Oncological Outcomes and Complications after Volume Replacement Oncoplastic Breast Conservations—The Glasgow Experience

Abstract

INTRODUCTIONOncoplastic breast conservation surgery (OBCS) combines the principles of surgical oncology and plastic surgery. OBCS has now become a growing option for the treatment of breast cancer and forms a part of breast-conserving therapy (BCT). We sought to investigate and report our experience in two breast units in Glasgow (Victoria Infirmary and Western Infirmary) on volume replacement OBCS.MATERIALS AND METHODSDetails of patients treated with volume replacement OBCS were identified from a prospectively recorded database from November 2010 to October 2015. The clinical records included in the oncoplastic dataset were analyzed for demographics, tumor, treatment characteristics, and recurrences. The data were analyzed for follow-up to determine the pattern and timing of recurrence up to April 2016. The primary outcome of this study was tumor-free margin resection rates, and the secondary outcomes were locoregional and distant recurrence rates as these correlate with the overall oncological safety of volume replacement oncoplastic breast surgery (OPBS).RESULTSA total of 30 volume replacement oncoplastic breast conservation procedures have been carried out in this time period. The mean age of the former group was 51 years. Twice as many patients presented symptomatically than had tumors detected on screening. The mean preoperative tumor size on radiology was 25.4 mm. Patients underwent 13 thoracoepigastric flaps, 5 lateral intercostal artery perforator (LICAP) flaps, 2 thoracodorsal artery perforator (TDAP) flaps, 1 lateral thoracic artery perforator (LTAP) flap, 1 crescent flap volume replacement surgery, and 8 matrix rotations. Two patients had neoadjuvant chemotherapy. Fourteen patients had adjuvant chemotherapy, and all patients were treated with adjuvant radiotherapy. Twenty-two patients were treated with hormonal therapy and four patients were treated with Herceptin. The rate of incomplete excision was 10%. Median follow-up time was 48.5 months. Only one regional recurrence was detected. Eight patients encountered some form of complication.CONCLUSIONThis study continues to show the relative oncological safety of volume replacement oncoplastic conservations as an option for reconstruction in breast cancer patients. Further research is urgently needed to build robust evidence supporting the long-term oncological safety.

Chest wall perforator flaps for partial breast reconstruction: Surgical outcomes from a multicenter study

“…There was one local recurrence in this series at a median follow-up of 15 months. A study by Ho et al [22] has reported on oncological safety of oncoplastic breast surgery with tissue replacement techniques in 30 procedures with a follow-up of more than 4 years. In our routine practice, ICAP flaps have become the procedure of choice for reconstruction in patients undergoing BCS for tumors in the lateral or lower breast quadrants with a high tumor to breast ratio.…”

A population-based audit of surgical practice and outcomes of oncoplastic breast conservations in Scotland – An analysis of 589 patients

“…Current evidence is largely based on single-institution retrospective series [3][4][5][6][7][8][9][10][11][12][13][14][15] . Systematic literature reviews, meta-analyses and reviews further strengthen the evidence base but numbers in many series are small 2, [16][17][18][19][20][21][22][23][24] .…”

International multidisciplinary expert panel consensus on breast reconstruction and radiotherapy

“…Studies have historically reported a higher incidence of fat necrosis and flap contracture in women undergoing immediate versus delayed autologous reconstruction, with PMRT significantly exacerbating surgical morbidity. Potential support for the efficacy and tolerability of autologous tissue to radiation treatment comes from proof‐of‐principle studies evaluating chest wall microvascular perforator tissue replacement flaps (thoracodorsal artery perforator, lateral intercostal artery perforator, lateral thoracic artery perforator) after partial mastectomy and radiotherapy. The use of autologous tissue is the standard of care for delayed breast reconstruction in the irradiated patient.…”