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.