Dual-Plane versus Prepectoral Breast Reconstruction in High–Body Mass Index Patients

Dual-Plane versus Prepectoral Breast Reconstruction in High–Body Mass Index Patients

by Gabriel, Allen; Sigalove, Steven; Storm-Dickerson, Toni L.; Sigalove, Noemi M.; Pope, Nicole; Rice, Jami; Maxwell, G. Patrick

Plastic and Reconstructive Surgery: June 2020 - Volume 145 - Issue 6 - p 1357-1365

Background: Breast reconstruction in patients with a high body mass index (BMI) (≥30 kg/m2) is technically challenging and is associated with increased postoperative complications. The optimal reconstructive approach for these patients remains to be determined. This study compared outcomes of prepectoral and dual-plane reconstruction in high-BMI patients to determine whether there was an association between postoperative complications and the plane of reconstruction. 

Methods: High-BMI patients who underwent immediate dual-plane or prepectoral expander/implant reconstruction were included in this retrospective study. Patients were stratified by reconstructive approach (dual-plane or prepectoral), and postoperative complications were compared between the groups. Multivariate logistic regression analysis was performed to determine whether the plane of reconstruction was an independent predictor of any complication after adjusting for potential confounding differences in patient variables between the groups.

Results: Of 133 patients, 65 (128 breasts) underwent dual-plane and 68 (129 breasts) underwent prepectoral reconstruction. Rates of seroma (13.3 percent versus 3.1 percent), surgical-site infection (9.4 percent versus 2.3 percent), capsular contracture (7.0 percent versus 0.8 percent), and any complication (25.8 percent versus 14.7 percent) were significantly higher in patients who had dual-plane versus prepectoral reconstruction (p < 0.05). Multivariate logistic regression identified dual-plane, diabetes, neoadjuvant radiotherapy, and adjuvant chemotherapy as significant, independent predictors of any complication (p < 0.05). Dual-plane reconstruction increased the odds of any complication by 3-fold compared with the prepectoral plane.

Conclusion: Compared with the dual-plane approach, the prepectoral approach appears to be associated with a lower risk of postoperative complications following immediate expander/implant breast reconstruction and may be a better reconstructive option in high-BMI patients. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Patient-Reported Outcomes after Irradiation of Tissue Expander versus Permanent Implant in Breast Reconstruction: A Multicenter Prospective Study

Patient-Reported Outcomes after Irradiation of Tissue Expander versus Permanent Implant in Breast Reconstruction: A Multicenter Prospective Study

by Yoon, Alfred P.; Qi, Ji; Kim, Hyungjin M.; Hamill, Jennifer B.; Jagsi, Reshma; Pusic, Andrea L.; Wilkins, Edwin G.; Kozlow, Jeffrey H.

Plastic and Reconstructive Surgery: May 2020 - Volume 145 - Issue 5 - p 917e-926e

Background: Whether to irradiate the tissue expander before implant exchange or to defer irradiation until after exchange in immediate, two-stage expander/implant reconstruction remains uncertain. The authors evaluated the effects of irradiation timing on complication rates and patient-reported outcomes in patients undergoing immediate expander/implant reconstruction.

Methods: Immediate expander/implant reconstruction patients undergoing postmastectomy radiation therapy at 11 Mastectomy Reconstruction Outcomes Consortium sites with demographic, clinical, and complication data were analyzed. Patient-reported outcomes were assessed with BREAST-Q, Patient-Reported Outcomes Measurement Information System, and European Organisation for Research and Treatment of Cancer Breast Cancer–Specific Quality-of-Life Questionnaire surveys preoperatively and 2 years postoperatively. Survey scores and complication rates were analyzed using bivariate comparison and multivariable regressions.

Results: Of 317 patients who met inclusion criteria, 237 underwent postmastectomy radiation therapy before expander/implant exchange (before-exchange cohort), and 80 did so after exchange (after-exchange cohort). Timing of radiation had no significant effect on risks of overall complications (OR, 1.25; p = 0.46), major complications (OR, 1.18; p = 0.62), or reconstructive failure (OR, 0.72; p = 0.49). Similarly, radiation timing had no significant effect on 2-year patient-reported outcomes measured by the BREAST-Q or the European Organisation for Research and Treatment of Cancer survey. Outcomes measured by the Patient-Reported Outcomes Measurement Information System showed less anxiety, fatigue, and depression in the after-exchange group. Compared with preoperative assessments, 2-year patient-reported outcomes significantly declined in both cohorts for Satisfaction with Breasts, Physical Well-Being, and Sexual Well-Being, but improved for anxiety and depression.

Conclusions: Radiation timing (before or after exchange) had no significant effect on complication risks or on most patient-reported outcomes in immediate expander/implant reconstruction. Although lower levels of anxiety, depression, and fatigue were observed in the after-exchange group, these differences may not be clinically significant. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.

Direct-to-Implant Breast Reconstruction with Simultaneous Nipple-Sparing Mastopexy Utilizing an Inferiorly Based Adipodermal Flap: Our Experience with Prepectoral and Subpectoral Techniques

Direct-to-Implant Breast Reconstruction with Simultaneous Nipple-Sparing Mastopexy Utilizing an Inferiorly Based Adipodermal Flap: Our Experience with Prepectoral and Subpectoral Techniques

by Mosharrafa, Ali M.; Mosharrafa, Tamir M.; Zannis, Victor J. 

Plastic and Reconstructive Surgery: May 2020 - Volume 145 - Issue 5 - p 1125-1133

Background: Direct-to-implant breast reconstruction continues to grow in popularity among reconstructive breast surgeons and patients alike. Women with large breasts and ptosis are often thought not to be candidates for nipple sparing or direct-to-implant reconstruction. The authors utilized a single-stage, nipple-sparing, direct-to-implant reconstruction with simultaneous mastopexy, while the nipple-areolar complex was kept viable on an inferiorly based adipodermal flap in a single stage. They report their experience and outcomes using this approach in women with breast ptosis and/or macromastia.

Methods: The authors reviewed all direct-to-implant reconstructions with simultaneous nipple-sparing mastopexies performed from June of 2015 to March of 2019. Sixty-five patients and 125 breast reconstructions were analyzed.

Results: Among the 65 patients (125 breast reconstructions), 15 (23 percent) had implants placed in the prepectoral space, and 50 (77 percent) had them placed subpectorally. Forty-seven patients (72 percent) had acellular dermal matrix used. Partial nipple-areolar complex necrosis occurred in six patients (9 percent). Other complications included partial mastectomy flap necrosis (n = 8 patients, 12 percent), implant exposure (n = 3, 4 percent), infection (n = 1, 1 percent), capsular contracture (n = 4, 6 percent), and reoperation (n = 11, 16 percent). Mean follow-up was 17 months (range, 3 to 47 months). There have been no cancer recurrences reported in any participants to date.

Conclusions: Nipple-sparing mastectomy with mastopexy and immediate direct-to-implant reconstruction dramatically improved the authors’ results for implant-based breast reconstruction patients. The higher than expected explantation rate of 7 percent early in the study has since improved. This approach provides an opportunity to expand indications for nipple-sparing mastectomy and direct-to-implant reconstruction to women with breast ptosis and/or macromastia. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Immediate Contralateral Mastopexy/Breast Reduction for Symmetry Can Be Performed Safely in Oncoplastic Breast-Conserving Surgery

Immediate Contralateral Mastopexy/Breast Reduction for Symmetry Can Be Performed Safely in Oncoplastic Breast-Conserving Surgery

by Deigni, Olivier A.; Baumann, Donald P.; Adamson, Karri A.; Garvey, Patrick B.; Selber, Jesse C.; Caudle, Abigail S.; Smith, Benjamin D.; Hanson, Summer E.; Robb, Geoffrey L.; Schaverien, Mark V.

Plastic and Reconstructive Surgery: May 2020 - Volume 145 - Issue 5 - p 1134-1142

Background: Oncoplastic breast-conserving surgery expands the indications for breast conservation. When performed using modified mastopexy/breast reduction techniques, the optimal timing of the contralateral symmetrizing mastopexy/breast reduction remains unclear. This study examined the effect of the timing of symmetrizing mastopexy/breast reduction on oncoplastic breast-conserving surgery outcomes.

Methods: A retrospective study was conducted of all patients who underwent oncoplastic breast-conserving surgery using mastopexy/breast reduction techniques at a single center from 2010 to 2016. Patients who received synchronous (immediate) contralateral breast symmetrizing mastopexy were compared with those who underwent a delayed symmetrizing mastopexy procedure. Demographic, treatment, and outcome data were collected. Descriptive statistics were used and multivariate analysis was performed to evaluate the various relationships.

Results: There were 429 patients (713 breasts) included in the study; of these, 284 patients (568 breasts) underwent oncoplastic breast-conserving surgery involving mastopexy/breast reduction techniques and immediate symmetrizing mastopexy, and 145 patients underwent delayed contralateral symmetrizing mastopexy. The overall complication rate was similar between the immediate and delayed groups (25.4 percent versus 26.9 percent, respectively; p = 0.82), as was the major complication rate (10.6 percent versus 6.2 percent; p = 0.16). Complications resulted in a delay in adjuvant therapy in 18 patients (4.2 percent); in two patients (0.7 percent), this delay resulted from a complication in the contralateral symmetrizing mastopexy breast. Immediate contralateral symmetrizing mastopexy was not associated with increased risk of complications per breast (p = 0.82) or delay to adjuvant therapy (p = 0.6).

Conclusion: Contralateral mastopexy/breast reduction for symmetry can be performed at the time of oncoplastic breast-conserving surgery in carefully selected patients without significantly increasing the risk of complications or delay to adjuvant radiation therapy. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Outcome of Quality of Life for Women Undergoing Autologous versus Alloplastic Breast Reconstruction following Mastectomy: A Systematic Review and Meta-Analysis

Outcome of Quality of Life for Women Undergoing Autologous versus Alloplastic Breast Reconstruction following Mastectomy: A Systematic Review and Meta-Analysis

by Eltahir, Yassir; Krabbe-Timmerman, Irene S.; Sadok, Nadia; Werker, Paul M. N.; de Bock, Geertruida H. 

Plastic and Reconstructive Surgery: May 2020 - Volume 145 - Issue 5 - p 1109-1123

Background: This review aimed to meta-analyze the quality of life of alloplastic versus autologous breast reconstruction, when measured with the BREAST-Q.

Methods: An electronic PubMed and EMBASE search was designed to find articles that compared alloplastic versus autologous breast reconstruction using the BREAST-Q. Studies that failed to present BREAST-Q scores and studies that did not compare alloplastic versus autologous breast reconstruction were excluded. Two authors independently extracted data from the included studies. A standardized data collection form was used. Quality was assessed using the Newcastle-Ottawa Scale. The mean difference and 95 percent confidence intervals between breast reconstruction means were estimated for each BREAST-Q subscale. Forest plots and the I2 statistic were used to assess heterogeneity and funnel plot publication bias. The Z test was used to assess overall effects. Results: Two hundred eighty abstracts were found; 10 articles were included. Autologous breast reconstruction scored significantly higher in the five subscales than alloplastic breast reconstruction. The Satisfaction with Breasts subscale indicated the greatest difference, with a mean difference of 6.41 (95 percent CI, 3.58 to 9.24; I2 = 70 percent). The Satisfaction with Results subscale displayed a mean difference of 5.52. The Sexual Well-Being subscale displayed a mean difference of 3.85. The Psychosocial Well-Being subscale displayed a mean difference of 2.64. The overall difference in physical well-being was significant, with high heterogeneity (mean difference, 3.33; 95 percent CI, 0.18 to 6.48; I2 = 85).

Conclusion: Autologous breast reconstruction had superior outcomes compared with alloplastic breast reconstruction as measured by the BREAST-Q.

Prepectoral Direct-to-Implant Breast Reconstruction: Safety Outcome Endpoints and Delineation of Risk Factors

Prepectoral Direct-to-Implant Breast Reconstruction: Safety Outcome Endpoints and Delineation of Risk Factors

by Nealon, Kassandra P.; Weitzman, Rachel E.; Sobti, Nikhil; Gadd, Michele; Specht, Michelle; Jimenez, Rachel B.; Ehrlichman, Richard; Faulkner, Heather R.; Austen, William G. Jr; Liao, Eric C.

Plastic and Reconstructive Surgery: May 2020 - Volume 145 - Issue 5 - p 898e-908e

Background: Continued evolution of implant-based breast reconstruction involves immediate placement of the implant above the pectoralis muscle. The shift to prepectoral breast reconstruction is driven by goals of decreasing morbidity such as breast animation deformity, range-of-motion problems, and pain, and is made possible by improvements in mastectomy skin flap viability. To define clinical factors to guide patient selection for direct-to-implant prepectoral implant reconstruction, this study compares safety endpoints and risk factors between prepectoral and subpectoral direct-to-implant breast reconstruction cohorts. The authors hypothesized that prepectoral direct-to-implant breast reconstruction is a safe alternative to subpectoral direct-to-implant breast reconstruction.

Methods: Retrospective chart review identified patients who underwent prepectoral and subpectoral direct-to-implant breast reconstruction, performed by a team of five surgical oncologists and two plastic surgeons. Univariate analysis compared patient characteristics between cohorts. A penalized logistic regression model was constructed to identify relationships between postoperative complications and covariate risk factors.

Results: A cohort of 114 prepectoral direct-to-implant patients was compared with 142 subpectoral direct-to-implant patients. The results of the penalized regression model demonstrated equivalence in safety metrics between prepectoral direct-to-implant and subpectoral direct-to-implant breast reconstruction, including seroma (p = 0.0883), cancer recurrence (p = 0.876), explantation (p = 0.992), capsular contracture (p = 0.158), mastectomy skin flap necrosis (p = 0.769), infection (p = 0.523), hematoma (p = 0.228), and revision (p = 0.122).

Conclusions: This study demonstrates that prepectoral direct-to-implant reconstruction is a safe alternative to subpectoral direct-to-implant reconstruction. Given the low morbidity and elimination of animation deformity, prepectoral direct-to-implant reconstruction should be considered when the mastectomy skin flap is robust. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

[Articles] Quality of life after breast-conserving therapy and adjuvant radiotherapy for non-low-risk ductal carcinoma in situ (BIG 3-07/TROG 07.01): 2-year results of a randomised, controlled, phase 3 trial

[Articles] Quality of life after breast-conserving therapy and adjuvant radiotherapy for non-low-risk ductal carcinoma in situ (BIG 3-07/TROG 07.01): 2-year results of a randomised, controlled, phase 3 trial

by Madeleine T King, Emma K Link, Tim J Whelan, Ivo A Olivotto, Ian Kunkler, Antonia Helen Westenberg, Guenther Gruber, Penny Schofield, Boon H Chua, BIG 3-07/TROG 07.01 trial investigators

The Lancet Oncology:  VOLUME 21, ISSUE 5, P685-698, MAY 01, 2020

Tumour bed boost was associated with persistent adverse effects on cosmetic status and arm and shoulder functional status, which might inform shared decision making while local recurrence analysis is pending.

Radiological audit of interval breast cancers: Estimation of tumour growth rates

Radiological audit of interval breast cancers: Estimation of tumour growth rates

by Emma G. MacInnes, Stephen W. Duffy, Julie A. Simpson, Matthew G. Wallis, Anne E. Turnbull, Louise S. Wilkinson, Keshthra Satchithananda, Rumana Rahim, David Dodwell, Brian V. Hogan, Oleg Blyuss, Nisha Sharma

The Breast: VOLUME 51, P114-119, JUNE 01, 2020

This multicentre, retrospective study aimed to establish correlation between estimated tumour volume doubling times (TVDT) from a series of interval breast cancers with their clinicopathological features. The potential impact of delayed diagnosis on prognosis was also explored.

What are the appropriate thresholds for High Quality Performance Indicators for breast surgery in Australia and New Zealand?

What are the appropriate thresholds for High Quality Performance Indicators for breast surgery in Australia and New Zealand?

by Shehnarz Salindera, Michelle Ogilvy, Andrew Spillane 

The Breast:  VOLUME 51, P94-101, JUNE 01, 2020

To evaluate BreastSurgANZ members’ compliance at various threshold rates for 4 evaluable High-Quality Performance Indicators (HQPIs) introduced to improve patient care. To benchmark global best practice to assist in determining the eventual threshold standards.

Long-Term Results and Reconstruction Failure in Patients Receiving Postmastectomy Radiation Therapy with a Temporary Expander or Permanent Implant in Place

Long-Term Results and Reconstruction Failure in Patients Receiving Postmastectomy Radiation Therapy with a Temporary Expander or Permanent Implant in Place

by Dicuonzo, Samantha; Leonardi, Maria Cristina; Radice, Davide; Morra, Anna; Gerardi, Marianna Alessandra; Rojas, Damaris Patricia; Surgo, Alessia; Dell’Acqua, Veronica; Luraschi, Rosa; Cattani, Federica; Rietjens, Mario; De Lorenzi, Francesca; Veronesi, Paolo; Galimberti, Viviana; Marvaso, Giulia; Fodor, Cristiana; Orecchia, Roberto; Jereczek-Fossa, Barbara Alicja

Plastic and Reconstructive Surgery: February 2020 - Volume 145 - Issue 2 - p 317-327

Background: This study investigated the risk of reconstruction failure after mastectomy, immediate breast reconstruction, and radiotherapy to either a temporary tissue expander or permanent implant.

Methods: Records of women treated at a single institution between June of 1997 and December of 2011 were reviewed. Two patient groups were identified based on type of immediate breast reconstruction: tissue expander followed by exchange with a permanent implant and permanent implant. The study endpoint was rate of reconstruction failure, defined as a replacement, loss of the implant, or conversion to flap.

Results: The tissue expander/permanent implant and the permanent implant groups consisted of 63 and 75 patients, respectively. The groups were well balanced for clinical and treatment characteristics. With a median follow-up of 116 months, eight implant losses, 50 implant replacements, and four flap conversions were recorded. Reconstruction failure occurred in 22 of 63 patients in the expander/implant group and in 40 of 75 patients in the permanent implant group. A traditional proportional hazards model showed a higher risk of reconstruction failure for the expander/implant group (hazard ratio, 2.01) and a significantly shorter time to reconstruction failure compared with the permanent implant group (109.2 months versus 157.7 months; p = 0.03); however, according to a competing risk model, the between-groups cumulative incidences were not significantly different (hazard ratio, 1.09).

Conclusions: Radiotherapy to either a tissue expander or a permanent implant presented a fairly large risk of reconstruction failure over time. The expander/implant group was not more likely to develop reconstruction failure compared to permanent implant group, but the timing of onset was shorter. More complex techniques should be investigated to lower the risk of reconstruction failure. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Predicting Ischemic Complications in the Inframammary Approach to Nipple-Sparing Mastectomy: The Midclavicular-to–Inframammary Fold Measurement

Predicting Ischemic Complications in the Inframammary Approach to Nipple-Sparing Mastectomy: The Midclavicular-to–Inframammary Fold Measurement

by Willey, Shawna C.; Fan, Kenneth L.; Luvisa, Kyle; Graziano, Francis D.; Lau, Stephanie H. Y.; Black, Cara K.; Song, David H.; Pittman, Troy

Plastic and Reconstructive Surgery: February 2020 - Volume 145 - Issue 2 - p 251e-262e

Background: The authors refine their anatomical patient selection criteria with a novel midclavicular-to–inframammary fold measurement for nipple-sparing mastectomy performed through an inframammary approach.

Methods: Retrospective review was performed of all nipple-sparing mastectomies performed through an inframammary approach. Exclusion criteria included other mastectomy incisions, staged mastectomy, previous breast operation, and autologous reconstruction. Preoperative anatomical measurements for each breast, clinical course, and specimen weight were obtained.

Results: One hundred forty breasts in 79 patients were analyzed. Mastectomy weight, but not sternal notch–to-nipple distance, was strongly correlated with midclavicular-to–inframammary fold measurement on linear regression (R2 = 0.651; p < 0.001). Mastectomy weight was not correlated with ptosis. Twenty-five breasts (17.8 percent) had ischemic complications: 16 (11.4 percent) were nonoperative and nine (6.4 percent) were operative. Those with mastectomy weights of 500 g or greater were nine times more likely to have operative ischemic complications than those with mastectomy weights less than 500 g (p = 0.0048). Those with a midclavicular-to–inframammary fold measurement of 30 cm or greater had a 3.8 times increased incidence of any ischemic complication (p = 0.00547) and a 9.2 times increased incidence of operative ischemic complications (p = 0.00376) compared with those whose midclavicular-to–inframammary fold measurement was less than 30 cm.

Conclusions: Breasts undergoing nipple-sparing mastectomy by means of an inframammary approach with midclavicular-to–inframammary fold measurement greater than or equal to 30 cm are at higher risk for having ischemic complications, warranting consideration for a staged approach or other incision. The midclavicular-to–inframammary fold measurement is useful for assessing the entire breast and predicting the likelihood of ischemic complications in inframammary nipple-sparing mastectomies. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.

3D digital breast cancer models with multimodal fusion algorithms

3D digital breast cancer models with multimodal fusion algorithms

by Sílvia Bessa, Pedro F. Gouveia, Pedro H. Carvalho, Cátia Rodrigues, Nuno L. Silva, Fátima Cardoso, Jaime S. Cardoso, Hélder P. Oliveira, Maria João Cardoso

The Breast: FULL LENGTH ARTICLE| VOLUME 49, P281-290, FEBRUARY 01, 2020

Breast cancer image fusion consists of registering and visualizing different sets of a patient synchronized torso and radiological images into a 3D model. Breast spatial interpretation and visualization by the treating physician can be augmented with a patient-specific digital breast model that integrates radiological images. But the absence of a ground truth for a good correlation between surface and radiological information has impaired the development of potential clinical applications.A new image acquisition protocol was designed to acquire breast Magnetic Resonance Imaging (MRI) and 3D surface scan data with surface markers on the patient’s breasts and torso.

Second conservative treatment for second ipsilateral breast tumor event: A systematic review of the different re-irradiation techniques

Second conservative treatment for second ipsilateral breast tumor event: A systematic review of the different re-irradiation techniques

by Lucile Montagne, Arthur Hannoun, Jean-Michel Hannoun-Levi 

The Breast: REVIEW| VOLUME 49, P274-280, FEBRUARY 01, 2020

To address the different partial breast re-irradiation techniques available in the context of second conservative treatment (SCT), as an alternative to salvage mastectomy, for 2nd ipsilateral breast tumor event (IBTE) and summarize their respective oncological and toxicity outcomes.

Stand-alone artificial intelligence - The future of breast cancer screening?

Stand-alone artificial intelligence - The future of breast cancer screening?

by Ioannis Sechopoulos, Ritse M. Mann 

The Breast: FULL LENGTH ARTICLE| VOLUME 49, P254-260, FEBRUARY 01, 2020

Although computers have had a role in interpretation of mammograms for at least two decades, their impact on performance has not lived up to expectations. However, in the last five years, the field of medical image analysis has undergone a revolution due to the introduction of deep learning convolutional neural networks – a form of artificial intelligence (AI). Because of their considerably higher performance compared to conventional computer aided detection methods, these AI algorithms have resulted in renewed interest in their potential for interpreting breast images in stand-alone mode.

Artificial intelligence in digital breast pathology: Techniques and applications

Artificial intelligence in digital breast pathology: Techniques and applications

by Asmaa Ibrahim, Paul Gamble, Ronnachai Jaroensri, Mohammed M. Abdelsamea, Craig H. Mermel, Po-Hsuan Cameron Chen, Emad A. Rakha

The Breast: ORIGINAL ARTICLE| VOLUME 49, P267-273, FEBRUARY 01, 2020

Breast cancer is the most common cancer and second leading cause of cancer-related death worldwide. The mainstay of breast cancer workup is histopathological diagnosis - which guides therapy and prognosis. However, emerging knowledge about the complex nature of cancer and the availability of tailored therapies have exposed opportunities for improvements in diagnostic precision. In parallel, advances in artificial intelligence (AI) along with the growing digitization of pathology slides for the primary diagnosis are a promising approach to meet the demand for more accurate detection, classification and prediction of behaviour of breast tumours.

Statistical modelling of HER2-positivity in breast cancer: Final analyses from two large, multicentre, non-interventional studies in Germany

Statistical modelling of HER2-positivity in breast cancer: Final analyses from two large, multicentre, non-interventional studies in Germany

by Josef Rüschoff, Annette Lebeau, Peter Sinn, Hans-Ulrich Schildhaus, Thomas Decker, Johannes Ammann, Claudia Künzel, Winfried Koch, Michael Untch

The Breast: ORIGINAL ARTICLE| VOLUME 49, P246-253, FEBRUARY 01, 2020

The German NIU HER2 model was developed based on five variables found to have statistically significant influences on HER2-positivity, to allow exploration of deviations between model-predicted and actual HER2-positivity rates as a measure of testing quality. The prospective, non-interventional EPI HER2 BC study (NCT02666261) compared NIU and EPI data, aiming to validate the NIU model.

Winter is over: The use of Artificial Intelligence to individualise radiation therapy for breast cancer

Winter is over: The use of Artificial Intelligence to individualise radiation therapy for breast cancer

by Philip M.P. Poortmans, Silvia Takanen, Gustavo Nader Marta, Icro Meattini, Orit Kaidar-Person 

The Breast: FULL LENGTH ARTICLE| VOLUME 49, P194-200, FEBRUARY 01, 2020

Artificial intelligence demonstrated its value for automated contouring of organs at risk and target volumes as well as for auto-planning of radiation dose distributions in terms of saving time, increasing consistency, and improving dose-volumes parameters. Future developments include incorporating dose/outcome data to optimise dose distributions with optimal coverage of the high-risk areas, while at the same time limiting doses to low-risk areas. An infinite gradient of volumes and doses to deliver spatially-adjusted radiation can be generated, allowing to avoid unnecessary radiation to organs at risk.

Are Breast Implants Safe?

Are Breast Implants Safe?

by Rohrich, Rod J.; Kaplan, Jordan 

Plastic and Reconstructive Surgery: February 2020 - Volume 145 - Issue 2 - p 587-589

Breast implants are among the most well-studied implantable medical devices placed in humans. They have been used in both reconstructive and aesthetic breast surgery for more than 60 years. The safety of the device has been affirmed repeatedly through extensive long-term studies and further research continues to take place in order to ensure patient safety.1 Recent scientific studies have shown an infrequent correlation between textured breast implants and anaplastic large cell lymphoma (ALCL), which has resulted in a specific subset of textured breast implants to be removed from market secondary to a higher incidence of this disease.2 Such action reaffirms the importance of ongoing research in all aspects of plastic surgery as we always place patient safety first and foremost.

As physicians who took a Hippocratic oath to do no harm, we must adhere to these same scientific standards if we are to meaningfully define the wide range of symptoms that have collectively become known on social media as “breast implant illness.” This condition has been attributed to any and all types of saline and silicone breast implants and their surrounding silicone shells. It has been postulated that the implant shell itself may have toxins or other yet-to-be-defined elements that cause a myriad of symptoms yet to be articulated in a scientific manner.3 A 2006 study published in the Annals of Chemistry evaluated the total platinum concentration in both patient tissue and breast implant samples. The authors concluded that women with silicone breast implants have platinum levels that exceed that of the general population.4 However, a critical analysis highlighted that platinum concentrations in blood and urine samples showed no statistically significant difference and that both the control and implanted groups were shown to have platinum levels comparable to those in platinum industry workers. Furthermore, the study design was deemed nonreproducible.5,6 Pinpointing a material explanation for breast implant illness symptoms has been impeded by poor data collection and lack of science and dissemination of misinformation on social media, which places patients with breast implants at risk of making improperly informed decisions.

This is not to say that breast implant illness does not exist—both patient advocacy groups and the U.S. Food and Drug Administration recognize various symptoms as being risks related to breast implants7—but rather that there is no current scientific evidence to support such claims. It is therefore the responsibility of plastic surgeons to advise patients who may present with symptoms associated with breast implant illness to seek full evaluation by our medical and rheumatology colleagues to ensure we are not missing any type of disease process; the American Society of Plastic Surgeons is taking the lead in working with patients and with the Food and Drug Administration to investigate these widely reported symptoms in an effort to supplant speculation with data and science.

Recent Advances in Implant-Based Breast Reconstruction

Recent Advances in Implant-Based Breast Reconstruction

by Colwell, Amy S.; Taylor, Erin M. 

Plastic and Reconstructive Surgery: February 2020 - Volume 145 - Issue 2 - p 421e-432e

Learning Objectives: After reading this article, the participant should be able to: 1. Understand the indications for implant-based breast reconstruction and the indications for nipple preservation compared to skin-sparing or skin-reducing patterns. 2. Understand the indications for direct-to-implant breast reconstruction versus tissue expander/implant breast reconstruction and the advantages and disadvantages of total, partial, or no muscle coverage. 3. Understand the role of acellular dermal matrix or mesh in reconstruction. 4. Learn the advantages and disadvantages of different types and styles of implants and develop a postoperative plan for care and pain management. 

Summary: Breast reconstruction with implants has seen a decade of advances leading to more natural breast reconstructions and lower rates of complications.

CDK4/6 inhibitor treatment for patients with hormone receptor-positive, HER2-negative, advanced or metastatic breast cancer: a US Food and Drug Administration pooled analysis

CDK4/6 inhibitor treatment for patients with hormone receptor-positive, HER2-negative, advanced or metastatic breast cancer: a US Food and Drug Administration pooled analysis

by Jennifer J Gao, Joyce Cheng, Erik Bloomquist, Jacquelyn Sanchez, Suparna B Wedam, Harpreet Singh, Laleh Amiri-Kordestani, Amna Ibrahim, Rajeshwari Sridhara, Kirsten B Goldberg, Marc R Theoret, Paul G Kluetz, Gideon M Blumenthal, Richard Pazdur, Julia A Beaver, Tatiana M Prowell

The Lancet Oncology: VOLUME 21, ISSUE 2, P250-260, FEBRUARY  01, 2020

Since the addition of CDKI to endocrine therapy seemed to benefit all clinicopathological subgroups of interest in this pooled analysis, further research is needed to identify patient subgroups for whom endocrine therapy alone might be appropriate for first-line or second-line treatment of hormone receptor-positive, HER2-negative metastatic breast cancer.