Tissue Expander Complications Do Not Preclude a Second Successful Implant-Based Breast Reconstruction

Tissue Expander Complications Do Not Preclude a Second Successful Implant-Based Breast Reconstruction

by Poppler, Louis H.; Mundschenk, Minh-Bao; Linkugel, Andrew; Zubovic, Ema; Dolen, Utku C.; Myckatyn, Terence M.  

Plastic and Reconstructive Surgery: January 2019 - Volume 143 - Issue 1 - p 24–34

Background: Implant-based breast reconstruction is the most common method of breast reconstruction in the United States, but the outcomes of subsequent implant-based reconstruction after a tissue expander complication are rarely studied. The purpose of this study was to determine the long-term incidence of implant loss in patents with a previous tissue expander complication. Methods: This is a retrospective review of the long-term outcomes of all patients with tissue expander complications at a large academic medical center from 2003 to 2013. Patients with subsequent tissue expander or implant complications were compared to those with no further complications to assess risk factors for additional complications or reconstructive failure.

Results: One hundred sixty-two women were included in this study. The mean follow-up period was 8.3 ± 3.1 years. Forty-eight women (30 percent) went on to undergo a second tissue expander or implant placement. They did not differ from women who went on to autologous reconstruction or no further reconstruction. Of these, 34 women (71 percent) had no further complications and 38 women (79 percent) had a successful implant-based reconstruction at final follow-up. There were no patient or surgical factors significantly associated with a second complication or implant loss. 

Conclusions: Following tissue expander complications, it is reasonable to offer women a second attempt at tissue expansion and implant placement. This study demonstrates that long-term success rates are high, and there are no definitive patient or surgical factors that preclude a second attempt at implant-based breast reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.

Evaluation of Prepectoral Implant Placement and Complete Coverage with TiLoop Bra Mesh for Breast Reconstruction: A Prospective Study on Long-Term and Patient-Reported BREAST-Q Outcomes

Evaluation of Prepectoral Implant Placement and Complete Coverage with TiLoop Bra Mesh for Breast Reconstruction: A Prospective Study on Long-Term and Patient-Reported BREAST-Q Outcomes

by Casella, Donato; Di Taranto, Giuseppe; Marcasciano, Marco; Sordi, Silvia; Kothari, Ashutosh; Kovacs, Tibor; Lo Torto, Federico; Cigna, Emanuele; Calabrese, Claudio; Ribuffo, Diego

Plastic and Reconstructive Surgery: January 2019 - Volume 143 - Issue 1 - p 1e–9e

Background: Breast reconstruction is rapidly evolving, because of the changing face of cancer surgery and the growing acceptance of acellular dermal matrices and synthetic meshes. Although some early reports showed encouraging results after prepectoral breast reconstruction, there is a paucity of data on long-term outcomes.

Methods: Between January of 2012 and March of 2015, 179 patients undergoing mastectomy were enrolled at the authors’ institution. Patients underwent mastectomy and immediate prepectoral breast reconstruction with the definitive implant entirely wrapped in a titanium-coated polypropylene mesh (TiLoop). The BREAST-Q questionnaire was administered before surgery and after 2 years. Capsular contracture was evaluated using the Baker scale. Oncologic, surgical, and aesthetic outcomes and changes in BREAST-Q score were analyzed over time.

Results: Average follow-up was 38.5 months. A total of 250 mastectomies were performed. The locoregional recurrence rate was 2.1 percent. Complications requiring reoperation were recorded in six patients (2.4 percent) and implant removal was necessary in three cases (1.2 percent), followed by reconstruction with submuscular expanders. Grade IV capsular contracture was detected in five breasts (2 percent), whereas 212 breasts were evaluated as grade I (84.8 percent), 28 breasts as grade II (11.2 percent), and five breasts as grade III (2 percent). Patients reported significant high rates in the BREAST-Q overall Satisfaction with Outcome (73.8), overall Satisfaction with Breasts (72.5), Psychosocial Well-being (77.7), and Sexual Well-being (57.9), scoring a significant increase in these domains from the preoperative period to the postoperative period (p < 0.05).

Conclusion: The authors report encouraging results of a prepectoral direct-to-implant reconstruction technique using a synthetic mesh, supporting the evaluation of the muscle-sparing subcutaneous approach as a valid alternative to traditional submuscular reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

The Use of Tumescent Technique in Mastectomy and Related Complications: A Meta-Analysis

by Siotos, Charalampos; Aston, Jeffrey W.; Euhus, David M.; Seal, Stella M.; Manahan, Michele A.; Rosson, Gedge D

Plastic and Reconstructive Surgery: January 2019 - Volume 143 - Issue 1 - p 39–48

Background: Postoperative skin necrosis in surgical patients is costly to hospitals and health care providers. Tumescent dissection technique is commonly used in mastectomy and immediate breast reconstruction, as it helps reduce blood loss; however, it may increase the risk of mastectomy skin flap necrosis. In this context, the authors have conducted a systematic review of the literature to perform a meta-analysis of the relationship between tumescent technique in mastectomy with or without breast reconstruction and complication rates.

Methods: The authors screened the PubMed (1966 to 2016), Scopus (2004 to 2016), Embase (1966 to 2016), and Web of Science (1964 to 2016) databases for relevant articles through March 30, 2017. The authors included studies on the use of tumescent technique in the context of mastectomy with or without immediate breast reconstruction. The primary outcome the authors evaluated was the rate of skin flap necrosis; the secondary outcomes were the rates of breast hematomas and infections. Because of the heterogeneity of the studies, the authors performed a meta-analysis using the random effects model.

Results: After screening, the authors evaluated five studies including 3982 mastectomies. Mastectomies performed under the preoperative application of tumescent solution had statistically higher rates of skin flap necrosis overall (p = 0.03) and major (p < 0.01) and minor skin necrosis (p = 0.03). However, the rates of hematoma and infection were not correlated with the use of tumescent technique.

Conclusions: The authors’ systematic review of the literature provides a better understanding of the consequences of the application of tumescent technique in mastectomy. The authors’ findings suggest that tumescent technique may increase the risk of skin necrosis in mastectomy with or without breast reconstruction.

Prepectoral Breast Reconstruction in the Setting of Postmastectomy Radiation Therapy: An Assessment of Clinical Outcomes and Benefits

Prepectoral Breast Reconstruction in the Setting of Postmastectomy Radiation Therapy: An Assessment of Clinical Outcomes and Benefits

by Sbitany, Hani; Gomez-Sanchez, Clara; Piper, Merisa; Lentz, Rachel  

Plastic and Reconstructive Surgery: January 2019 - Volume 143 - Issue 1 - p 10–20

Background: Prepectoral breast reconstruction following mastectomy has become a more widely performed technique in recent years because of its numerous benefits for women. These include full pectoralis muscle preservation, reduced loss of strength, reduced pain, and elimination of animation deformity. As with any breast reconstruction technique, widespread adoption is dependent on a low morbidity profile in the setting of postmastectomy radiation therapy, as this adjuvant therapy is routine in breast cancer treatment. The authors assess the clinical outcomes of patients undergoing postmastectomy radiation therapy following prepectoral breast reconstruction, and compare these to outcomes of patients undergoing postmastectomy radiation therapy with submuscular reconstruction.

Methods: A single surgeon’s experience with immediate prepectoral breast reconstruction, followed by postmastectomy radiation therapy, from 2015 to 2017 was reviewed. Patient demographics and incidence of complications during the tissue expander stage were assessed. In addition, the morbidity profile of these patients was compared to that of patients undergoing submuscular/dual-plane reconstruction and postmastectomy radiation therapy over the same period. Results: Over 3 years, 175 breasts underwent immediate prepectoral reconstruction, and 236 breasts underwent immediate submuscular/dual-plane reconstruction. Overall rates of adjuvant radiation therapy (postmastectomy radiation therapy) were similar between prepectoral [26 breasts (14.9 percent)] and submuscular [31 breasts (13.1 percent)] (p = 0.6180) reconstruction. There were no significant differences in complication rates between the two reconstructive cohorts, in the setting of postmastectomy radiation therapy, including rates of explantation (15.4 percent versus 19.3 percent; p = 0.695).

Conclusions: Prepectoral breast reconstruction is a safe and effective option in the setting of postmastectomy radiation therapy. The morbidity profile is similar to that encountered with submuscular reconstruction in this setting. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

A New Method for Partial Breast Reconstruction: 3-Year New Zealand Experience

A New Method for Partial Breast Reconstruction: 3-Year New Zealand Experience

by Harman, John; Govender, Stan; Simpson, John; Benjamin, Benji  

Plastic and Reconstructive Surgery: January 2019 - Volume 143 - Issue 1 - p 49–52

Summary: In New Zealand, oncoplastic surgery is common, but partial breast reconstruction presents challenges for radiation therapy targeting. Tissue rearrangement creates ambiguity when targeting the tumor bed, with resultant overestimation of treatment volumes. Thus, adoption of advanced methods of radiation therapy have been hindered. This pilot study describes use of a novel three-dimensional implant that provides a scaffolding for tissue ingrowth during partial breast reconstruction and delineates the tumor bed more precisely to assist radiation planning and mammographic surveillance. After informed consent, 15 women were implanted with the three-dimensional bioabsorbable implant. The device was sutured to the tumor bed during lumpectomy, and tissue flaps were mobilized and attached to the implant. Visualization of the marker and radiation treatment volumes were recorded and compared. The implant provided volume replacement and helped to maintain breast contour. Cosmetic outcomes were excellent; no device- or radiation-related complications occurred. One patient had a postoperative hematoma that resolved after percutaneous drainage; there were no postoperative infections. Three-year follow-up shows no tumor recurrences and no untoward effects. When compared to conventional radiation targeting, use of the implant showed that a greater than 50 percent reduction in treatment volume was possible in some cases. Three-year mammograms show no significant artifact, normal tissue ingrowth, and minimal fibrosis. This study describes a method of oncoplastic breast reconstruction using an implantable device that marks the site of tumor excision and provides for volume replacement with tissue ingrowth. Patients tolerated it well, and radiation therapy planning, positioning, and treatment were facilitated.

T-DM1 for residual, invasive, HER2-positive breast cancer

[News] T-DM1 for residual, invasive, HER2-positive breast cancer

by Talha Khan Burki  

The Lancet Oncology: Volume 20, Issue 1, PE13, January 01, 2019

A new study has concluded that adjuvant trastuzumab emtansine (T-DM1) reduces the risk of recurrence or death in patients with HER2-positive breast cancer who have residual disease after neoadjuvant therapy and surgery. In the phase 3, open-label trial, women with HER2-positive, early-stage breast cancer had received neoadjuvant therapy consisting of at least six cycles of chemotherapy, including a taxane, and trastuzumab for at least 9 weeks. Patients were randomly assigned to receive 14 cycles of either T-DM1 or trastuzumab (n=743 per group).

Use of letrozole after aromatase inhibitor-based therapy in postmenopausal breast cancer (NRG Oncology/NSABP B-42): a randomised, double-blind, placebo-controlled, phase 3 trial

[Articles] Use of letrozole after aromatase inhibitor-based therapy in postmenopausal breast cancer (NRG Oncology/NSABP B-42): a randomised, double-blind, placebo-controlled, phase 3 trial

by Eleftherios P Mamounas, Hanna Bandos, Barry C Lembersky, Jong-Hyeon Jeong, Charles E Geyer, Priya Rastogi, Louis Fehrenbacher, Mark L Graham, Stephen K Chia, Adam M Brufsky, Janice M Walshe, Gamini S Soori, Shaker R Dakhil, Thomas E Seay, James L Wade, Edward C McCarron, Soonmyung Paik, Sandra M Swain, D Lawrence Wickerham, Norman Wolmark

The Lancet Oncology: Volume 20, issue 1, P88-99, January 01, 2019

After 5 years of aromatase inhibitor-based therapy, 5 years of letrozole therapy did not significantly prolong disease-free survival compared with placebo. Careful assessment of potential risks and benefits is required before recommending extended letrozole therapy to patients with early-stage breast cancer.

Total Muscle Coverage versus AlloDerm Human Dermal Matrix for Implant-Based Breast Reconstruction

Total Muscle Coverage versus AlloDerm Human Dermal Matrix for Implant-Based Breast Reconstruction

by Ivey, J. Simon; Abdollahi, Hamid; Herrera, Fernando A.; Chang, Eric I

Plastic and Reconstructive Surgery: January 2019 - Volume 143 - Issue 1 - p 1–6

Background: Prosthetic breast reconstruction is the most common method for treatment of patients undergoing mastectomy. Acellular dermal matrix has become more popular in implant-based breast reconstruction. Methods: The authors conducted a retrospective review of all patients undergoing prosthetic breast reconstruction between August of 2002 and December of 2013. Patients were analyzed in terms of demographics, fill volumes, number of expansions, costs, and complications. Results: A total of 284 patients underwent mastectomy surgery with 481 implant-based breast reconstructions. Four hundred eight tissue expanders had total muscle coverage, whereas 73 had AlloDerm. The rate of overall complications and major complications was significantly higher in the AlloDerm group: 20.5 percent versus 8.8 percent (p = 0.005), and 13.7 percent versus 5.1 percent (p = 0.0001), respectively. The mean initial fill volume was significantly lower in the total muscle coverage group compared to the acellular dermal matrix group (54 ± 47 versus 167 ± 139; p = 0.00003), resulting in a higher number of expansions (8.1 versus 5.8; p = 0.000051) and longer time to full expansion (60.2 days versus 43.3 days; p = 0.0002). This did not translate into a faster time to expander exchange (162.4 days versus 162.3 days; p = 0.13). Use of AlloDerm added a mean cost of $2217 for each breast.

Conclusions: Implant-based breast reconstruction has evolved with the advent of acellular dermal matrices. Although the use of acellular dermal matrix allows increased initial fill volumes and fewer total expansions, there is an increased risk of complications and increased costs, especially in patients undergoing bilateral reconstruction. Total muscle coverage remains an excellent option for providing quality breast reconstruction without increased complications. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

What’s new in oncology: Breast Cancer

    

What's new in oncology  (UpToDate – you *may* need to be logged into UpToDate before accessing these links. You can access via Zenworks (on a Trust computer) and then register for your own account which enables you to use the app and collect CPD points)

Authors: April F Eichler, MD, MPH, Diane MF Savarese, MD, Sadhna R Vora, MD

Literature review current through: Nov 2018. | This topic last updated: Dec 12, 2018.

Atezolizumab and nab-paclitaxel in triple negative breast cancer (November 2018)

Overall survival with fulvestrant and palbociclib in advanced HR-positive, HER2-negative breast cancer (November 2018)

  

Aromatase inhibitor-induced joint pain and acupuncture (July 2018)

Updated guidelines on HER2 ISH interpretation in breast cancer (July 2018) 

Avoidance of adjuvant chemotherapy in women with HR-positive, node-negative breast cancer and intermediate Recurrence Score (RS) (July 2018) 

Duration of adjuvant trastuzumab in early HER2-positive breast cancer (July 2018)

 Ovarian suppression with either tamoxifen or an aromatase inhibitor in premenopausal women with early breast cancer (July 2018)

Mixed data regarding denosumab as adjuvant breast cancer treatment (July 2018)

Addition of carboplatin to neoadjuvant chemotherapy for triple negative breast cancer (May 2018)

Incision Choices in Nipple-Sparing Mastectomy: A Comparative Analysis of Outcomes and Evolution of a Clinical Algorithm

Incision Choices in Nipple-Sparing Mastectomy: A Comparative Analysis of Outcomes and Evolution of a Clinical Algorithm

by Frey, Jordan D.; Salibian, Ara A.; Levine, Jamie P.; Karp, Nolan S.; Choi, Mihye  

Plastic and Reconstructive Surgery: December 2018 - Volume 142 - Issue 6 - p 826e–835e

Background: Nipple-sparing mastectomy allows for preservation of the entire nipple-areola complex using various incision patterns. Reconstructive trends and overall risk associated with these diverse nipple-sparing mastectomy incisions have yet to be fully elucidated.

Methods: All nipple-sparing mastectomies from 2006 to 2017 were identified; outcomes were stratified by type of mastectomy incision: lateral or vertical radial, inframammary fold, Wise pattern, previous, and periareolar.

Results: A total of 1207 nipple-sparing mastectomies were included for final analysis. Of these, 638 (52.9 percent) used an inframammary fold incision, 294 (24.4 percent) used a lateral radial incision, 161 (13.3 percent) used a vertical radial incision, 60 (5.0) used a Wise pattern incision, 35 (2.9 percent) used a previous incision, and 19 (1.6 percent) used a periareolar incision. The groups were heterogeneous and differed significantly with regard to various factors, including age (p < 0.001), body mass index (p < 0.001), reconstruction modality (p < 0.001), and others. In crude multivariate logistic regression analysis, vertical radial (16.1 percent) and inframammary fold incisions (21.0 percent) were associated with lower overall complication rates. In a reduced multivariate logistic regression model, inframammary fold incisions (p = 0.001) emerged as significantly protective of overall complications after controlling all variables.

Conclusions: Nipple-sparing mastectomy may be safely performed using various mastectomy incisions, each with unique advantages and limitations. Overall, inframammary fold incisions appear to be associated with the lowest risk, whereas Wise pattern incisions may increase risk. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

The Stacked Hemiabdominal Extended Perforator Flap for Autologous Breast Reconstruction

The Stacked Hemiabdominal Extended Perforator Flap for Autologous Breast Reconstruction

 by Beugels, Jop; Vasile, Julie V.; Tuinder, Stefania M. H.; Delatte, Stephen J.; St-Hilaire, Hugo; Allen, Robert J.; Levine, Joshua L.  

Plastic and Reconstructive Surgery: December 2018 - Volume 142 - Issue 6 - p 1424–1434

Background: Options for bilateral autologous breast reconstruction in thin women are limited. The aim of this study was to introduce a novel approach to increase abdominal flap volume with the stacked hemiabdominal extended perforator (SHAEP) flap. The authors describe the surgical technique and analyze their results.

Methods: A retrospective study was conducted of all SHAEP flap breast reconstructions performed since February of 2014. Patient demographics, operative details, complications, and flap reexplorations were recorded. The bipedicled hemiabdominal flap was designed as a combination of the deep inferior epigastric artery perforator (DIEP) and a second, more lateral pedicle: the deep or superficial circumflex iliac perforator vessels, the superficial inferior epigastric artery, or a lumbar artery or intercostal perforator.

Results: A total of 90 SHAEP flap breast reconstructions were performed in 49 consecutive patients. Median operative time was 500 minutes (range, 405 to 797 minutes). Median hemiabdominal flap weight that was used for reconstruction was 598 g (range, 160 to 1389 g). No total flap losses were recorded. Recipient-site complications included partial flap loss (2.2 percent), hematoma (3.3 percent), fat necrosis (2.2 percent), and wound problems (4.4 percent). Minor donor-site complications occurred in five patients (10.2 percent). Most flaps were harvested on a combination of the DIEP and deep circumflex iliac artery vessels.

Conclusions: This study demonstrated that the SHAEP flap is an excellent option for bilateral autologous breast reconstruction in women who require significant breast volume but have insufficient abdominal tissue for a bilateral DIEP flap. The bipedicled SHAEP flap allows for enhanced flap perfusion, increased volume, and abdominal contour improvement using a single abdominal donor site. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Assessing Age as a Risk Factor for Complications in Autologous Breast Reconstruction

Assessing Age as a Risk Factor for Complications in Autologous Breast Reconstruction

by Torabi, Radbeh; Stalder, Mark W.; Tessler, Oren; Bartow, Matthew J.; Lam, Jonathan; Patterson, Charles; Wise, M. Whitten; Dupin, Charles L.; St. Hilaire, Hugo  

Plastic and Reconstructive Surgery: December 2018 - Volume 142 - Issue 6 - p 840e–846e

Background: Breast cancer is primarily a diagnosis of older women. Many patients seeking breast reconstruction are elderly women (aged 65 years or older). However, many surgeons anecdotally believe that surgery in elderly patients is inherently dangerous, or at least prone to more complications. 

Methods: The authors conducted a retrospective cohort study composed of chart review of all deep inferior epigastric perforator flap breast reconstruction patients at a single institution divided into an elderly cohort (65 years or older) and a nonelderly cohort (younger than 65 years). Cohort was the primary predictor variable. Demographic and comorbidity data were secondary predictor variables. Primary outcomes were complete flap loss, partial flap loss, or need for flap reexploration. Secondary outcomes such as wound healing problems, seroma, and others were also assessed. 

Results: There were 285 flaps in the nonelderly cohort and 54 flaps in the elderly cohort. The elderly cohort had higher rates of diabetes, hypertension, and hyperlipidemia. Chi-square analysis showed no significant differences in primary outcomes between the two cohorts. Breast wound dehiscence was significantly higher in the elderly cohort (p < 0.01). On logistic regression, being elderly was seen as a significant risk factor for complete flap loss (OR, 10.92; 95 percent CI, 0.97 to 122.67; p = 0.05). The overall success rate for the nonelderly cohort was 99.6 percent, whereas the success rate for the nonelderly cohort was 96.3 percent. 

Conclusions: Elderly women desire breast reconstruction. Free flap breast reconstruction is a viable and safe procedure in these patients. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.

Modern Primary Breast Augmentation: Best Recommendations for Best Results

Modern Primary Breast Augmentation: Best Recommendations for Best Results

 by Wan, Dinah; Rohrich, Rod J.  

Plastic and Reconstructive Surgery: December 2018 - Volume 142 - Issue 6 - p 933e–946e

Learning Objectives: After reading this article, the participant should be able to: 

1. Develop a practical method for preoperative implant size selection. 

2. List characteristics and examples of fourth- and fifth-generation silicone implants. 

3. Recognize the differences in “profile” designations across implant manufacturers. 

4. Recall updated statistics on breast implant–associated anaplastic large cell lymphoma and describe current guidelines on disease diagnosis and treatment. 

5. Apply atraumatic and aseptic surgical techniques in primary breast augmentation. 

Summary: Modern primary breast augmentation requires an intimate knowledge of the expanding breast implant market, including characteristics of current generation silicone implants and “profile” types. Optimal implant size selection requires balancing patient desires with tissue qualities. Evidence and awareness of breast implant–associated anaplastic large cell lymphoma continue to grow, and patients and surgeons alike should be informed on the most updated facts of the disease entity. Atraumatic surgical technique and aseptic adjuncts are critical in reducing periprosthetic inflammation and contamination, both of which are known instigators of capsular contracture and potentially breast implant–associated anaplastic large cell lymphoma.

Fat Graft Safety after Oncologic Surgery: Addressing the Contradiction between In Vitro and Clinical Studies

Fat Graft Safety after Oncologic Surgery: Addressing the Contradiction between In Vitro and Clinical Studies

by Orbay, Hakan; Hinchcliff, Katharine M.; Charvet, Heath J.; Sahar, David E.  

Plastic and Reconstructive Surgery: December 2018 - Volume 142 - Issue 6 - p 1489–1499

Background: The authors investigate the in vitro and in vivo interaction of human breast cancer cells and human adipose-derived stem cells to address the controversy on the safety of postmastectomy fat grafting. Methods: The authors co-cultured human adipose-derived stem cells and MDA-MB-231 breast cancer cells in an in vitro cell migration assay to examine the migration of breast cancer cells. In the in vivo arm, the authors injected breast cancer cells (group I), human breast cancer cells plus human adipose-derived stem cells (group II), human breast cancer cells plus human fat graft (group III), and human breast cancer cells plus human fat graft plus human adipose-derived stem cells (group IV) to the mammary fat pads of female nude mice (n = 20). The authors examined the tumors, livers, and lungs histologically after 2 weeks. Results: Migration of breast cancer cells increased significantly when co-cultured with adipose-derived stem cells (p < 0.05). The tumor growth rate in group IV was significantly higher than in groups I and II (p < 0.05). The tumor growth rate in group III was also higher than in groups I and II, but this difference was not statistically significant (p > 0.05). Histologically, there was no liver/lung metastasis at the end of 2 weeks. The vascular density in the tumors from group IV was significantly higher than in other groups (p < 0.01). Conclusion: The injection of breast cancer cells, fat graft, and adipose-derived stem cells together increases breast cancer xenograft growth rates significantly.

[Articles] Neoadjuvant chemotherapy with or without anthracyclines in the presence of dual HER2 blockade for HER2-positive breast cancer (TRAIN-2): a multicentre, open-label, randomised, phase 3 trial

[Articles] Neoadjuvant chemotherapy with or without anthracyclines in the presence of dual HER2 blockade for HER2-positive breast cancer (TRAIN-2): a multicentre, open-label, randomised, phase 3 trial

 by Mette S van Ramshorst, Anna van der Voort, Erik D van Werkhoven, Ingrid A Mandjes, Inge Kemper, Vincent O Dezentjé, Irma M Oving, Aafke H Honkoop, Lidwine W Tick, Agnes J van de Wouw, Caroline M Mandigers, Laurence J van Warmerdam, Jelle Wesseling, Marie-Jeanne T Vrancken Peeters, Sabine C Linn, Gabe S Sonke, Dutch Breast Cancer Research Group (BOOG)  

The Lancet Oncology: Volume 19, issue 12, P1630-1640, December 01, 2018

In view of the high proportion of pathological complete responses recorded in both groups and the fact that febrile neutropenia was more frequent in the anthracycline group, omitting anthracyclines from neoadjuvant treatment regimens might be a preferred approach in the presence of dual HER2 blockade in patients with early HER2-positive breast cancer. Long-term follow-up is required to confirm these results.

Breast Implant Mycobacterial Infections: An Epidemiologic Review and Outcome Analysis

Breast Implant Mycobacterial Infections: An Epidemiologic Review and Outcome Analysis

Authors:  Al-Halabi, Becher; Viezel-Mathieu, Alex; Shulman, Zachary; Behr, Marcel A.; Fouda Neel, Omar  

Plastic and Reconstructive Surgery:  November 2018 - Volume 142 - Issue 5 

Background: Epidemiologic evidence of periprosthetic mycobacterial infections is limited. The recent boom in cosmetic surgery tourism has been associated with a rise of surgical-site infections in returning patients. This review aims to explore available data, examine trends of documented periprosthetic mycobacterial infections, and analyze outcomes of management techniques. Methods: A search in the Biosis, Embase, LILACS, MEDLINE, and Web of Science databases from inception until December of 2017 for “Breast Implants” and “Mycobacterial Infections” and equivalents was performed. Data were pooled after two screening rounds following full-text retrieval and cross-referencing.

Results: Forty-one reports describing 171 female patients who had breast prosthesis–related mycobacterial infections were identified. Bibliometric case-based analysis revealed a rise of periprosthetic mycobacterial infections in developing countries since the start of the millennium. The mean patient’s age was 37.9 years and the majority of patients had undergone bilateral breast augmentation. Most patients presented with breast pain or tenderness, after an average incubation period of 9 months. Mycobacterium fortuitum was isolated from 90 cases (52.6 percent). Immediate explantation with or without delayed reimplantation was the most commonly used surgical strategy, complemented by combination antimicrobial therapy for an average of 4.6 months. The mean follow-up time was 39.7 months, during which recurrence was observed in 21 of 171 patients (12.3 percent).

Conclusions: The emergence of periprosthetic mycobacterial infections in relation to cosmetic medical tourism alerts clinicians to the importance of educating the public about the associated risks. In addition, this study identifies risk factors associated with recurrence of periprosthetic mycobacterial infections.

Inflammatory breast cancer. A challenging disease with poor prognosis

Inflammatory breast cancer. A challenging disease with poor prognosis

by Mariam Salim, Hafsa Arif, Osama Shakeel, Amina Iqbal, Huma Majeed, Zulqarnain Chaudhry  

The Breast: October 2018 Volume 41, Supplement 1, Page S22

Introduction: Inflammatory breast cancer (IBC) is an aggressive angioinvasive form of breast cancer associated with a high incidence of early nodal and systemic metastasis. It is a rare cancer in our population, while its incidence is increasing worldwide especially in the United States. It accounts for 1-6% of total breast cancer cases. By its ability to metastasize rapidly, most IBC tumors are characterized as stage IIIB at the time of detection. It is known for aggressive histopathologic features and poor survival.

Can breast cancer metastasize to an unusual organ? : case report and review

Can breast cancer metastasize to an unusual organ? : case report and review

by Marija Karakolevska - Ilova  

The Breast: October 2018Volume 41, Supplement 1, Pages S21–S22

Introduction: Metastatic cancer in the thyroid is uncommon and large autopsy studies found out that the incidence of thyroid metastases in patients with a history of cancer ranges from 1.9% to 24%, so in any patient with a previous history of malignancy, a new thyroid mass should be considered as recurrence until proved otherwise. The most frequent primary cancers are renal cell (48.1%), colorectal (10.4%), lung (8.3%) and breast (7.8%) cancers.Most patients with thyroid metastases have widespread metastatic disease but occasionally the thyroid may be the only site of disease with the same impact on prognosis as nonthyroidal metastases.

Physicians attitudes and knowledge about fertility preservation

Physicians attitudes and knowledge about fertility preservation

by M. Lambertini  

The Breast: October 2018Volume 41, Supplement 1, Page S4

In young breast cancer patients diagnosed during their reproductive years, the possible occurrence of treatment-induced premature ovarian insufficiency is of particular concern being associated with important menopause-related symptoms, psychosocial issues as well as infertility. Over the past years, solid evidence has been accumulated to support the management of young patients facing issues related to fertility preservation and specific guidelines have been developed to help physicians in dealing with this topic.

Follow-up clinics: nurses to lead them?

Follow-up clinics: nurses to lead them?

by Y. Wengström  

The Breast: October 2018 Volume 41, Supplement 1, Page S3

Despite substantial evidence that intensive follow up after cancer treatment may not lead to improvements in survival or quality of life, is inefficient at detecting recurrence, and is highly cost ineffective, most patients with cancer are routinely seen in outpatient clinics for many years. The high degree of psychological and functional morbidity among cancer patients suggests a need for close monitoring and support; however, research shows that routine follow up in busy clinics actually provides an environment conducive to supporting patients after a diagnosis of cancer.