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.

Inframammary approach to nipple-areola-sparing mastectomy

Inframammary approach to nipple-areola-sparing mastectomy. Plastic and reconstructive surgery, Nov 2013, Vol. 132(5), p.700e-708e.

Salibian, A.H, et al.

http://journals.lww.com/plasreconsurg/Abstract/2013/11000/Inframammary_Approach_to_Nipple_Areola_Sparing.2.aspx

Different approaches have been advocated for performing nipple-areola–sparing mastectomy. The inframammary approach has been viewed as having limited applications, particularly in large breasts. The authors review their experience with nipple-areola–sparing mastectomy using the inframammary approach for different breast sizes.

Breast reconstruction following nipple-sparing mastectomy

Breast reconstruction following nipple-sparing mastectomy: A systematic review of the literature with pooled analysis. Plastic and reconstructive surgery, Nov 2013, Vol. 132(5), p.1043-54.

Endara, M., et al.

http://journals.lww.com/plasreconsurg/Fulltext/2013/11000/Breast_Reconstruction_following_Nipple_Sparing.1.aspx

Nipple-sparing mastectomy is a controversial option for breast cancer treatment due to locoregional recurrence and distant metastasis. In addition to these oncologic factors, technical factors such as ideal incision type or reconstructive options are also debatable. This systematic review examines current trends with nipple-sparing mastectomy, including selection criteria, locoregional and distant metastasis rates, incision choice, and reconstructive options.

A review of the management of ductal carcinoma in situ following breast conserving surgery

A review of the management of ductal carcinoma in situ following breast conserving surgery.The breast, Dec 2013, Vol. 22(6), p.1019-25.

Boxer, M.M., et al.

http://www.thebreastonline.com/article/S0960-9776(13)00246-4/abstract?rss=yes

Ductal carcinoma in situ (DCIS) is a heterogeneous, pre-malignant disease accounting for 10–20% of all new breast tumours. Evidence shows a statistically significant local control benefit for adjuvant radiotherapy (RT) following breast conserving surgery (BCS) for all patients. The baseline recurrence risk of individual patients varies according to clinical-pathological criteria and in selected patients, omission of RT may be considered, following a discussion with the patient. 

Biological therapies in breast cancer

Biological therapies in breast cancer: Common toxicities and management strategies. The breast, Vol. 22(6), p.1009-18.

Barrouso-Sousa, R., et al.

http://www.thebreastonline.com/article/S0960-9776(13)00262-2/abstract?rss=yes

In recent years, a number of new molecules – commonly known as biological therapies – have been approved or are in late stages of regulatory evaluation for the treatment of advanced breast cancer. These innovative compounds have improved treatment efficacy and have probably contributed to the increase in survival length observed in some breast cancer subtypes. 

Another review on triple negative breast cancer

Another review on triple negative breast cancer: Are we on the right way towards the exit from the labyrinth?
The breast, Dec 2013, Vol. 22(6), p.1026-33.

Chiorean, R., et al.

http://www.thebreastonline.com/article/S0960-9776(13)00241-5/abstract?rss=yes

Triple negative breast cancer is a heterogeneous group of tumors, lacking the expression of estrogen, progesterone and HER-2 receptors. As frequency, it accounts about 15–20% of all breast cancers. Although in the last years there was a “boom” in publishing over this issue, multiple molecular classifications being elaborated, “the triple negative breast cancer odyssey ” is still far away from ending, as the complicated molecular pathways of pathogenesis and drug resistance mechanisms remain yet insufficiently explored.

Comparing five alternative methods of breast reconstruction

Comparing five different methods of breast reconstruction surgery: A cost-effectiveness analysis. Plastic and reconstructive surgery, Nov 2013, Vol. 132(5), p.709e-723e.

Grover, R., et al.

http://journals.lww.com/plasreconsurg/Abstract/2013/11000/Comparing_Five_Alternative_Methods_of_Breast.3.aspx

The purpose of this study was to assess the cost-effectiveness of five standardized procedures for breast reconstruction to delineate the best reconstructive approach in postmastectomy patients in the settings of nonirradiated and irradiated chest walls.

Buried flap reconstruction after nipple-sparing mastectomy

Buried flap reconstruction after nipple-sparing mastectomy: Advancing toward single-stage breast reconstruction. Plastic and reconstructive surgery, Oct 2013, Vol. 132(4), p.4893-497e.

Levine, S.M., et al.

http://journals.lww.com/plasreconsurg/Abstract/2013/10000/Buried_Flap_Reconstruction_after_Nipple_Sparing.3.aspx

Recent evolutions of oncologic breast surgery and reconstruction now allow surgeons to offer the appropriate patients a single-stage, autologous tissue reconstruction with the least donor-site morbidity. The authors present their series of buried free flaps in nipple-sparing mastectomies as proof of concept, and to explore indications, techniques, and early outcomes from their series.

Trends in incidence of breast cancer among women under 40 in seven European countries

Trends in incidence of breast cancer among women under 40 in seven European countries: A GRELL co-operative study. Cancer epidemiology, Oct 2013, Vol. 37(5), p.544-49.

Leclere, B., et al.

http://www.cancerepidemiology.net/article/S1877-7821(13)00077-5/abstract

Young women are not usually screened for breast cancer (BC). The trends in incidence in this population may better reflect changes in risk factors. However, studies on this subject are scarce and heterogeneous. The aim of this study was to describe the trends in incidence of BC in women under 40 from 1990 to 2008, using pooled European data. 

The benefits and harms of breast cancer screening

The benefits and harms of breast cancer screening: An independent review. British journal of cancer, 2013, 108 p.2205-40.

Marmot, M.G., et al.

http://www.nature.com/bjc/journal/v108/n11/full/bjc2013177a.html

The breast cancer screening programmes in the United Kingdom currently invite women aged 50–70 years for screening mammography every 3 years. Since the time the screening programmes were established, there has been debate, at times sharply polarised, over the magnitude of their benefit and harm, and the balance between them. The expected major benefit is reduction in mortality from breast cancer. The major harm is overdiagnosis and its consequences; overdiagnosis refers to the detection of cancers on screening, which would not have become clinically apparent in the woman’s lifetime in the absence of screening. Professor Sir Mike Richards, National Cancer Director, England, and Dr Harpal Kumar, Chief Executive Officer of Cancer Research UK, asked Professor Sir Michael Marmot to convene and chair an independent panel to review the evidence on benefits and harms of breast screening in the context of the UK breast screening programmes. The panel, authors of this report, reviewed the extensive literature and heard testimony from experts in the field who were the main contributors to the debate. 

The sex hormone system in carriers of BRCA1/2 mutations

The sex hormone system in carriers of BRCA 1/2 mutations: a case-control study. The lancet oncology, Nov 2013, Vol. 13(12), 1226-32.

Widschwendter, M., et al.

http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(13)70448-0/fulltext

Penetrance for breast cancer, ovarian cancer, or both in carriers of BRCA1/BRCA2 mutations is disproportionately high. Sex hormone dysregulation and altered end-organ hormone sensitivity might explain this organ-specific penetrance. We sought to identify differences in hormone regulation between carriers of BRCA1/2 and women who are negative for BRCA1/2 mutations.

2 years versus 1 year of adjuvant trastuzumab for HER2-positive breast cancer

2 years versus 1 year of adjuvant trastuzumab for HER2-positive breast cancer: An open-label, randomised controlled trial. The lancet, Sept 2013, Vol. 382(9897), p.1021-28.

Goldhirsch, A., et al.

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)61094-6/abstract?rss=yes

Trastuzumab has established efficacy against breast cancer with overexpression or amplification of the HER2 oncogene. The standard of care is 1 year of adjuvant trastuzumab, but the optimum duration of treatment is unknown. We compared 2 years of treatment with trastuzumab with 1 year of treatment, and updated the comparison of 1 year of trastuzumab versus observation at a median follow-up of 8 years, for patients enrolled in the HERceptin Adjuvant (HERA) trial.

Adjuvant docetaxel and cyclophosphamide plus trastuzumab in patients with HER2-amplified early stage breast cancer

Adjuvant docetaxel and cyclophosphamide plus trastuzumab in patients with HER2-amplified early stage breast cancer: A single-group, open-label, phase 2 study. The lancet oncology, Oct 2013, Vol. 14(11), p.1121-28.

Jones, F.E., et al.

http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(13)70384-X/abstract?rss=yes

Previous results suggest that docetaxel plus cyclophosphamide improves disease-free survival (DFS) and overall survival compared with doxorubicin plus cyclophosphamide in early stage breast cancer. We assessed the addition of 1 year of trastuzumab to a non-anthracycline regimen, docetaxel plus cyclophosphamide, in patients with HER2-amplified early stage breast cancer and examined whether this regimen was equally effective in patients with TOP2A-amplified and TOP2A-non-amplified disease.

Breast cancer in women at high risk

Breast cancer in women at high risk: The role of rapid genetic testing for BRCA1 and -2 mutations and the consequences for treatment strategies. The breast, Oct 2013, Vol. 22(5), p.561-68

Francken, A.B., et al.

http://www.thebreastonline.com/article/S0960-9776(13)00210-5/abstract?rss=yes

Specific clinical questions rise when patients, who are diagnosed with breast cancer, are at risk of carrying a mutation in BRCA1 and -2 gene due to a strong family history or young age at diagnosis. These questions concern topics such as 1. Timing of genetic counseling and testing, 2. Choices to be made for BRCA1 or -2 mutation carriers in local treatment, contralateral treatment, (neo)adjuvant systemic therapy, and 3. The psychological effects of rapid testing. The knowledge of the genetic status might have several advantages for the patient in treatment planning, such as the choice whether or not to undergo mastectomy and/or prophylactic contralateral mastectomy.

The effects of postmastectomy adjuvant radiotherapy on immediate two-stage prosthetic breast reconstruction

The effects of postmastectomy adjuvant radiotherapy on immediate two-stage prosthetic breast reconstruction: A systematic review. Plastic and reconstructive surgery, Sept 2013, Vol. 132(3), p.511-18.

Lam, T.C., et al.

http://journals.lww.com/plasreconsurg/Abstract/2013/09000/The_Effects_of_Postmastectomy_Adjuvant.1.aspx

The authors performed a systematic review of the literature on the outcome of therapy for patients with breast cancer who underwent adjuvant radiotherapy after an immediate two-stage prosthetic breast reconstruction, either following tissue expansion (stage 1) or after removal of the tissue expander and insertion of a final breast implant (stage 2). Their outcomes were compared to those of patients who had reconstruction without postmastectomy irradiation.