The Breast: August 2019
Volume 46, Pages 144–156
by Chi Wei Mok, Hung-Wen Lai
Wednesday, 3 July 2019
Endoscopic-assisted surgery in the management of breast cancer: 20 years review of trend, techniques and outcomes
Breast cancer follow-up after a primary diagnosis: A confused picture
The Breast: August 2019
Volume 46, Pages 97–100
by Susanne Cruickshank, Matthew Barber
The follow-up care of people diagnosed with early breast
cancer varies across the world. In the UK, services have evolved in an ad hoc
way, with no standardized approach nationally. Some people are seen face to
face at regular intervals, others are discharged at two years, while others are
followed up over the telephone. This is creating confusion for patients as to
what is best practice. The lack of evidence to support intensive surveillance
is frequently cited as the main reason to reduce or indeed review the benefits
of face to face clinical consultations in the hospital/community setting.
About the French prohibition of textured breast implants: is it justified or over-cautious? The EUSOMA, ESSO/BRESSO position
The Breast: August 2019
Volume 46, Pages 95–96
by M.J. Cardoso, L. Biganzoli, I.T. Rubio, Leidenius M,
Curigliano G, Cutuli B, Marotti L, T. Kovacs, L. Wyld
After the publication of the EUSOMA position regarding
breast implant associated anaplastic large cell lymphoma (BIA-ALCL) and the use
of textured implants in January 2019 [1], the medical devices regulatory
authority in France, the ANSM (National Agency of Medicine and Health
Products), has recently banned all use of textured surface breast implants.
This decision was based on concerns about the risk of BIA ALCL which may be
more likely in women with textured versus smooth surfaced implants [2].
Reducing seroma formation and its sequelae after mastectomy by closure of the dead space: The interim analysis of a multi-center, double-blind randomized controlled trial (SAM trial)
The Breast: August 2019
Volume 46, Pages 81–86
by Renée W.Y. Granzier, James van Bastelaar, Sander M.J. van
Kuijk, Kim F.H. Hintzen, Cathelijne Heymans, Lotte L.B. Theunissen, Els R.M.
van Haaren, Alfred Janssen, Geerard L. Beets, Yvonne L.J. Vissers
The main objective of this double-blind randomized
controlled trial (RCT) was to assess seroma formation and its sequelae in
patients undergoing mastectomy. Patients were randomized into one of three
groups in which different wound closure techniques were applied: 1) conventional
wound closure without flap fixation (CON) 2) flap fixation using sutures (FF–S)
and 3) flap fixation using an adhesive tissue glue (FF-G).
Current knowledge of risk reducing mastectomy: Indications, techniques, results, benefits, harms
The Breast: August 2019
Volume 46, Pages 48–51
by Andrew D. Baildam
The last twenty years have seen a complete change in
society's attitude to the strategy of risk reduction of breast cancer in
high-risk individuals by means of proactive mastectomy. Once termed
‘prophylactic mastectomy’, risk reducing mastectomy (RRM) was considered two
decades ago not only extreme, but in some quarters almost unethical. RRM is now
commonly undertaken in specialist breast units for women at high individual
breast cancer risk, by virtue of an inherited breast cancer related gene
mutation or from calculated high statistical risk from family history data, and
the efficacy of RRM in reducing subsequent incident diagnoses of breast cancer
has been published from a number of centres.
Efficacy of extended aromatase inhibitors for hormone-receptor–positive breast cancer: A literature-based meta-analysis of randomized trials
The Breast: August 2019
Volume 46, Pages 19–24
by S.P. Corona, G. Roviello, C. Strina, M. Milani, S.
Madaro, D. Zanoni, G. Allevi, S. Aguggini, M.R. Cappelletti, M. Francaviglia,
C. Azzini, A. Cocconi, M. Sirico, M. Bortul, F. Zanconati, F. Giudici, P.
Rosellini, F. Meani, O. Pagani, D. Generali
Endocrine treatment with Tamoxifen and aromatase inhibitors
(AIs) is a staple in the management of hormone receptor positive breast cancer
(HR + BC). It has become clear that HR + BC carries a
consistent risk of relapse up to 15 years post-diagnosis. While increasing
evidence supports the use of extended adjuvant Tamoxifen over 5 years,
controversial data are available on the optimal duration of extended AIs
adjuvant treatment.We performed a meta-analysis to assess the real impact of
extended adjuvant therapy with AIs on disease-free survival (DFS).
De-escalation of complexity in oncoplastic breast surgery: Case series from a specialized breast center
The Breast: August 2019Volume
46, Pages 12–18
by G. Catanuto, A. Khan, V. Ursino, E. Pietraforte, G.
Scandurra, C. Ravalli, N. Rocco, M.B. Nava, F. Catalano
Oncoplastic breast surgery has evolved the surgical
treatment of breast cancer over the past two decades. This practice still lacks
validation and poses several dilemmas in terms of safety, local and systemic
control, timing of adjuvant treatments and cost-effectiveness. Our case series
investigates the effects of a reduced surgical complexity on cosmetic results
and quality of life.
Patient-reported health problems and healthcare use after treatment for early-stage breast cancer
The Breast: August 2019 Volume 46, Pages 4–11
by K.M. de Ligt, M. Heins, J. Verloop, C.H. Smorenburg, J.C.
Korevaar, S. Siesling
A clear picture of treatment-related health problems
following breast cancer treatment is useful in anticipating the informational
and other needs of patients during follow-up. This study aimed to identify
treatment-related health problems in breast cancer patients up to five years
after diagnosis. Secondly, the use of care associated with these health
problems was identified.
A New and Innovative Method of Preoperatively Planning and Projecting Vascular Anatomy in DIEP Flap Breast Reconstruction: A Randomized Controlled Trial
Plastic and Reconstructive Surgery: June 2019 - Volume
143 - Issue 6 - p 1151e–1158e
by Hummelink, Stefan; Hoogeveen, Yvonne L.; Schultze Kool,
Leo J.; Ulrich, Dietmar J. O.
Background: In
deep inferior epigastric perforator (DIEP) flap breast reconstructions, a free
tissue flap from the abdomen is shaped into a breast and transferred to the
thorax. Survival of this free flap relies on minuscule blood vessels, so-called
perforators, providing blood supply to this newly molded breast. Preoperative
mapping of these randomly distributed blood vessels is essential to avoid
complications. The purpose of this study was to investigate whether the
preoperative projection of a virtual three-dimensional plan based on computed
tomographic angiography onto the abdomen leads to more correctly identified
perforator locations and less operative time spent on dissecting the free flap
compared to the commonly used Doppler ultrasound planning method.
Methods: The
authors conducted a randomized, open, single-center, superiority trial in
patients undergoing DIEP flap breast reconstruction with 1-week follow-up.
Randomized participants were 60 adults (projection method, n = 33; Doppler
method, n = 27) undergoing DIEP flap breast reconstruction without lymph node
transfer.
Results: Sixty
patients provided 69 DIEP flaps for analysis. The projection method is capable
preoperatively of displaying significantly more perforators compared to the
Doppler method (61.7 ± 7.3 percent versus 41.2 ± 8.2 percent, respectively; p =
0.020)). During the procedure, flap harvest time is decreased by 19 minutes
(136 ± 7 minutes versus 155 ± 7 minutes; p = 0.012). Complications were
comparable across both groups.
Conclusion: Not
only can more perforators be identified intraoperatively using the projection
method compared with Doppler ultrasound, there is also a significant time
reduction in harvesting the DIEP flap. CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, II.
Stacked Lateral Thigh Perforator Flap as a Novel Option for Autologous Breast Reconstruction
Plastic and Reconstructive Surgery: June 2019 - Volume
143 - Issue 6 - p 1601–1604
by Tessler, Oren; Guste, John; Bartow, Matthew J.; Torabi,
Radbeh; Gimenez, Alejandro; Patel, Shukan B.; Matatov, Tim; Torabi, Rozbeh; St.
Hilaire, Hugo; Allen, Bob
Background:
Autologous breast reconstruction using perforator flaps offers excellent
outcomes, minimizes donor-site morbidity, and allows for precise donor-site
selection. The deep inferior epigastric artery perforator, profunda artery
perforator, and gluteal artery perforator flaps along with the stacked flap
technique are the most common options. This study reports the first series of
the stacked lateral thigh perforator flap.
Methods: A
retrospective review of all stacked lateral thigh perforator flaps done by a
single group of surgeons was performed. Demographics, flap weights,
complications, indications, and surgical technique were tabulated for each
patient.
Results: Eight
female patients with a history of breast cancer underwent delayed unilateral
breast reconstruction with stacked lateral thigh perforator flaps for a total
of 16 flaps. Mean patient age, body mass index, flap weight, and stacked flap
weight were 47.3 years, 26.2 kg/m2, 333.1 g, and 666.1 g, respectively.
Microsurgical revascularization was completed in anterograde and retrograde
fashion to the internal mammary vasculature. Flap survival was 100 percent and
one subsequent flap revision was performed. Two patients developed a seroma at
the donor site. Indications included insufficient abdominal tissue, prominent
lateral thigh lipodystrophy, prior abdominal surgery, and failed prior
abdominally based autologous reconstruction.
Conclusions: This
series demonstrates that the lateral thigh perforator flap is a reliable and
effective option for a stacked breast reconstruction. Its ease of harvest
(stemming from reliable anatomy), straightforward dissection, and
intraoperative positioning make it an appealing flap option. The stacked
lateral thigh perforator flap allows the reconstructive surgeon to tailor
breast reconstruction to the patient, focusing on body habitus and minimizing
morbidity. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
Tissue-Based Planning and Technique for Breast Augmentation with Anatomical Implants
Tissue-Based Planning and Technique for Breast Augmentation with Anatomical Implants
Plastic and Reconstructive Surgery: June 2019 - Volume
143 - Issue 6 - p 1634–1636
by Adams, William P. Jr; Afrooz, Paul N.; Stuzin, James M.
Summary: Breast
augmentation with anatomical implants offers several potential advantages.
Tissue-based planning is patient specific and essential in choosing the correct
dimensions of an implant, thereby providing greater control in breast shape
following augmentation. This video vignette demonstrates tissue-based planning
in a patient with a constricted breast, allowing the surgeon to accurately
choose the proper implant dimensions, which correct the constriction while
providing aesthetic control of breast shape. Operative techniques of precise
pocket formation, prospective hemostasis, and judging the aesthetic contour
following implant insertion are demonstrated.
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