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12 pages, 9453 KiB

Open AccessArticle

The Local Rhombus-Shaped Flap—An Easy and Reliable Technique for Oncoplastic Breast Cancer Surgery and Defect Closure in Breast and Axilla

by Hisham Fansa and Sora Linder

Cancers 2024, 16(17), 3101; https://doi.org/10.3390/cancers16173101 - 6 Sep 2024

Viewed by 381

Abstract

Primarily, breast-conserving therapy is an oncological intervention, but eventually it is judged by its cosmetic result. Remaining cavities from tumor resection can promote seromas, delay healing and cause lasting discomfort. Additionally, volume loss, dislocation of nipple/areola and fat necrosis lead to (cosmetically) unfavorable [...] Read more.

Primarily, breast-conserving therapy is an oncological intervention, but eventually it is judged by its cosmetic result. Remaining cavities from tumor resection can promote seromas, delay healing and cause lasting discomfort. Additionally, volume loss, dislocation of nipple/areola and fat necrosis lead to (cosmetically) unfavorable results, aggravated by radiotherapy. Oncoplastic surgery can reduce these sequelae. A local flap that has rarely been used in breast cancer surgery is the Limberg rhombic flap. The tumor defect is planned as a rhombus. The sides of the rhombus are of equal length and ideally have an angle of 60° and 120°. The flap that closes the defect is planned as an extension of equal length of the short diagonal. The second incision of the flap is placed according to the defect angle of 60°, running parallel to the defect at the same length. This creates a second rhombus. The flap is transposed into the defect, and the donor area is primarily closed. It is axially perfused and safe with a 1:1 length-to-width ratio. Compared to local perforator flaps, defect closure is easily managed without microsurgical skills. In the breast, the flap can be used in volume replacement and volume displacement techniques as an all-layer flap to cover defects, or it can be deepithelialized and buried. In the axilla, it can cover full-thickness defects when skin is involved. The advantages of the rhombic flap are its safety and simplicity to add volume and close defects, thus reducing the complexity of oncoplastic surgery. Full article

(This article belongs to the Special Issue Trends in Mastectomy and Breast Reconstruction for Cancer)

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12 pages, 1409 KiB

Open AccessArticle

Enhancing Post-Mastectomy Care: Telehealth’s Impact on Breast Reconstruction Accessibility for Breast Cancer Patients

by Stephen A. Stearns, Daniela Lee, Valeria P. Bustos, Anthony Haddad, Natalie Hassell, Erin Kim, Jose A. Foppiani, Theodore C. Lee, Samuel J. Lin and Bernard T. Lee

Cancers 2024, 16(14), 2555; https://doi.org/10.3390/cancers16142555 - 16 Jul 2024

Viewed by 599

Abstract

Objective: To examine how the recent sharp rise in telemedicine has impacted trends in accessibility of breast reconstruction (BR). Patients and Methods: A retrospective study reviewed patients who underwent a total mastectomy at our institution from 1 August 2016 to 31 January 2022. [...] Read more.

Objective: To examine how the recent sharp rise in telemedicine has impacted trends in accessibility of breast reconstruction (BR). Patients and Methods: A retrospective study reviewed patients who underwent a total mastectomy at our institution from 1 August 2016 to 31 January 2022. By comparing cohorts before and during the widespread implementation of telemedicine, we assessed telehealth’s impact on healthcare accessibility, measured by distance from patients’ residences to our institution. Results: A total of 359 patients were included in this study. Of those, 176 received total mastectomy prior to the availability of telemedicine, and 183 in the subsequent period. There were similar baseline characteristics among patients undergoing mastectomy, including distance from place of residence to hospital (p = 0.67). The same proportion elected to receive BR between groups (p = 0.22). Those declining BR traveled similar distances as those electing the procedure, both before the era of widespread telemedicine adoption (40.3 and 35.6 miles, p = 0.56) and during the height of telemedicine use (22.3 and 61.3 miles, p = 0.26). When tracking follow-up care, significantly more patients during the pandemic pursued at least one follow-up visit with their original surgical team, indicative of the increased utilization of telehealth services. Conclusions: While the rate of BR remained unchanged during the pandemic, our findings reveal significant shifts in healthcare utilization, highly attributed to the surge in telehealth adoption. This suggests a transformative impact on breast cancer care, emphasizing the need for continued exploration of telemedicine’s role in enhancing accessibility and patient follow-up in the post-pandemic era. Full article

(This article belongs to the Special Issue Trends in Mastectomy and Breast Reconstruction for Cancer)

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12 pages, 1829 KiB

Open AccessArticle

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 Houvenaeghel Show full author list Hide full author list

Cancers 2024, 16(6), 1198; https://doi.org/10.3390/cancers16061198 - 19 Mar 2024

Cited by 1 | Viewed by 864

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

Open AccessArticle

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

Cited by 1 | Viewed by 1259

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

Open AccessArticle

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

Cited by 4 | Viewed by 1675

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

Open AccessArticle

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 1369

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

Open AccessCommunication

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 2 | Viewed by 950

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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Review

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14 pages, 533 KiB

Open AccessReview

The Effects of Radiotherapy on the Sequence and Eligibility of Breast Reconstruction: Current Evidence and Controversy

by Andrew R. Campbell, Alexander J. Didier, Taha M. Sheikh, Sami Ansari, Dean E. Watkins, Alan M. Fahoury, Swamroop V. Nandwani and Mohammad Rashid

Cancers 2024, 16(17), 2939; https://doi.org/10.3390/cancers16172939 - 23 Aug 2024

Viewed by 517

Abstract

Immediate breast reconstruction (IBR) following a mastectomy, combined with radiotherapy, presents a multifaceted approach to breast cancer treatment, balancing oncological safety and aesthetic outcomes. IBR, typically involving the use of implants or autologous tissue, aims to restore breast morphology directly after a mastectomy, [...] Read more.

Immediate breast reconstruction (IBR) following a mastectomy, combined with radiotherapy, presents a multifaceted approach to breast cancer treatment, balancing oncological safety and aesthetic outcomes. IBR, typically involving the use of implants or autologous tissue, aims to restore breast morphology directly after a mastectomy, minimizing the psychological and physical impacts. However, integrating radiotherapy with IBR is complex due to the potential adverse effects on reconstructed tissues. Radiotherapy, essential for reducing local recurrence, can induce fibrosis, capsular contracture, and compromised aesthetic results. This narrative review covers the current trends in the sequencing of breast reconstruction and radiotherapy. We discuss patient selection, timing of radiotherapy, and reconstructive techniques, with special attention paid to quality-of-life outcomes that are increasingly reported in clinical trials. Emerging evidence supports the feasibility of IBR with careful patient selection and tailored therapeutic approaches, although ongoing research is necessary to refine protocols and enhance outcomes. Overall, IBR in the context of radiotherapy remains a promising but intricate treatment modality, requiring a nuanced balance between cancer control and aesthetic restoration. Full article

(This article belongs to the Special Issue Trends in Mastectomy and Breast Reconstruction for Cancer)

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