Do all patients with HER2 positive breast cancer require one year of adjuvant trastuzumab? A systematic review and meta-analysis

 

Do all patients with HER2 positive breast cancer require one year of adjuvant trastuzumab? A systematic review and meta-analysis

by Paul Stewart, Phillip Blanchette, Prakesh S. Shah, Xiang Y. Ye, R. Gabriel Boldt, Ricardo Fernandes, Ted Vandenberg, Jacques Raphael

The Breast: Open Access: Published: October 21, 2020

One year of adjuvant trastuzumab is considered the standard treatment for patients with HER2 positive breast cancer. However, a shorter duration of trastuzumab may be associated with reduced costs and side effects. Results from randomized trials with diverse non-inferiority margins comparing one year to a shorter duration of adjuvant trastuzumab are not consistent and have not been systematically reviewed using a non-inferiority meta-analysis approach.We conducted a systematic review and meta-analysis of randomized trials to assess whether a shorter duration of adjuvant trastuzumab was non-inferior to one year of treatment or not.

Correlation of size and focality with prognosis in small breast carcinoma: a single institution case series

 

Correlation of size and focality with prognosis in small breast carcinoma: a single institution case series

 

by Mauro G. Mastropasqua, Francesca Addante, Sara Pirola, Giuseppe Ingravallo, Giuseppe Viale 

 

The Breast: Open Access: Published: October 16, 2020

 

The clinical behavior and prognosis of small multifocal and microinvasive breast cancers are still debated together with the best method of assessing tumor size in multiple invasive carcinomas. This study evaluates the clinico-pathological features of single and multiple breast cancers up to 0.5 cm in order to evaluate the rate of recurrences.

Eligibility of real-world patients with metastatic breast cancer for clinical trials

 

Eligibility of real-world patients with metastatic breast cancer for clinical trials

 

by Atul Batra, Shiying Kong, Winson Y. Cheung 

 

The Breast: Open Access: Published: October 17, 2020

 

The results of clinical trials in metastatic breast cancer (MBC) are generalized to real-world patients. This study determines the proportion of real-world patients who would be eligible for clinical trials and compares outcomes in eligible versus ineligible patients.

Highlights

•One third of patients with metastatic breast cancer are clinical trial ineligible.

•Renal dysfunction and prior immunosuppression are common reasons.

•Ineligible patients are less likely to receive chemotherapy, but not hormonal therapy.

•Systemic treatment, but not eligibility, is associated with overall survival.

•Eligibility criteria should be broadened to represent more real-world patients.

HER2 positivity is not associated with adverse prognosis in high-risk estrogen receptor-positive early breast cancer patients treated with chemotherapy and trastuzumab

 

HER2 positivity is not associated with adverse prognosis in high-risk estrogen receptor-positive early breast cancer patients treated with chemotherapy and trastuzumab

 

by Shuai Li, Jiayi Wu, Ou Huang, Jianrong He, Li Zhu, Weiguo Chen, Yafen Li, Xiaosong Chen, Kunwei Shen 

 

The Breast: Open Access: Published: October 14, 2020

 

Co-expression of human epidermal growth factor receptor-2 (HER2) and hormone receptor (HR) predicted worse prognosis in early breast cancer before trastuzumab was developed. We aimed to investigate whether HER2 positivity was still associated with worse outcome in high-risk estrogen receptor (ER) positive patients treated with trastuzumab and chemotherapy. In the present study, 227 ER+/HER2+ patients treated with trastuzumab and chemotherapy (HER2-pos-T group) and 1097 ER+/HER2-patients treated with chemotherapy alone (HER2-neg group) during 2009 and 2015 were retrospectively enrolled for the comparison of disease-free survival (DFS) and overall survival (OS).

Breast-Conserving Surgery with or without Irradiation in Women with Invasive Ductal Carcinoma of the Breast Receiving Preoperative Systemic Therapy: A National Cohort Study

 

Breast-Conserving Surgery with or without Irradiation in Women with Invasive Ductal Carcinoma of the Breast Receiving Preoperative Systemic Therapy: A National Cohort Study

by Jiaqiang Zhang, Chang-Yun Lu, Lei Qin, Ho-Min Chen, Szu-Yuan Wu 

The Breast: VOLUME 54, P139-147, DECEMBER 01, 2020

To investigate the outcomes of adjuvant whole breast radiation therapy (WBRT) in patients with invasive ductal carcinoma of the breast (breast IDC) receiving preoperative systemic therapy (PST) and breast-conserving surgery (BCS), and their prognostic factors, considering overall survival (OS), locoregional recurrence (LRR), distant metastasis (DM), and disease-free survival.

Differences in breast cancer risk after benign breast disease by type of screening diagnosis

 Differences in breast cancer risk after benign breast disease by type of screening diagnosis

 

by Javier Louro, Marta Román, Margarita Posso, Laura Comerma, Carmen Vidal, Francina Saladié, Rodrigo Alcantara, Mar Sanchez, M. Jesús Quintana, Javier del Riego, Joana Ferrer, Lupe Peñalva, Xavier Bargalló, Miguel Prieto, María Sala, Xavier Castells

 

The Breast: Open Access: Published: October 03, 2020

 

We aimed to assess differences in breast cancer risk across benign breast disease diagnosed at prevalent or incident screens.

 

Highlights

•Breast cancer risk after a benign breast disease varied with the screening type.

•Incident benign breast disease had a higher breast cancer risk than prevalent.

•The risk remained increased regardless of benign breast disease subtype.

Symptoms in Long-term Breast Cancer Survivors: A Cross-sectional Study in Primary Care

 

Symptoms in Long-term Breast Cancer Survivors: A Cross-sectional Study in Primary Care

 

by S.W.M.C. Maass, L.M. Boerman, D. Brandenbarg, P.F.M. Verhaak, J.H. Maduro, G.H. de Bock, A.J. Berendsen

 

The Breast: VOLUME 54, P133-138, DECEMBER 01, 2020

 

Various long-term symptoms can manifest after breast cancer treatment, but we wanted to clarify whether these are more frequent among long-term breast cancer survivors than matched controls and if they are associated with certain diagnoses.

First-line bevacizumab and eribulin combination therapy for HER2-negative metastatic breast cancer: Efficacy and safety in the GINECO phase II ESMERALDA study

 First-line bevacizumab and eribulin combination therapy for HER2-negative metastatic breast cancer: Efficacy and safety in the GINECO phase II ESMERALDA study

 

by Anne-Claire Hardy-Bessard, Fabien Brocard, Florian Clatot, Alain Lortholary, Benoît You, Julien Grenier, Jérôme Martin-Babau, Brigitte Lucas, Jérôme Meunier, Jean-Marc Ferrero, Aude-Marie Savoye, Adina Marti, Raymond Despax, Isabelle Moullet, George Emile

 

The Breast: Open Access: Published: September 30, 2020

 

Combining bevacizumab with paclitaxel significantly improves progression-free survival (PFS) versus paclitaxel alone in HER2-negative metastatic breast cancer (MBC). Eribulin is active and tolerable in pretreated MBC. To assess whether eribulin may offer a more tolerable yet effective combination partner for bevacizumab, we evaluated a bevacizumab/eribulin combination regimen as first-line therapy for MBC.

Immediate Breast Reconstruction after Mastectomy with Polyurethane Implants versus Textured Implants: A Retrospective Study with Focus on Capsular Contracture

 

Immediate Breast Reconstruction after Mastectomy with Polyurethane Implants versus Textured Implants: A Retrospective Study with Focus on Capsular Contracture

 

by Andrea Loreti, Giacomo Siri, Matteo De Carli, Benedetta Fanelli, Floriana Arelli, Diana Spallone, Ornella Abate, Massimo La Pinta, Elena Manna, Emanuele Zarba Meli, Leopoldo Costarelli, Damiana Andrulli, Laura Broglia, Paola Scavina, Lucio Fortunato

 

The Breast: VOLUME 54, P127-132, DECEMBER 01, 2020

 

Capsular contracture (CC) is the most common complication following Immediate Breast Reconstruction (IBR) with breast implants. Different implant surfaces were developed aiming to reduce the incidence of CC. We evaluated the incidence and degree of CC after Direct-to-Implant (DTI) IBR with insertion of textured (TE) or polyurethane (PU) covered implants.

Circulating tumour DNA analysis to direct therapy in advanced breast cancer (plasmaMATCH): a multicentre, multicohort, phase 2a, platform trial

 Circulating tumour DNA analysis to direct therapy in advanced breast cancer (plasmaMATCH): a multicentre, multicohort, phase 2a, platform trial

by Nicholas C Turner, Belinda Kingston, Lucy S Kilburn, Sarah Kernaghan, Andrew M Wardley, Iain R Macpherson, Richard D Baird, Rebecca Roylance, Peter Stephens, Olga Oikonomidou, Jeremy P Braybrooke, Mark Tuthill, Jacinta Abraham, Matthew C Winter, Hannah Bye, Michael Hubank, Heidrun Gevensleben, Ros Cutts, Claire Snowdon, Daniel Rea, David Cameron, Abeer Shaaban, Katrina Randle, Sue Martin, Katie Wilkinson, Laura Moretti, Judith M Bliss, Alistair Ring

 

The Lancet Oncology:  VOLUME 21, ISSUE 10, P1296-1308, OCTOBER 01, 2020

ctDNA testing offers accurate, rapid genotyping that enables the selection of mutation-directed therapies for patients with breast cancer, with sufficient clinical validity for adoption into routine clinical practice. Our results demonstrate clinically relevant activity of targeted therapies against rare HER2 and AKT1 mutations, confirming these mutations could be targetable for breast cancer treatment...

Veliparib with carboplatin and paclitaxel in BRCA-mutated advanced breast cancer (BROCADE3): a randomised, double-blind, placebo-controlled, phase 3 trial

 Veliparib with carboplatin and paclitaxel in BRCA-mutated advanced breast cancer (BROCADE3): a randomised, double-blind, placebo-controlled, phase 3 trial

by Véronique Diéras, Hyo S Han, Bella Kaufman, Hans Wildiers, Michael Friedlander, Jean-Pierre Ayoub, Shannon L Puhalla, Igor Bondarenko, Mario Campone, Erik H Jakobsen, Mathilde Jalving, Cristina Oprean, Marketa Palácová, Yeon Hee Park, Yaroslav Shparyk, Eduardo Yañez, Nikhil Khandelwal, Madan G Kundu, Matthew Dudley, Christine K Ratajczak, David Maag, Banu K Arun

 

The Lancet Oncology: ARTICLES| VOLUME 21, ISSUE 10, P1269-1282, OCTOBER 01, 2020

 

The addition of veliparib to a highly active platinum doublet, with continuation as monotherapy if the doublet were discontinued, resulted in significant and durable improvement in progression-free survival in patients with germline BRCA mutation-associated advanced breast cancer. These data indicate the utility of combining platinum and PARP inhibitors in this patient population.

Efficiency in DIEP Flap Breast Reconstruction: The Real Benefit of Computed Tomographic Angiography Imaging

 Efficiency in DIEP Flap Breast Reconstruction: The Real Benefit of Computed Tomographic Angiography Imaging

 by Haddock, Nicholas T.; Dumestre, Danielle O.; Teotia, Sumeet S. 

Plastic and Reconstructive Surgery: October 2020 - Volume 146 - Issue 4 - p 719-723

Background: In deep inferior epigastric perforator (DIEP) flap breast reconstruction, many surgeons use preoperative imaging for perforator mapping as a method to plan the operation, reduce operative times, and potentially limit morbidity. This study compared operative times for specific portions of DIEP flap harvest with and without preoperative computed tomographic angiography imaging.

Methods: Two patient groups undergoing DIEP flap breast reconstruction were studied prospectively. In the experimental group, the harvesting surgeon was blinded to the preoperative computed tomographic angiography scan; in the control group, the harvesting surgeon assessed the scan preoperatively. Times for initial perforator identification, perforator selection, flap harvest time, and total procedure times were compared. Perforator choice was evaluated. Correlation of perforator choice preoperatively and intraoperatively was also performed.

Results: Times were recorded in 60 DIEP flaps (27 blinded and 33 unblinded). The nonblinded group was more efficient in all categories: time to first perforator identification (28.6 minutes versus 17.8 minutes; p < 0.0001), time to perforator decision-making (23.1 minutes versus 5.6 minutes; p < 0.0001), time to flap harvest (128 minutes versus 80 minutes; p < 0.0001), and total operative time (417 minutes versus 353 minutes; p < 0.001). Perforator location was not different between groups. Blinded intraoperative decisions correlated with preoperative imaging in 74 percent of flaps. More perforators were included in the blinded flaps compared to the nonblinded flaps (2.3 versus 1.4; p < 0.001).

Conclusions: Use of preoperative computed tomographic angiography leads to decreased operative times, specifically with regard to perforator identification and perforator selection. Without preoperative computed tomographic angiography, surgeons included more perforators in the flaps. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.

Comparing the Lumbar and SGAP Flaps to the DIEP Flap Using the BREAST-Q

 

Comparing the Lumbar and SGAP Flaps to the DIEP Flap Using the BREAST-Q

 

by Opsomer, Dries; Vyncke, Tom; Ryx, Michelle; Stillaert, Filip; Van Landuyt, Koenraad; Blondeel, Phillip 

 

Plastic and Reconstructive Surgery: September 2020 - Volume 146 - Issue 3 - p 276e-282e

 

Background:

The deep inferior epigastric artery perforator (DIEP) flap is the gold standard in autologous breast reconstruction. When the abdomen is not available, alternative donor sites can be found at the buttock, the lumbar region, or the thighs. These flaps are referred to as second-choice flaps. This study compares the superior gluteal artery perforator (SGAP) flap and the lumbar artery perforator (LAP) flap to the DIEP flap using patient-reported outcomes.

Methods:

A retrospective study was performed reviewing the records of 417 women who underwent a free flap breast reconstruction with either a DIEP, an LAP, or an SGAP flap, between 2006 and 2018. Patients were asked to fill out the BREAST-Q questionnaire, and patient-reported outcomes were analyzed and correlated to the demographic information.

Results:

The response rate was 54.5 percent, with 50 LAP, 153 DIEP, and 25 SGAP flap patients participating. When questioned about their satisfaction with breasts and satisfaction with outcome, all three procedures were rated similarly high. When comparing the physical well-being of the donor site and appearance of the donor site, LAP flap patients reported significantly lower scores than DIEP and SGAP flap patients.

Conclusions:

Patients who undergo LAP or SGAP flap breast reconstruction seem similarly satisfied with the appearance and outcome of their free flap breast reconstruction compared with DIEP flap patients. The donor-site morbidity and its impact on the patient’s well-being in SGAP and LAP flap patients have been underestimated. Despite more donor-site discomfort, the LAP and SGAP flaps are feasible alternatives whenever the DIEP flap is not possible.

Comparison of Telfa Rolling and a Closed Washing System for Autologous Fat Processing Techniques in Postmastectomy Breast Reconstruction

 

Comparison of Telfa Rolling and a Closed Washing System for Autologous Fat Processing Techniques in Postmastectomy Breast Reconstruction

 

Valmadrid, Al C.; Kaoutzanis, Christodoulos; Wormer, Blair A.; Farinas, Angel F.; Wang, Li; Al Kassis, Salam; Perdikis, Galen; Braun, Stephane A.; Higdon, Kent K

 

Plastic and Reconstructive Surgery: September 2020 - Volume 146 - Issue 3 - p 486-497

 

Background:

The purpose of this study was to compare the commonly used fat grafting techniques—Telfa rolling and a closed washing system—in breast reconstruction patients.

Methods:

Consecutive patients undergoing fat grafting were retrospectively reviewed and grouped by technique. Patients with less than 180 days of follow-up were excluded. Demographics, operative details, and complications were compared using univariate analysis with significance set at p < 0.05.

Results:

Between January of 2013 and September of 2017, 186 women underwent a total of 319 fat grafting procedures. There was no difference in demographics, number of procedures performed, volume of fat grafted, and number of days after reconstruction that fat grafting was performed between groups (p > 0.05). Telfa rolling patients had longer operative times for second fat grafting procedures (implant exchange often completed prior) [100.0 minutes (range, 60.0 to 150.0 minutes) versus 79.0 minutes (range, 64.0 to 94.0 minutes); p = 0.03]. Telfa rolling breasts had more palpable masses requiring imaging (26.0 percent versus 14.4 percent; p = 0.01) and an increased incidence of fat necrosis (20.6 percent versus 8.0 percent; p < 0.01). The closed washing system was found to be an independent predictor of decreased rates of imaging-confirmed fat necrosis (OR, 0.29; p = 0.048). There was no difference in fat necrosis excision or cancer recurrence between the groups.

Conclusion:

The closed washing system was independently associated with decreased rates of imaging-confirmed fat necrosis compared to Telfa rolling without an increase in other complications. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Final results of the UK Age trial on breast cancer screening age

 

Final results of the UK Age trial on breast cancer screening age

by Anthony B Miller

 

The Lancet Oncology: VOLUME 21, ISSUE 9, P1125-1126, SEPTEMBER 01, 2020

In The Lancet Oncology, the findings from a 23-year follow-up of the UK Age trial are presented by Stephen Duffy and colleagues.1 No difference in mortality from breast cancer was found between the group that began yearly mammography screening at age 39–41 years until they entered the National Health Service (NHS) Breast Screening Programme at age 50–52 years, and a group that did not begin mammography screening until they entered the NHS Breast Screening Programme (126 deaths vs 255 deaths occurring after more than 10 years of follow-up; relative rate 0·98 [95% CI 0·79–1·22]; p=0·86).

Effect of mammographic screening from age 40 years on breast cancer mortality (UK Age trial): final results of a randomised, controlled trial

 Effect of mammographic screening from age 40 years on breast cancer mortality (UK Age trial): final results of a randomised, controlled trial

by Stephen W Duffy, Daniel Vulkan, Howard Cuckle, Dharmishta Parmar, Shama Sheikh, Robert A Smith, Andrew Evans, Oleg Blyuss, Louise Johns, Ian O Ellis, Jonathan Myles, Peter D Sasieni, Sue M Moss

 

The Lancet Oncology:  VOLUME 21, ISSUE 9, P1165-1172, SEPTEMBER 01, 2020

 

Background

The appropriate age range for breast cancer screening remains a matter of debate. We aimed to estimate the effect of mammographic screening at ages 40–48 years on breast cancer mortality.

Methods

We did a randomised, controlled trial involving 23 breast screening units across Great Britain. We randomly assigned women aged 39–41 years, using individual randomisation, stratified by general practice, in a 1:2 ratio, to yearly mammographic screening from the year of inclusion in the trial up to and including the calendar year that they reached age 48 years (intervention group), or to standard care of no screening until the invitation to their first National Health Service Breast Screening Programme (NHSBSP) screen at approximately age 50 years (control group). Women in the intervention group were recruited by postal invitation. Women in the control group were unaware of the study. The primary endpoint was mortality from breast cancers (with breast cancer coded as the underlying cause of death) diagnosed during the intervention period, before the participant's first NHSBSP screen. To study the timing of the mortality effect, we analysed the results in different follow-up periods. Women were included in the primary comparison regardless of compliance with randomisation status (intention-to-treat analysis). This Article reports on long-term follow-up analysis. The trial is registered with the ISRCTN registry, ISRCTN24647151.

Findings

160 921 women were recruited between Oct 14, 1990, and Sept 24, 1997. 53 883 women (33·5%) were randomly assigned to the intervention group and 106 953 (66·5%) to the control group. Between randomisation and Feb 28, 2017, women were followed up for a median of 22·8 years (IQR 21·8–24·0). We observed a significant reduction in breast cancer mortality at 10 years of follow-up, with 83 breast cancer deaths in the intervention group versus 219 in the control group (relative rate [RR] 0·75 [95% CI 0·58–0·97]; p=0·029). No significant reduction was observed thereafter, with 126 deaths versus 255 deaths occurring after more than 10 years of follow-up (RR 0·98 [0·79–1·22]; p=0·86).

Interpretation

Yearly mammography before age 50 years, commencing at age 40 or 41 years, was associated with a relative reduction in breast cancer mortality, which was attenuated after 10 years, although the absolute reduction remained constant. Reducing the lower age limit for screening from 50 to 40 years could potentially reduce breast cancer mortality.

Funding

National Institute for Health Research Health Technology Assessment programme.

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https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(20)30528-3/fulltext?rss=yes#section-7c530872-6235-4433-899c-b3f276970189 (as of 24.11.2020) 

Olaparib and durvalumab in patients with germline BRCA-mutated metastatic breast cancer (MEDIOLA): an open-label, multicentre, phase 1/2, basket study

 Olaparib and durvalumab in patients with germline BRCA-mutated metastatic breast cancer (MEDIOLA): an open-label, multicentre, phase 1/2, basket study

 

by Susan M Domchek, Sophie Postel-Vinay, Seock-Ah Im, Yeon Hee Park, Jean-Pierre Delord, Antoine Italiano, Jerome Alexandre, Benoit You, Sara Bastian, Matthew G Krebs, Ding Wang, Saiama N Waqar, Mark Lanasa, Joon Rhee, Haiyan Gao, Vidalba Rocher-Ros, Emma V Jones, Sakshi Gulati, Anna Coenen-Stass, Iwanka Kozarewa, Zhongwu Lai, Helen K Angell, Laura Opincar, Pia Herbolsheimer, Bella Kaufman

 

The Lancet Oncology: VOLUME 21, ISSUE 9, P1155-1164, SEPTEMBER 01, 2020

 

Background

Poly (ADP-ribose) polymerase inhibitors combined with immunotherapy have shown antitumour activity in preclinical studies. We aimed to assess the safety and activity of olaparib in combination with the PD-L1-inhibitor, durvalumab, in patients with germline BRCA1-mutated or BRCA2-mutated metastatic breast cancer.

Methods

The MEDIOLA trial is a multicentre, open-label, phase 1/2, basket trial of durvalumab and olaparib in solid tumours. Patients were enrolled into four initial cohorts: germline BRCA-mutated, metastatic breast cancer; germline BRCA-mutated, metastatic ovarian cancer; metastatic gastric cancer; and relapsed small-cell lung cancer. Here, we report on the cohort of patients with breast cancer. Patients who were aged 18 years or older (or aged 19 years or older in South Korea) with germline BRCA1-mutated or BRCA2-mutated or both and histologically confirmed, progressive, HER2-negative, metastatic breast cancer were enrolled from 14 health centres in the UK, the USA, Israel, France, Switzerland, and South Korea. Patients should not have received more than two previous lines of chemotherapy for metastatic breast cancer. Patients received 300 mg olaparib in tablet form orally twice daily for 4 weeks and thereafter a combination of olaparib 300 mg twice daily and durvalumab 1·5 g via intravenous infusion every 4 weeks until disease progression. Primary endpoints were safety and tolerability, and 12-week disease control rate. Safety was analysed in patients who received at least one dose of study treatment, and activity analyses were done in the full-analysis set (patients who received at least one dose of study treatment and were not excluded from the study). Recruitment has completed and the study is ongoing. This trial is registered with ClinicalTrials.gov, NCT02734004.

Findings

Between June 14, 2016, and May 2, 2017, 34 patients were enrolled and received both study drugs and were included in the safety analysis. 11 (32%) patients experienced grade 3 or worse adverse events, of which the most common were anaemia (four [12%]), neutropenia (three [9%]), and pancreatitis (two [6%]). Three (9%) patients discontinued due to adverse events and four (12%) patients experienced a total of six serious adverse events. There were no treatment-related deaths. 24 (80%; 90% CI 64·3–90·9) of 30 patients eligible for activity analysis had disease control at 12 weeks.

Interpretation

Combination of olaparib and durvalumab showed promising antitumour activity and safety similar to that previously observed in olaparib and durvalumab monotherapy studies. Further research in a randomised setting is needed to determine predictors of therapeutic benefit and whether addition of durvalumab improves long-term clinical outcomes compared with olaparib monotherapy.

Funding

AstraZeneca.

Stability of Long-Term Outcomes in Implant-Based Breast Reconstruction: An Evaluation of 12-Year Surgeon- and Patient-Reported Outcomes in 3489 Nonirradiated and Irradiated Implants

 

Stability of Long-Term Outcomes in Implant-Based Breast Reconstruction: An Evaluation of 12-Year Surgeon- and Patient-Reported Outcomes in 3489 Nonirradiated and Irradiated Implants

 

by Seth, Akhil K.; Cordeiro, Peter G. 

 

Plastic and Reconstructive Surgery: September 2020 - Volume 146 - Issue 3 - p 474-484

 

Background:

Outcomes following prosthetic breast reconstruction have been well studied. However, the majority of studies are limited by short-term follow-up and a lack of aesthetic and patient-reported outcomes. This study objectively examines long-term surgeon- and patient-reported outcomes following two-stage prosthetic breast reconstruction.

Methods:

Consecutive patients undergoing two-stage prosthetic breast reconstruction from 1994 to 2016 performed by the senior author (P.G.C.), with at least 1-year follow-up after implant exchange, were reviewed retrospectively. Long-term surgeon-reported outcomes, including aesthetic and capsular contracture scores, and patient-reported outcomes using the BREAST-Q, were recorded at each outpatient visit and analyzed over the 12-year follow-up period.

Results:

Retrospective review revealed 2284 patients, or 3489 breasts, that fit the inclusion criteria. Aesthetic scores and capsular contracture rates remained stable over the entire follow-up period. Subset analysis demonstrated that bilateral and nonirradiated reconstructions consistently had the highest aesthetic scores, whereas unilateral irradiated breasts had the lowest. Irradiated breasts consistently had high rates of capsular contracture, although the extent of contracture improved over time in all patients. Patient-reported BREAST-Q scores showed either stability or improvement over time in all patients. Irradiated and nonirradiated patients demonstrated comparable long-term satisfaction with outcomes despite significant differences in satisfaction with their breasts.

Conclusions:

The authors’ study, the largest of its kind, demonstrates that prosthetic breast reconstruction outcomes do not deteriorate over time. This stability is apparent in both long-term surgeon- and patient-reported outcomes data measured in the same patients. These results contradict the surgical dogma surrounding prosthetic breast reconstruction and therefore should be given significant consideration when counseling patients. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Venous Thromboembolism following Microsurgical Breast Reconstruction: A Longitudinal Analysis of 12,778 Patients

 

Venous Thromboembolism following Microsurgical Breast Reconstruction: A Longitudinal Analysis of 12,778 Patients

 

by Rochlin, Danielle H.; Sheckter, Clifford C.; Pannucci, Christopher; Momeni, Arash 

 

Plastic and Reconstructive Surgery: September 2020 - Volume 146 - Issue 3 - p 465-473

 

Background:

Venous thromboembolism is a dreaded complication following microsurgical breast reconstruction. Although the high-risk nature of the procedure is well known, a thorough analysis of modifiable risk factors has not been performed. The purpose of this study was to analyze the association of such factors with the postoperative occurrence of venous thromboembolism longitudinally.

Methods:

Using the Truven MarketScan Database, a retrospective cohort study of women who underwent microsurgical breast reconstruction from 2007 to 2015 and who developed postoperative venous thromboembolism within 90 days of reconstruction was performed. Predictor variables included age, timing of reconstruction, body mass index, history of radiation therapy, history of venous thromboembolism, Elixhauser Comorbidity Index, and length of stay. Univariate analyses were performed, in addition to logistic and zero-inflated Poisson regressions, to evaluate predictors of venous thromboembolism and changes in venous thromboembolism over the study period, respectively.

Results:

Twelve thousand seven hundred seventy-eight women were identified, of which 167 (1.3 percent) developed venous thromboembolism. The majority of venous thromboembolisms (67.1 percent) occurred following discharge, with no significant change from 2007 to 2015. Significant predictors of venous thromboembolism included Elixhauser score (p < 0.01), history of venous thromboembolism (p < 0.03), and length of stay (p < 0.001). Compared to patients who developed a venous thromboembolism during the inpatient stay, patients who developed a postdischarge venous thromboembolism had a lower mean Elixhauser score (p < 0.001).

Conclusions:

Postoperative venous thromboembolism continues to be an inadequately addressed problem, as evidenced by a stable incidence over the study period. Identification of modifiable risk factors, such as length of stay, provides potential avenues for intervention. As the majority of venous thromboembolisms occur following discharge, future studies are warranted to investigate the role for an intervention in this period. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.

Breast Reduction: Surgical Techniques with an Emphasis on Evidence-Based Practice and Outcomes

 

Breast Reduction: Surgical Techniques with an Emphasis on Evidence-Based Practice and Outcomes

 by Colohan, Shannon M.; Massenburg, Benjamin B.; Gougoutas, Alexander J. 

 Plastic and Reconstructive Surgery: September 2020 - Volume 146 - Issue 3 - p 339e-350e

 

Learning Objectives:

 After studying this article, the participant should be able to:

1. Understand the relevant anatomy involved in breast reduction.

2. Understand the different breast reduction techniques and their indications.

3. Appreciate the outcomes of these techniques as they pertain to clinical outcomes.

 

Summary:

 This continuing medical education article is designed to refresh one’s knowledge on breast reduction while placing emphasis on clinical outcomes. It reviews the relevant anatomy, techniques, and published literature on outcomes, including those that are patient-reported. Photographic representations of most techniques are shown, in addition to supplemental digital video content, to demonstrate each technique. This is designed to be an overview, and the reader should appreciate that no one technique is “right,” and the technique used should be selected with patient factors and desired outcomes in mind.