Combined breast surgery and abdominoplasty

Combined breast surgery and abdominoplasty: Strategies for success. Plastic and Reconstructive Surgery, May 2015, Vol. 135(5), p.849(e)-860(e).

Matarasso, A. and Smith, D.M.

http://journals.lww.com/plasreconsurg/Abstract/2015/05000/Combined_Breast_Surgery_and_Abdominoplasty__.17.aspx

Abdominoplasty and breast surgery are frequently appealing to patients as combined procedures. The practice of combining abdominoplasty with other procedures originates from abdominoplasty performed in conjunction with intraabdominal or gynecologic surgery. Initially, the focus of combined surgery was on ensuring safety and minimizing local (e.g., wound healing) complications. As surgeons began combining abdominoplasty with distant procedures such as breast surgery, because the individual procedures have little adverse impact on one another and are not altered because of the combination, concerns with systemic morbidity surpassed the initial focus on avoiding local complications. 

Breast reduction in patients with prior breast irradiation

Breast reduction in patients with prior breast irradiation: Outcomes using a central mound technique. Plastic and Reconstructive Surgery, May 2015, Vol. 135(5), p.1276-82.

Weichman, K.E., et al.

http://journals.lww.com/plasreconsurg/Fulltext/2015/05000/Breast_Reduction_in_Patients_with_Prior_Breast.2.aspx

 Breast reduction in patients with a history of lumpectomy and irradiation is controversial because of a heightened risk of infection and wound healing complications. Persistent macromastia or asymmetry remains a problem in this patient population that is commonly not addressed. The authors studied the safety and efficacy of a central mound technique with minimal dissection for breast reduction or mastopexy in patients with a history of breast irradiation.

Methods: A case-control study of all patients undergoing bilateral breast reduction mammaplasty between 2008 and 2013 at Memorial Sloan Kettering Cancer Center was conducted. Patients who had unilateral breast irradiation and bilateral reduction using the central mound technique were included. Each patient had a control breast and an irradiated breast. Complications and outcomes were analyzed.

Results: Thirteen patients were included for analysis. Their average age was 50.23 ± 9.9 years, and average time from irradiation to breast reduction mammaplasty was 41.3 ± 48.5 months (range, 9 to 132 months). The average specimen weight of irradiated breasts was less than that of control breasts; however, this failed to reach statistical significance (254.2 ± 173.5 g versus 386.9 ± 218.5 g; p = 0.099). One patient developed fat necrosis in the previously irradiated breast and underwent biopsy. There was no incidence of nipple necrosis or breast cancer in either irradiated or nonirradiated breasts.

Conclusions: Breast reduction mammaplasty in patients who have had irradiation is feasible and can be performed safely in select cases. The central mound technique provides reliable and reproducible results and should be considered in patients with macromastia/asymmetry and a history of irradiation.

Family breast cancer "as treatable as other tumours"

Family breast cancer" as treatable as other tumours". BBC News Online, 20.5.15

http://www.bbc.co.uk/news/health-32777696

The unfolding story of cancer

The unfolding story of cancer. The Lancet, May 2015, Vol. 385(9980), p.1824

Campbell, P.T.

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)60915-1/fulltext?rss=yes

Few diseases provoke the visceral fear of cancer. This reaction is justified: more than 14 million people worldwide this year will be diagnosed with cancer. We have learned a great deal about the prevention, causes, treatment, biology, socioeconomics, and political implications of cancer since the time of the ancients when, in writing about treatment for breast cancer, the Egyptian Imhotep wrote “there is none”. Currently, nearly nine of ten women diagnosed with breast cancer in the UK and the USA will live 5 years or more beyond diagnosis. And there have been advances for other cancers, such as leukaemia. Indeed, cancer mortality in the past 20 years has decreased by about 20–30% in the UK and the USA. Despite these clinical and public health advances, at least 8 million people worldwide are expected to die from cancer this year.

Diagnosis and management of galactorrhea after breast augmentation

Diagnosis and management of galactorrhea after breast augmentation. Plastic and Reconstructive Surgery, May 2015, Vol. 135(5), p.1349-56.

Basile, F.V. and Basile, A.R.

http://journals.lww.com/plasreconsurg/Abstract/2015/05000/Diagnosis_and_Management_of_Galactorrhea_after.15.aspx

 A known but not fully understood complication of breast augmentation is galactorrhea. To date, all publications on this subject have been case reports. The purpose of this retrospective study was to examine a large group of consecutive patients who had undergone breast augmentation and identify the incidence of galactorrhea and galactocele, and the associated preoperative and intraoperative risk factors. The authors also evaluated the treatment algorithm used.

Current attitudes to breast reconstruction surgery for women at risk of post-mastectomy radiatherapy

Current attitudes to breast reconstruction surgery for women at risk of post-mastectomy radiotherapy:  A survey of UK breast surgeons. The Breast [in press], published online May 2015.

Duxbury, P.J., et al.

http://www.thebreastonline.com/article/S0960-9776(15)00108-3/abstract?rss=yes

Decision-making for women requiring reconstruction and post-mastectomy radiotherapy (PMRT) includes oncological safety, cosmesis, patient choice, potential delay/interference with adjuvant treatment and surgeon/oncologist preference. This study aimed to quantitatively assess surgeons' attitudes and perceptions about reconstructive options in this setting, and to ascertain if surgical volume influenced advice given.

How to compare the oncological safety of oncoplastic breast conservation surgery

How to compare the oncological safety of oncoplastic breast conservation surgery - to wide local excision or mastectomy? The Breast, May 2015 [in press]

Mansell, J., et al.

http://www.thebreastonline.com/article/S0960-9776(15)00109-5/abstract?rss=yes

Comparative studies suggest that patients treated with oncoplastic breast conservation surgery (OBCS) have similar pathology to patients treated with wide local excision (WLE). However, patients treated with OBCS have never been compared to patients treated with mastectomy. The aim of this study was to identify which control group was comparable to patients undergoing OBCS.

Evaluation of effect of self-examination and physical examination on breast cancer

Evaluation of effect of self-examination and physical examination on breast cancer. The Breast, May 2015 [in press]

Hassan, L.M., et al.

http://www.thebreastonline.com/article/S0960-9776(15)00105-8/abstract?rss=yes

Breast cancer is the number one cancer of women in the world. More than 90% of breast cancers can be cured with early diagnosis followed by effective multimodality treatment. The efficacy of screening by breast self-examination (BSE) and breast physical examination (BPx) is best evaluated using randomized screening trials.

Factors influencing time between surgery and radiotherapy

Factors influencing time between surgery and radiotherapy: A population based study of breast cancer patients. The Breast, May 2015 [in press]

Katik, S., et al.

http://www.thebreastonline.com/article/S0960-9776(15)00099-5/abstract?rss=yes

This study describes variation in the time interval between surgery and radiotherapy in breast cancer (BC) patients and assesses factors at patient, hospital and radiotherapy centre (RTC) level influencing this variation. To do so, the factors were investigated in BC patients using multilevel logistic regression. The study sample consisted of 15,961 patients from the Netherlands Cancer Registry at 79 hospitals and 19 (RTCs) with breast-conserving surgery or mastectomy directly followed by radiotherapy.

Clinical outcomes of women with breast cancer and a PALB2 mutation

Clinical outcomes of women with breast cancer and a PALB2 mutation: a prospective cohort analysis. The Lancet Oncology, June 2015, Vol. 16(6), p.638-44.

Cybulski, C., et al.

http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(15)70142-7/fulltext?rss=yes

Mutations in PALB2 predispose to breast cancer, but the effect on prognosis of carrying a PALB2mutation has not been ascertained. We aimed to estimate the odds ratio for breast cancer in women with an inherited mutation in PALB2 and 10-year survival after breast cancer in patients who carry aPALB2 mutation.

Parasternal infiltration composite breast augmentation

Parasternal infiltration composite breast augmentation. Plastic and Reconstructive Surgery, April 2015, Vol. 135(4), p.1010-18.


Bravo, F.G.


http://journals.lww.com/plasreconsurg/Fulltext/2015/04000/Parasternal_Infiltration_Composite_Breast
.12.aspx

Background: The simultaneous combination of both fat grafting to the breast and mammary implants has been recently proposed as a useful technique in breast augmentation surgery. The purpose of this study was to evaluate the aesthetic benefits of selective parasternal fat grafting at the time of primary implant breast augmentation.

Methods: Fifty-nine consecutive primary breast augmentation patients were studied retrospectively. Patients were divided into two groups: group 1 patients (n = 38) were treated only with breast implants, whereas group 2 patients (n = 21) received breast implants and parasternal fat grafting of 60 to 140 cc of adipose tissue. The length between the medial border of each breast, defined as the parasternal vertical aesthetic line, was measured preoperatively and postoperatively for both groups and compared through statistical analysis.

Results: The mean length between the parasternal vertical aesthetic lines in group 1 postoperatively was significantly higher, 2.26 ± 1.24 cm (p < 0.0001); whereas this length for group 2 was significantly lower after surgery, 0.60 ± 0.32 cm (p < 0.0001). No cysts or fat necroses were observed in group 2, presumably because of the low volume of fat used.

Conclusions: Parasternal fat grafting performed simultaneously with breast augmentation is a safe procedure, and seems to provide a valuable cosmetic advantage by improving the medial transition zone of the breast implant with the presternal area. It prevents a “separated-breasts” deformity, which may produce unnatural results in implant-based breast augmentations, especially in thin patients.

Tamoxifen and Aromatase inhibitors as potential perioperative thrombotic risk factors in free flap breast reconstruction

Tamoxifen and Aromatase inhibitors as potential perioperative thrombotic risk factors in free flap breast reconstruction. Plastic and Reconstructive Surgery, April 2015 Vol. 135(4), p.670(e)-79(e).


Mirzabiegi, M.N., et al.


http://journals.lww.com/plasreconsurg/Fulltext/2015/04000/Tamoxifen__Selective_Estrogen_
Receptor_Modulators_.6.aspx


Selective estrogen-receptor modulators and aromatase inhibitors have become ubiquitous in the treatment of breast cancer. However, hormone therapy is a well-established thromboembolic risk factor. The purpose of this study is two-fold: (1) to further evaluate tamoxifen as a potential thrombotic risk factor and (2) to evaluate use of aromatase inhibitors as a potential novel risk factor.

Results: One thousand three hundred forty-seven flaps were performed on 858 patients. There were no statistically significant differences in thrombotic complications or flap failure in comparing those that did not receive preoperative hormone therapy versus those that did receive preoperative hormone therapy, nor were there significant differences specific to those receiving tamoxifen or aromatase inhibitors. A post hoc power analysis was performed with the supposition that hormone therapy exposure results in a two-fold increase in complication rate. The study power was found to be 0.863.

Conclusions: Tamoxifen may have been previously overestimated as a microvascular thrombotic risk factor. At a minimum, these data suggest that withholding tamoxifen for 2 weeks before surgery can mitigate thrombotic risk.

Breast reconstruction outcomes after nipple-sparing mastectomy and radiation therapy

Breast reconstruction outcomes after nipple-sparing mastectomy and radiation therapy. Plastic and Reconstructive Surgery, April 2015, Vol. 135(4), p.959-66.


Reish, R.G., et al.


http://journals.lww.com/plasreconsurg/Abstract/2015/04000/Breast_Reconstruction_Outcomes_
after.4.aspx


Few studies in the literature examine outcomes of immediate breast reconstruction after mastectomy with nipple preservation and radiation therapy. Nipple-sparing mastectomy and immediate reconstruction in patients who had or will receive radiation therapy is associated with a higher incidence of complications and operative revisions compared with patients without radiation. However, most patients have successful reconstructions with nipple retention and no recurrences.

The impact of postoperative expansion initiation timing on breast expander capsular characteristics

The impact of postoperative expansion initiation timing on breast expander capsular characteristics: A prospective combined clinical and scanning electron microscopy study. Plastic and Reconstructive Surgery, April 2015, Vol. 135(4), p.967-974.


Paek, L.S., et al.


http://journals.lww.com/plasreconsurg/Abstract/2015/04000/The_Impact_of_Postoperative_Expansion
_Initiation.5.aspx


 In the first stage of expander-to-implant breast reconstruction, postoperative expansion is classically initiated at 10 to 14 days (conventional approach). The authors hypothesized that it may be beneficial to wait 6 weeks postoperatively before initiating serial expansion (delayed approach). Clinical and ultrastructural periprosthetic capsule analysis is first required before determining whether a delayed approach ultimately improves capsular tissue adherence and expansion process predictability.

Breast density legislation

Breast density legislation - practical considerations. NEJM 2015, 372: 593-5


Slanetz, P.J., et al.


http://www.nejm.org/doi/full/10.1056/NEJMp1413728?af=R&rss=currentIssue

Ever since Nancy Cappello, a Connecticut woman who hadn't been told that her mammograms showed dense breast tissue, was diagnosed with stage 3 breast cancer in 2004 and advocated for a new state law, there's been a growing movement to educate women about breast density and the potential role of supplemental screening in early cancer detection. Cappello's state was the first to pass a law requiring physicians to offer supplemental whole-breast ultrasonography to women with dense breasts — defined as containing more than 50% fibroglandular tissue — and mandating that insurers cover the additional screening.

Since then, the number of breast-density laws in the United States has grown rapidly: as of January 2015, a total of 21 states had adopted such legislation. Laws vary considerably among states, with some requiring only that physicians notify women with dense breasts of their status and others stipulating that supplemental screening be offered to such women. Most state laws, however, do not mandate insurance coverage of additional screening, though the lack of such coverage could increase income-based health disparities.

Pertuzumab, Trastuzumab, and Docetaxel in HER2-Positive metastatic breast cancer

Pertuzumab, Trastuzumab and Docetaxel in HER2-Positive metastatic breast cancer. NEJM 2015, 372: 724-34


Swain, S.M., et al.


http://www.nejm.org/doi/full/10.1056/NEJMoa1413513?af=R&rss=currentIssue


In patients with metastatic breast cancer that is positive for human epidermal growth factor receptor 2 (HER2), progression-free survival was significantly improved after first-line therapy with pertuzumab, trastuzumab, and docetaxel, as compared with placebo, trastuzumab, and docetaxel. Overall survival was significantly improved with pertuzumab in an interim analysis without the median being reached. We report final prespecified overall survival results with a median follow-up of 50 months.

Over-diagnosis in breast cancer

Over-diagnosis in breast cancer - 45 years to become a mainstream idea. BMJ [podcast]

https://soundcloud.com/bmjpodcasts/overdiagnosis-in-breast-cancer-45-years-to-become-a-mainstream-idea

Does breast reconstruction after mastectomy for breast cancer affect overall survival?

Does breast reconstruction after mastectomy for breast cancer affect overall survival? Long-term follow-up of a retrospective population-based cohort. Plastic and Reconstructive Surgery, March 2015, Vol. 135(3), p.468e-476e.

Platt, J., et al.

http://journals.lww.com/plasreconsurg/Abstract/2015/03000/Does_Breast_Reconstruction_after_Mastectomy_for.4.aspx

Background: This study compared overall and breast cancer–specific survival using long-term follow-up data among women diagnosed with invasive breast cancer undergoing mastectomy or breast reconstruction.

Comparison of postoperative pain control in autologous abdominal free flap versus inplant-based breast reconstructions

Comparison of postoperative pain control in autologous abdominal free flap versus inplant-based breast reconstructions. Plastic and Reconstructive Surgery, Feb 2015, Vol. 135(2), p.356-67.

Gassman, A.A., et al.

http://journals.lww.com/plasreconsurg/Abstract/2015/02000/Comparison_of_Postoperative_Pain_Control_in.9.aspx

Women who undergo mastectomy and breast reconstruction are shown to express more pain than those who undergo mastectomy alone. The authors evaluated postoperative pain outcomes following breast reconstruction.

Advanced age is a predictor of 30-day complications after autologous but not implant-based post-mastectomy breast reconstruction

Advanced age is a predictor of 30-day complications after autologous but not  implant-based post-mastectomy breast reconstruction. Plastic and Reconstructive Surgery, Feb. 2015, Vol. 135(2), p.253e-261e

Butz, D.R., et al.

http://journals.lww.com/plasreconsurg/Fulltext/2015/02000/Advanced_Age_Is_a_Predictor_of_30_Day.6.aspx

Older breast cancer patients undergo postmastectomy breast reconstruction infrequently, in part because of a perception of increased surgical risk. This study sought to investigate the effects of age on perioperative complications after postmastectomy breast reconstruction.