone.42%20(1).pdf

For women, breast cancer remains a common and dreaded experience; it is normal for a diagnosis of breast cancer to evoke grief, anger, and intense fear. The options of breast conservation and reconstruction give women a new sense of control over their treatment and are quite successful in helping women feel comfortable with their bodies again.

Understanding the effect of breast augmentation on quality of life

Understanding the effect of breast augmentation on quality of life: Prospective analysis using the BREAST-Q.
Plastic and Reconstructive Surgery, April 2014, Vol. 133(4), p.787-95.

Alderman, A.K., et al.

http://journals.lww.com/plasreconsurg/Fulltext/2014/04000/Understanding_the_Effect_of_Breast_Augmentation_on.6.aspx

The aim of this study was to prospectively evaluate patient satisfaction and quality of life with elective breast augmentation. Patients with bilateral submuscular breast augmentations prospectively completed the BREAST-Q preoperatively and 6 weeks and 6 months postoperatively; t tests compared preoperative and postoperative scores at 6 weeks and 6 months, and standard indicators of effect sizes were calculated. Logistic regression was used to evaluate the association between patient and surgical factors on satisfaction outcomes.

Breast cancer screening pamphlets mislead women

Breast cancer screening pamphlets mislead women. BMJ 2014; 348

Gigerenzer, G.

http://www.bmj.com/content/348/bmj.g2636?rss=1

Why should I have mammography? That question is regularly asked in pamphlets for screening. The answer is also regularly misleading. Women are told what they should do, but without being given the facts necessary to make informed decisions. This form of paternalism has a long tradition. In a campaign poster in the 1980s, the American Cancer Society declared: “If you haven’t had a mammogram, you need more than your breasts examined.”

Management of women at high risk of breast cancer

Management of women at high risk of breast cancer. BMJ 2014, 348:g2756

Armstrong, A.C. and Evans, G.D.

http://www.bmj.com/highwire/filestream/696134/field_highwire_article_pdf/0/bmj.g2756

Breast cancer is the commonest malignancy diagnosed in women worldwide and accounts for over 30% of all cancers diagnosed in women in the United Kingdom.1 The average lifetime risk of developing breast cancer for women in the United Kingdom and United States is estimated to be 12%, although this may
be an overestimate, as it is not clear what age this assumes a woman lives to and whether full adjustment has been made for those who die young from other causes. It is also unclear whether multiple breast cancers in a single woman are counted as several women with breast cancer.

Anastrozole for prevention of breast cancer in high-risk postmenopausal women

Anastrozole for prevention of breast cancer in high-risk postmenopausal women: An international, double-blind, randomised placebo-controlled trial. The Lancet, March 2014, Vol. 383(9922), p.1041-48.

Cuzick, J., et al.

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)62292-8/abstract?rss=yes

Aromatase inhibitors effectively prevent breast cancer recurrence and development of new contralateral tumours in postmenopausal women. We assessed the efficacy and safety of the aromatase inhibitor anastrozole for prevention of breast cancer in postmenopausal women who are at high risk of the disease.

Breast cancer chemoprevention

Breast cancer chemoprevention: little progress in practice? The Lancet, March 2014 Vol. 383(9922), p.1018-20.

Cameron, D.A.

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)62555-6/fulltext?rss=yes

In The Lancet, Jack Cuzick and colleagues report the first results from IBIS-II (International Breast cancer Intervention Study II), in which 3864 postmenopausal women at high risk of breast cancer were randomly assigned to receive the potent, non-steroidal aromatase inhibitor anastrozole or placebo every day for 5 years. After a median follow-up of 5 years, 40 (2%) of 1920 women in the anastrozole group and 85 (4%) of 1944 in the placebo group had developed breast cancer (hazard ratio 0·47, 95% CI 0·32—0·68). This finding is in keeping with those of other similar studies.So far, unsurprisingly, the investigators have not recorded evidence for a difference in breast cancer or all-cause mortality: 18 deaths had been reported in the anastrozole group and 17 in the placebo group.

Venous thromboembolism risk in mastectomy and immediate breast reconstruction

Venous thromboembolism risk in mastectomy and immediate breast reconstruction: Analysis of the 2005 to 2011 American College of Surgeons National Surgical Quality Improvement Program Data Sets. Plastic and Reconstructive Surgery, March 2014, Vol. 133(3), p.263e-273e.

Fischer, J.P., et al.

http://journals.lww.com/plasreconsurg/Abstract/2014/03000/Venous_Thromboembolism_Risk_in_Mastectomy_and.9.aspx

Venous thromboembolism, including deep venous thrombosis and pulmonary embolism, is a morbid and costly complication following surgical procedures. The authors aim to assess the added risk of venous thromboembolism in patients undergoing immediate breast reconstruction.

The effect of prior abdominal surgery on abdominally based free flaps in breast reconstruction

The effect of prior abdominal surgery on abdominally based free flaps in breast reconstruction. Plastic and reconstructive surgery, March 2014, Vol. 133(3), p.247e-255e.

Roostaeian, J., et al.

http://journals.lww.com/plasreconsurg/Abstract/2014/03000/The_Effect_of_Prior_Abdominal_Surgery_on.4.aspx

The abdomen has long remained the preferred donor site in breast reconstruction. Over time, the flap has evolved to limit morbidity with reduced muscular harvest. Previous abdominal operations, however, may limit the ability to perform a muscle- or fascia-sparing flap. The purpose of this study was to evaluate outcomes in women who had prior abdominal operations and underwent abdominally based autologous breast reconstruction.

Mastectomy rates for ductal carcinoma in situ vary widely in UK

Mastectomy rates for ductal carcinoma in situa vary widely in UK, audit shows [news item]. BMJ 2014; 348:g2332

Mayor, S.

http://www.bmj.com/content/348/bmj.g2332?rss=1&hwoasp=authn%3A1395931440%3A4044144%3A3266341127%3A0%3A0%3AKU2BGBsYX8ly%2BjhKOx1Tkg%3D%3D

Data from the UK NHS Breast Cancer Screening Programme show significant variation between hospitals in the number of women with ductal carcinoma in situ undergoing mastectomy when lumpectomy would normally be indicated, shows an audit reported last week at the European Breast Cancer Conference.

Breast cancer screening offers few benefits to women over 70

Breast cancer screening offers few benefits to women over 70, finds study [research news].  BMJ 2014; 348:g2333.

Wise, J.

http://www.bmj.com/highwire/filestream/691661/field_highwire_article_pdf/0/bmj.g2333

Extending the Netherlands’ breast cancer screening programme to include women over the age of 70 did not lead to a fall in the number of advanced stage breast cancers detected, even though the number of early stage tumours detected rose, an evaluation has found. The study’s leader, Gerrit-Jan Liefers, a surgical oncologist and head of the geriatric oncology research group at Leiden University Medical Centre, said that if the programme were effective he would expect the incidence of advanced stage cancer to decrease, because any cancer would have been detected at an earlier stage. The study’s finding “implies that the effect of
screening in elderly women is limited and leads to a large proportion of overdiagnosis,” he said.

Total breast reconstruction using the thoracodorsal artery perforator flap without implant

Total breast reconstruction using the thoracodorsal artery perforator flap without implant. Plastic and reconstructive surgery, Feb. 2014, vol. 132(2), p.251-4.

Santanelli, F., et al.  

http://journals.lww.com/plasreconsurg/Abstract/2014/02000/Total_Breast_Reconstruction_Using_the.7.aspx

The thoracodorsal artery perforator flap was described mainly for partial breast reconstruction by Hamdi. The purpose of this article is to describe the use of the pedicled thoracodorsal artery perforator flap for total autologous breast reconstruction without using an implant.

Defining nipple displacement and the prevention and treatment of the high-riding nipple

Defining nipple displacement and the prevention and treatment of the high-riding nipple. Plastic and reconstructive surgery, Jan. 2014, Vol. 133(1), p.64e-66e.

Swanson, E.

http://journals.lww.com/plasreconsurg/Fulltext/2014/01000/Defining_Nipple_Displacement,_and_the_Prevention.42.aspx

Spear et al. propose a new classification to evaluate the postoperative high-riding nipple. This ratio uses as its landmarks the nipple level, the inframammary fold, and the superior breast margin, based on a method reported previously by Mallucci and Branford. The method is not compared to existing classifications that measure the nipple level (as opposed to a treatment algorithm). The authors use the term “nipple displacement” synonymously with nipple malposition. Nipple displacement, however, is defined more precisely as the vertical distance between the nipple level and the level of maximum breast projection.

Neoadjuvant chemotherapy for breast cancer

Neoadjuvant chemotherapy for breast cancer: any progress? The Lancet Oncology, Feb. 2014, Vol. 15(2), p.131-2.

http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(13)70584-9/fulltext?rss=yes

Colleoni, M. and Goldhirsch, A.

Neoadjuvant chemotherapy is a well established approach to treatment of locally advanced breast cancer. Preoperative therapy allows breast-conserving surgery in many patients and provides prognostic information that could guide the choice of treatments to maximise the degree of response (ie, towards pathological complete remission [pCR]).

Medications for risk reduction of primary breast cancer in women

Medications for risk reduction of primary breast cancer in women: US preventative services task force recommendation statement. Annals of internal medicine, Nov. 2013, Vol. 159(10), p.698-708.

Moyer, V.A., et al.

http://annals.org/article.aspx?articleid=1770699

The USPSTF reviewed evidence on the effectiveness, adverse effects, and subgroup variations of medications to reduce the risk for breast cancer—specifically, the selective estrogen receptor modulators tamoxifen and raloxifene. The USPSTF also reviewed a meta-analysis of placebo-controlled trials to understand the relative benefits and harms of tamoxifen and raloxifene. The USPSTF recommends against the routine use of medications, such as tamoxifen or raloxifene, for risk reduction of primary breast cancer in women who are not at increased risk for breast cancer.

Factors associated with the development of chronic pain after surgery for breast cancer

Factors associated with the development of chronic pain after surgery for breast cancer: A prospective cohort from a tertiary center in the United States. The breast, Jan/Feb. 2014, Vol. 20(1), p.9-14.

De Oliveira, G.S., et al.

http://onlinelibrary.wiley.com/doi/10.1111/tbj.12207/full

Chronic pain has been shown to affect up to 60% of patients undergoing surgery for breast cancer. Besides younger age, other risk factors for the development of chronic pain have not been consistent in previous studies. The objective of the current investigation was to detect the prevalence and risk factors for the development of chronic pain after breast cancer surgery by examining a patient population from a tertiary cancer center in the United States.

Aromatase inhibitor associated musculoskeletal symptoms are associated with reduced physical activity among breast cancer survivors

Aromatase inhibitor associated musculoskeletal symptoms are associated with reduced physical activity among breast cancer survivors. The breast journal, Jan/Feb 2014, Vol. 20(1), p.22-28.

Brown, J.C., et al.

http://onlinelibrary.wiley.com/doi/10.1111/tbj.12202/full

Physical activity (PA) has numerous health benefits for breast cancer survivors. Recent data suggest that some breast cancer survivors treated with aromatase inhibitors may experience aromatase inhibitor associated musculoskeletal symptoms. It is unknown whether aromatase inhibitor associated musculoskeletal symptoms are associated with reduced PA and what other risk factors are associated with such PA reductions. We conducted a cross-sectional study at a large university-based breast cancer clinic among breast cancer survivors prescribed an aromatase inhibitor.

Predictors of nipple ischemia after nipple sparing mastectomy

Predictors of nipple ischemia after nipple sparing mastectomy. The breast journal, Jan/Feb 2014, Vol. 20(1), p.69-73.

Carlson, G.W., et al.

http://onlinelibrary.wiley.com/doi/10.1111/tbj.12208/full

Nipple sparing mastectomy (NSM) has become an accepted approach in selected cases of breast cancer and prophylactic mastectomy. Various surgical techniques have been described and nipple ischemia has been a common complication. Potential risk factors for nipple ischemia after NSM are examined. To examine predisposing factors for nipple ischemia after NSM. Prospective evaluation of 71 consecutive NSM in 45 patients from 2009 to 2011 was performed.

Unusual nonrefractile eosinophilic crystal in breast ducts in a patient with invasive mucinous carcinoma

Unusual nonrefractile eosinophilic crystal in breast ducts in a patient with invasive mucinous carcinoma. The breast journal, Jan/Feb 2014, Vol. 20(1), p.84-86.

Quddus, M.R., et al.

http://onlinelibrary.wiley.com/doi/10.1111/tbj.12210/full

A 72-year-old, G4P2 white woman presented with a recent abnormal mammogram showing a nodule at 8 o'clock of her right breast and indeterminate calcification in the subareolar region. An initial stereotactic core followed by wide local excision and sentinel node biopsy showed a pT1aN0(sn)M(na) low-grade invasive mucinous carcinoma. In dilated benign ducts, adjacent to the carcinoma, numerous eosinophilic, nonrefractile crystals were identified.

Breast conserving surgery versus mastectomy for early-stage breast cancer

Breast conserving surgery versus mastectomy for early-stage breast cancer: Could patient choice lead to an inferior outcome? [Letter].  The breast journal, Jan/Feb 2014, Vol. 20(1), p.97-99.

Silva, E.

http://onlinelibrary.wiley.com/doi/10.1111/tbj.12220/full

In recent years, an increasing number of reports have dwelled on the impact and necessity of patient choice in the treatment of early stage breast cancer. Some have questioned whether women can or cannot make an informed choice when conflict arises between a woman's choice and her physician's recommendation.

Muscle-sparing TRAM flap does not protect breast reconstruction

Muscle-sparing TRAM flap does not protect breast reconstruction from post-mastectomy radiation damage compared with the DIEP flap.  Plastic and reconstructive surgery, Feb 2014, Vol. 132(2), p.223-33.

Garvey, P.B., et al.

http://journals.lww.com/plasreconsurg/Abstract/2014/02000/Muscle_Sparing_TRAM_Flap_Does_Not_Protect_Breast.4.aspx

Irradiation to free flaps following immediate breast reconstruction has been shown to compromise outcomes. The authors hypothesized that irradiated muscle-sparing free transverse rectus abdominis musculocutaneous (TRAM) flaps experience less fat necrosis than irradiated deep inferior epigastric perforator (DIEP) flaps.

New register for breast implants in England

New register for breast implants in England. [video] BBC News, Dec. 2013.

http://www.bbc.co.uk/news/uk-wales-25540659

A register of all breast implant operations is to be introduced in England in the wake of the PIP scare, the Department of Health has announced.

There will also be a clampdown on cosmetic surgery advertising and new qualifications introduced for surgeons who carry out cosmetic procedures.

Living with double mastectomy

Living with double mastectomy [video]. BBC News, Dec. 2013.

http://www.bbc.co.uk/news/health-25550734

When the actress Angelina Jolie announced that she had had a preventative double mastectomy to reduce her risk of developing breast cancer, she highlighted the dangers to women around the world.

At the same time, Bobbie Lamden, was preparing for her own surgery.

Graham Satchell went to meet her in September when she went into hospital, three months later Bobbie talks about life since the surgery took place.

Managing necrosis of the nipple-areola complex in breast reconstruction after nipple-sparing mastectomy

Managing necrosis of the nipple-areola complex in breast reconstruction after nipple-sparing mastectomy: Immediate nipple-areola complex reconstruction with banked skin. Plastic and reconstructive surgery, Jan 2014, Vol. 133(1), p.73e-74e.

Park, S.W., et al.

http://journals.lww.com/plasreconsurg/Fulltext/2014/01000/Managing_Necrosis_of_the_Nipple_Areola_Complex_in.52.aspx

Nipple-sparing mastectomy is perceived to have certain aesthetic benefits that improve the outcomes of breast reconstruction. When the spared nipple or areola is necrotized, however, suboptimal outcomes will follow. Conservative treatment with secondary healing has been the main approach to date when nipple-areola complex necrosis occurs.

Repairing the high-riding nipple with reciprocal transposition flaps

Repairing the high-riding nipple with reciprocal transposition flaps and classification and management of the postoperative high-riding nipple. Plastic and reconstructive surgery, Jan 2014, Vol. 133(1), p.57e-58e.

Bovill, E.S., et al.

http://journals.lww.com/plasreconsurg/Fulltext/2014/01000/Repairing_the_High_Riding_Nipple_with_Reciprocal.35.aspx

We read with interest the recent article by Spear et al.describing a useful technique for correction of the postoperative, high-riding nipple, and the subsequent review and classification. We too have found nipple-sparing mastectomy reconstruction with either expanders or single-stage implants to confer an excellent aesthetic outcome in suitable patients. 

Comprehensive analysis of donor-site morbidity in abdominally based free flap breast reconstruction

Comprehensive analysis of donor-site morbidity in abdominally based free flap breast reconstruction. Plastic and reconstructive surgery, Dec 2013, Vol. 132(6), p.1383-91.

Chang, E.I., et al.

http://journals.lww.com/plasreconsurg/Abstract/2013/12000/Comprehensive_Analysis_of_Donor_Site_Morbidity_in.1.aspx

This study aimed to provide a comprehensive analysis of factors that might contribute to abdominal donor-site morbidity after abdominally based free flap breast reconstruction.

Anastrozole for prevention of breast cancer in high-risk postmenopausal women (IBIS-II)

Anastrozole for prevention of breast cancer in high-risk postmenopausal women (IBIS-II): An international, double-blind, randomised placebo-controlled trial.  The lancet, Dec 2013 [early online publication]

Cuzick, J., et al.

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)62292-8/fulltext

Aromatase inhibitors effectively prevent breast cancer recurrence and development of new contralateral tumours in postmenopausal women. We assessed the efficacy and safety of the aromatase inhibitor anastrozole for prevention of breast cancer in postmenopausal women who are at high risk of the disease.