Extreme Oncoplasty: Breast Conservation in Patients with Large, Multifocal, and Multicentric Breast Cancer

Savioli, Francesca; Seth, Subodh; Morrow, Elizabeth; Doughty, Julie; Stallard, Sheila; Malyon, Andrew; Romics, László

doi:10.2147/bctt.s296242

Cited by 10 publications

(20 citation statements)

References 35 publications

(70 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In several studies [16, 19], DCIS and ILC were predictive risk factors for positive surgical margins and reoperation. Fischer et al [20] reported that MRI reduced the rate of re-excision for positive margins.…”

Section: Discussionmentioning

confidence: 99%

“…These favorable results suggested that eOBCS was an effective treatment option in selected patients. In several studies [16,19], DCIS and ILC were predictive risk factors for positive surgical margins and reoperation. Fischer et al [20] reported that MRI reduced the rate of re-excision for positive margins.…”

Section: Marginsmentioning

confidence: 99%

“…The high re-excision rate was attributed to having more cases with DCIS (73%) on final pathology. Savioli et al [19] performed re-excision in 3 (6%) patients and mastectomy in 6 (12%) patients. Pearce et al [14] applied TRM to 28 patients and mini Latissimus Dorsi flaps in 62 patients in a median time of 80 (10-380) months.…”

Section: Marginsmentioning

confidence: 99%

See 2 more Smart Citations

Pushing the Limits of Breast-Conserving Surgery with Extreme Oncoplasty

Kılıç¹,

Bademler²,

İlhan³

et al. 2023

Breast Care

View full text Add to dashboard Cite

Introduction: We aimed to report the long-term surgical outcomes of extreme oncoplasty techniques in selected patients with unifocal (UF)/ cT3 or multifocal-multicentric tumors (MFMC). Material- Methods: Patients who were initially recommended to have mastectomy had extreme oncoplastic breast conserving surgery (eOBCS) including therapeutic reduction mammoplasty, racquet and round block mammoplasty, Grisotti flap or combined technique were included. Preoperative tumor parameters, clinical outcomes, rate of local recurrence, survival and patients’ satisfaction were assessed. Results: Eighty-six patients with a median age of 51 years were followed for a median follow-up of 75 (8- 154) months; 31 (36%) had cT3 and 55 (64%) had MFMC tumor. The majority of patients (83.6%) had invasive cancer. The median UF tumor size was 58 mm (range 51- 100) on imaging and 51 mm (range 50- 60) on final pathology. The median tumor span for MFMC was 65 mm (range 53- 95) on imaging, whereas the median of the largest tumor size was 30 mm (range 22- 60) on final pathology. Seventy-one patients (82.5%) were ER-positive, 17 (19.7%) were HER2 positive, and 8 (9.3%) were TNBC. Four patients (4.7%) required further intervention for having positive margins (3 re-excisions, 1 completion mastectomy). Three local recurrences (3.4%) and 10 (11.6%) distant metastasis occurred. The cosmetic outcome was excellent in 37 (43%) patients. No major complications were observed. Conclusions: eOBCS can be a good option in patients who initially require a mastectomy. Appropriate patient selection, a multidisciplinary approach, and patient consent are essential steps of the procedure.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Marginsmentioning

confidence: 99%

See 1 more Smart Citation

Pushing the Limits of Breast-Conserving Surgery with Extreme Oncoplasty

Kılıç¹,

Bademler²,

İlhan³

et al. 2023

Breast Care

View full text Add to dashboard Cite

show abstract

“…In addition, BCT has limited applications in patients with multifocal or multicentric (MF/MC) disease and in cases of extensive microcalcifications. Though conventionally MF/ MC cancers have been labeled as a contraindication for BCS, with modern extreme oncoplasty, they can be accommodated under the TM fold (11)(12)(13)(14)(15).…”

Section: Introductionmentioning

confidence: 99%

“…The concept of oncoplastic breast surgery (OBS) was first introduced in the 1990s by Prof. Audretsch when he described the technique of partial reconstruction of the breast using plastic surgical (15)(16)(17). OBS is now increasingly being accepted as the standard of care in the surgical management of breast cancer cases across the world due to benefits such as oncological safety with concurrent improvement in aesthetic results and QoL (5,8,18).…”

Section: Introductionmentioning

confidence: 99%

Therapeutic mammoplasty: a “wise” oncoplastic choice—lessons from the largest single-center cohort from Asia

et al. 2023

View full text Add to dashboard Cite

IntroductionThe majority of breast cancer patients from India usually present with advanced disease, limiting the scope of breast conservation surgery. Therapeutic mammoplasty (TM), an oncoplastic technique that permits larger excisions, is quite promising in such a scenario and well suited to breast cancer in medium-to-large-sized breasts with ptosis and in some cases of large or multifocal/multicentric tumors. Here, we describe our TM cohort of 205 (194 malignant and 11 benign) patients from 2012 to 2019 treated at a single surgeon center in India, the largest Asian dataset for TM.MethodsAll patients underwent treatment after careful discussions by a multidisciplinary tumor board and patient counseling. We report the clinicopathological profiles and surgical, oncological, cosmetic, and patient-related outcomes with different TM procedures.ResultsThe median age of breast cancer patients was 49 years; that of benign disease patients was 41 years. The breast cancer cohort underwent simple (n = 84), complex (n = 71), or extreme (n = 44) TM surgeries. All resection margins were analyzed through intra-operative frozen-section assessment with stringent rad-path analysis protocols. The margin positivity rate was found to be 1.4%. A majority of the cohort was observed to have pT1–pT2 tumors, and the median resection volume was 180 cc. Low post-operative complication rates and good-to-excellent cosmetic scores were observed. The median follow-up was 39 months. We observed 2.07% local and 5.7% distal recurrences, and disease-specific mortality was 3.1%. At median follow-up, the overall survival was observed to be 95.9%, and disease-free survival was found to be 92.2%. The patient-reported outcome measures (PROMs) showed good-to-excellent scores for all types of TMs across BREAST-Q domains.ConclusionWe conclude that in India, a country where women present with large and locally advanced tumors, TM safely expands the indications for breast conservation surgery. Our results show oncological and cosmetic outcomes at acceptable levels. Most importantly, PROM scores suggest improved overall wellbeing and better satisfaction with the quality of life. For patients with macromastia, this technique not only focuses on cancer but also improves self-image and reduces associated physical discomfort often overlooked by women in the Indian setting. The popularization of this procedure will enable Indian patients with breast cancer to receive the benefits of breast conservation.

show abstract

Impact of Oncoplastic Surgery on Oncologic Outcomes in Patients with Breast Cancer

Turgeon,

Willcox,

Styblo

et al. 2024

Plastic and Reconstructive Surgery - Global Open

View full text Add to dashboard Cite

Background: For patients with breast cancer, oncoplastic surgery (OPS) serves as a valuable technique that allows for immediate reconstruction at the time of resection. While the aim of OPS is to improve breast cosmesis, it is critical to ensure OPS does not negatively impact appropriate cancer treatment. Methods: Based on current literature, this study provides a broad overview on the potential oncologic advantages of OPS for patients diagnosed with breast cancer. Results: OPS has been shown to be a safe and reliable approach with oncologic advantages. More specifically, OPS broadens the indications for breast conservation therapy (BCT); allows for a more generous margin of resection, thus decreasing rates of re-excision; and provides the opportunity to sample additional breast tissue, which may detect occult disease. Reduction mammaplasty may also decrease the risk for developing breast cancer. Importantly, in the era of multimodality therapy, long-term oncologic outcomes and postoperative surveillance algorithms appear to be similar when comparing patients who undergo OPS and BCT. Conclusions: For patients with breast cancer, oncoplastic surgery has emerged as a valuable technique to improve breast cosmesis while achieving optimal oncologic outcomes. As the landscape of breast oncology continues to evolve, it is critical for a multidisciplinary team to be involved to guide management and reconstructive strategies.

show abstract

Extreme Oncoplasty: Breast Conservation in Patients with Large, Multifocal, and Multicentric Breast Cancer

Cited by 10 publications

References 35 publications

Pushing the Limits of Breast-Conserving Surgery with Extreme Oncoplasty

Pushing the Limits of Breast-Conserving Surgery with Extreme Oncoplasty

Therapeutic mammoplasty: a “wise” oncoplastic choice—lessons from the largest single-center cohort from Asia

Impact of Oncoplastic Surgery on Oncologic Outcomes in Patients with Breast Cancer

Contact Info

Product

Resources

About