Wednesday 3 July 2019

Endoscopic-assisted surgery in the management of breast cancer: 20 years review of trend, techniques and outcomes



The Breast: August 2019 Volume 46, Pages 144–156

by Chi Wei Mok, Hung-Wen Lai 

 To review current literature on the outcomes, techniques and trend of endoscopic-assisted breast surgery (EABS) in the management of breast cancer over a 20 years period Materials and Methods: Literature search was performed using PubMed/Medline database from 1st January 1998 to 31st December 2018 using the terms “endoscopy”, “endoscopy-assisted”, “breast cancer”, “mastectomy” and “breast conserving surgery”. Additional studies were also identified by reviewing references of relevant articles. Only case series and cohort studies were included in this review.

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



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.