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Cancers
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Trends in Mastectomy and Breast Reconstruction for Cancer
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Trends in Mastectomy and Breast Reconstruction for Cancer

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Methods and Technologies Development".

Deadline for manuscript submissions: 15 August 2024 | Viewed by 4919

Special Issue Editor

Dr. Gilles Houvenaeghel

E-Mail Website
Guest Editor
Institut Paoli Calmettes, Aix Marseille Université, 13009 Marseille, France
Interests: breast cancer; sentinel lymph node biopsy; breast reconstruction; robotic surgery; surgical oncology; gynecologic oncology

Special Issue Information

Dear Colleagues,

Since the 1990s, there has been a steady increase in breast-conserving surgeries associated with the development of oncoplasty. Nevertheless, total mastectomies for breast cancer (BC) are still indicated for 12 to 30% of patients and up to 40%. The immediate breast reconstruction (IBR) rate has increased in recent years in order to improve quality of life, and implant-based reconstruction was the most commonly performed procedure. The purpose of this Special Issue is to cover several topics: pre- or retro-pectoral implant-IBR with or without mesh, robotic mastectomies, nipple sparing mastectomy (NSM) for primary BC or local recurrence, post-mastectomy radiotherapy and IBR, axillary lymph node dissection after sentinel lymph node biopsy for mastectomies, IBR with pedicled or free flaps, IBR by exclusive lipofiling, surgical complications with or without IBR, and monitoring after mastectomy with implant-IBR for ductal carcinoma in situ and invasive BC. This Special Issue welcomes reviews as well as original research articles.

Dr. Gilles Houvenaeghel
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Cancers is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • breast cancer
  • immediate breast reconstruction
  • breast implant
  • flap reconstruction
  • post-mastectomy radiotherapy
  • lipofilling
  • complications
  • robotic mastectomy
  • nipple sparing mastectomy
  • axillary surgery

Published Papers (5 papers)

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Research

12 pages, 1829 KiB  
Article
Does Breast Surgery Type Alter Incidental Axillary Irradiation? A Dosimetric Analysis of the “Sentinel Envahi et Randomisation du Curage” SERC Trial
by Camille Nicolas, Claire Petit, Agnès Tallet, Jean-Marie Boher, Leonel Varela Cagetti, Veronique Favrel, Laurence Gonzague Casabianca, Morgan Guenole, Hugues Mailleux, Julien Darreon, Marie Bannier, Monique Cohen, Laura Sabiani, Camille Tallet, Charlene Teyssandier, Anthony Gonçalves, Alexandre De Nonneville, Leonor Lopez Almeida, Nathan Coste, Marguerite Tyran and Gilles Houvenaegheladd Show full author list remove Hide full author list
Cancers 2024, 16(6), 1198; https://doi.org/10.3390/cancers16061198 - 19 Mar 2024
Viewed by 631
Abstract
Background. An incidental axillary dose of adjuvant radiotherapy using tangential beams is usually given after breast-conserving surgery for breast cancer. The goal of this sub-study was to evaluate this incidental dose in the setting of post-mastectomy radiotherapy (PMRT) according to two different radiotherapy [...] Read more.
Background. An incidental axillary dose of adjuvant radiotherapy using tangential beams is usually given after breast-conserving surgery for breast cancer. The goal of this sub-study was to evaluate this incidental dose in the setting of post-mastectomy radiotherapy (PMRT) according to two different radiotherapy techniques. Methods. Patients participating in a randomized SERC trial who received PMRT in a single center were included. We collected the incidental axillary dose delivered to the Berg level 1 using different dosimetric parameters and compared two techniques using Student’s t-test: three-dimensional conformal radiotherapy (3D-CRT) and volumetric arc therapy (VMAT). Results. We analyzed radiotherapy plans from 52 patients who received PMRT from 2012 to 2021. The mean dose delivered to the Berg level 1 was 37.2 Gy. It was significantly higher with VMAT than with 3D-CRT—43.6 Gy (SD = 3.1 Gy) versus 34.8 Gy (SD = 8.6 Gy) p < 0.001. Eighty-four percent of the Berg level 1 was covered by 40 Gy isodose in the VMAT group versus 55.5% in the 3D-CRT group p < 0.001. Conclusions. On the Berg level 1, PMRT gives a dose at least equivalent to the one given by post-breast-conserving surgery radiotherapy, making it possible to limit completion axillary lymph node dissections in select pN1a patients treated with a mastectomy. Modern radiotherapy techniques like VMAT tend to increase this incidental dose. Full article
(This article belongs to the Special Issue Trends in Mastectomy and Breast Reconstruction for Cancer)
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18 pages, 313 KiB  
Article
Postoperative Outcomes of Pre-Pectoral Versus Sub-Pectoral Implant Immediate Breast Reconstruction
by Gilles Houvenaeghel, Marie Bannier, Catherine Bouteille, Camille Tallet, Laura Sabiani, Axelle Charavil, Arthur Bertrand, Aurore Van Troy, Max Buttarelli, Charlène Teyssandier, Agnès Tallet, Alexandre de Nonneville and Monique Cohen
Cancers 2024, 16(6), 1129; https://doi.org/10.3390/cancers16061129 - 12 Mar 2024
Viewed by 877
Abstract
Introduction: Immediate breast reconstruction (IBR) techniques are rapidly evolving. We compared the results from a single-center implant IBR cohort between subpectoral and prepectoral implants with and without a mesh. Methods: We analyzed all complications and grade 2–3 complications, the implant loss rate, the [...] Read more.
Introduction: Immediate breast reconstruction (IBR) techniques are rapidly evolving. We compared the results from a single-center implant IBR cohort between subpectoral and prepectoral implants with and without a mesh. Methods: We analyzed all complications and grade 2–3 complications, the implant loss rate, the surgery time, the length of stay (LOS), patient satisfaction, the interval time to adjuvant therapy and cost, with a comparison between subpectoral and prepectoral implant IBR. Results: Subpectoral implant IBR was carried out in 529 mastectomies (62.0%) and prepectoral in 324, with a significant increase in prepectoral placement in recent years. Mesh was used in 176 prepectoral placements (54.3%). Any grade of complication was reported in 147 mastectomies (17.2%), with a significantly higher rate for prepectoral implant IBR (p = 0.036). Regression analysis showed that prepectoral implant was not significantly associated with any grade of complication or with grade 2–3 complications. Prepectoral implant IBR was associated with a significantly shorter operative time and lower LOS. Grade 2–3 complications were significantly associated with lower satisfaction. Higher costs were significantly associated with the subpectoral placement and mesh. A complication rate predictive score identified five groups with a significant increase in grade 2–3 complications. Conclusions: Prepectoral-M-IBR increased over time with no difference in complication rates compared to subpectoral-M-IBR. Prepectoral implant placement can be considered a safe technique. Full article
(This article belongs to the Special Issue Trends in Mastectomy and Breast Reconstruction for Cancer)
15 pages, 993 KiB  
Article
Incidence and Risk Assessment of Capsular Contracture in Breast Cancer Patients following Post-Mastectomy Radiotherapy and Implant-Based Reconstruction
by Maria Vinsensia, Riccarda Schaub, Eva Meixner, Philipp Hoegen, Nathalie Arians, Tobias Forster, Line Hoeltgen, Clara Köhler, Kristin Uzun-Lang, Vania Batista, Laila König, Oliver Zivanovic, Andre Hennigs, Michael Golatta, Jörg Heil, Jürgen Debus and Juliane Hörner-Rieber
Cancers 2024, 16(2), 265; https://doi.org/10.3390/cancers16020265 - 7 Jan 2024
Viewed by 1219
Abstract
Our study aims to identify the risk factors and dosimetry characteristics associated with capsular contracture. Methods: We retrospectively analyzed 118 women with breast cancer who underwent PMRT following an IBR between 2010 and 2022. Patients were treated with PMRT of 50.0–50.4 Gy in [...] Read more.
Our study aims to identify the risk factors and dosimetry characteristics associated with capsular contracture. Methods: We retrospectively analyzed 118 women with breast cancer who underwent PMRT following an IBR between 2010 and 2022. Patients were treated with PMRT of 50.0–50.4 Gy in 25–28 fractions. Capsular contracture was categorized according to the Baker Classification for Reconstructed Breasts. Results: After a median follow-up of 22 months, the incidence of clinically relevant capsular contracture (Baker III–IV) was 22.9%. Overall, capsular contracture (Baker I–IV) occurred in 56 patients (47.5%) after a median of 9 months after PMRT. The rate of reconstruction failure/implant loss was 25.4%. In the univariate analysis, postoperative complications (prolonged pain, prolonged wound healing, seroma and swelling) and regional nodal involvement were associated with higher rates of capsular contracture (p = 0.017, OR: 2.5, 95% CI: 1.2–5.3 and p = 0.031, respectively). None of the analyzed dosimetric factors or the implant position were associated with a higher risk for capsular contracture. Conclusion: Postoperative complications and regional nodal involvement were associated with an increased risk of capsular contracture following breast reconstruction and PMRT, while none of the analyzed dosimetric factors were linked to a higher incidence. Additional studies are needed to identify further potential risk factors. Full article
(This article belongs to the Special Issue Trends in Mastectomy and Breast Reconstruction for Cancer)
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11 pages, 1212 KiB  
Article
Single-Stage Immediate Breast Reconstruction with Acellular Dermal Matrix after Breast Cancer: Comparative Study and Evaluation of Breast Reconstruction Outcomes
by Basilio Dueñas-Rodríguez, Joaquín Navarro-Cecilia, Carolina Luque-López, Belén Sánchez-Andujar, Juan Arsenio Garcelán-Trigo, María Jesús Ramírez-Expósito and José Manuel Martínez-Martos
Cancers 2023, 15(22), 5349; https://doi.org/10.3390/cancers15225349 - 9 Nov 2023
Viewed by 1017
Abstract
We evaluate postoperative complications, aesthetic results and satisfaction outcomes in patients with breast cancer after intervening with a skin-sparing or nipple-sparing mastectomy with an immediate prosthetic reconstruction with or without a biological mesh. Patients with multifocal breast cancer, ductal carcinoma in situ with [...] Read more.
We evaluate postoperative complications, aesthetic results and satisfaction outcomes in patients with breast cancer after intervening with a skin-sparing or nipple-sparing mastectomy with an immediate prosthetic reconstruction with or without a biological mesh. Patients with multifocal breast cancer, ductal carcinoma in situ with an indication for a mastectomy and cT2 tumors with no response to primary systemic treatment were included, whereas patients aged >75 years, with inflammatory carcinoma, and severe circulatory disorders were excluded. Patients in the control group were reconstructed using a prosthesis, whereas the study group included patients reconstructed using a prosthesis and biological acellular porcine dermal mesh (Strattice™). In both groups, the result was assessed using the BREAST-Q instrument. A total of 51 patients (62 intervened breasts) were included in the study group and 38 patients (41 intervened breasts) in the control group. Implant loss and removal occurred in three patients in the study group (5.9%) and nine patients in the control group (24.3%; p = 0.030). Infections appeared in three patients in the study group (4.8%) and three patients in the control group (7.3%; p = 1.00). Skin necrosis appeared in 5 patients in the study group (12.2%) and 11 patients in the control group (21.6%; p = 0.367). Seroma appeared in five patients in the study group (12.2%) and five patients in the control group (8.1%; p = 0.514). The BREAST-Q questionnaire is a comparison between both groups regarding “satisfaction with breasts after surgery” (p = 0.026), “sexual well-being after intervention” (p = 0.010) and “satisfaction with the information received” (p = 0.049). We have noted a statistically significant decrease in implant loss in women receiving an implant with a biological mesh. A higher satisfaction was observed in patients reconstructed using Strattice™, with statistically significant differences in three items. Full article
(This article belongs to the Special Issue Trends in Mastectomy and Breast Reconstruction for Cancer)
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8 pages, 1147 KiB  
Communication
Improved Rate of Negative Margins for Inflammatory Breast Cancer Using Intraoperative Frozen Section Analysis
by Joshua Kong, Sudeshna Bandyopadhyay, Wei Chen, Faisal Al-Mufarrej, Lydia Choi and Mary A. Kosir
Cancers 2023, 15(18), 4597; https://doi.org/10.3390/cancers15184597 - 16 Sep 2023
Cited by 1 | Viewed by 759
Abstract
Background: Inflammatory breast cancer (IBC) is a rare and aggressive form of breast cancer with a poor survival rate. Modified radical mastectomy (MRM) with negative pathologic margins is critical for improved survival. We aim to study the potential benefit of intraoperative frozen section [...] Read more.
Background: Inflammatory breast cancer (IBC) is a rare and aggressive form of breast cancer with a poor survival rate. Modified radical mastectomy (MRM) with negative pathologic margins is critical for improved survival. We aim to study the potential benefit of intraoperative frozen section analysis (FSA) to improve disease-free margins. Methods: This prospective, monocentric study included 19 patients who underwent MRM for IBC. For each patient, a 2 mm continuous skin edge was sent for FSA to guide further resection. The rate of tumor-free margins and the concurrence between the FSA and permanent pathological results were analyzed. Results: Overall, 15 of the 19 patients achieved negative margins, including four patients who would have had positive margins without FSA. The odds ratio of achieving a negative final margin with FSA was infinity (p = 0.031), and there was a strong agreement between the FSA and permanent pathological results (Kappa—0.83; p < 0.0001). Conclusions: The FSA technique decreased the number of positive margins in IBC patients undergoing MRM, thereby potentially reducing the need for re-operation, allowing immediate wound closure, and preventing delays in the administration of adjuvant radiation therapy. More extensive trials are warranted to establish the use of intraoperative FSA in IBC treatment. Full article
(This article belongs to the Special Issue Trends in Mastectomy and Breast Reconstruction for Cancer)
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Planned Papers

The below list represents only planned manuscripts. Some of these manuscripts have not been received by the Editorial Office yet. Papers submitted to MDPI journals are subject to peer-review.

Title: Effect Pre-construction and Post-reconstruction Radiotherapy on Immediate Breast Reconstruction: Current trends and Strategies of Risk Reduction
Authors: Campbell A; Didier A; Sheikh T; Watkins D; Fahoury A; Ansari S; Nandwani S; Rashid M
Affiliation: University of Toledo Medical Center

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