Primary breast irradiation in large-breasted or heavy women: Analysis of cosmetic outcome

Gray, James R.; McCormick, Beryl; Cox, Louise; Yahalom, Joachim

doi:10.1016/0360-3016(91)90781-x

Cited by 192 publications

(66 citation statements)

References 17 publications

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“…Analyses are based on assessments of late adverse effects made in clinic or from photographs, focusing on changes in breast size and shape, breast oedema and telangiectasia. Marked acute skin reactions in the inframammary fold of heavy-breasted patients may explain part of the association via an increased risk of consequential late effects.Suboptimal dosimetry is thought to explain at least part of the association between breast size and risk of late normal tissue damage after radiotherapy delivered using 2D techniques [1,2,4,6,17]. A cause and effect relationship is supported by the 5-year results of a randomised trial (N = 306) comparing 2D and 3D radiation dosimetry [18], but not so far by the 2-year results of a larger confirmatory study [19].…”

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confidence: 99%

Large breast size as a risk factor for late adverse effects of breast radiotherapy: Is residual dose inhomogeneity, despite 3D treatment planning and delivery, the main explanation?

Goldsmith

Haviland

Tsang

et al. 2011

Radiotherapy and Oncology

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a b s t r a c tBackground and Purpose: Large breast size is associated with an increased risk of late adverse effects after breast conservation surgery and radiotherapy, even when 3D dosimetry is used. The purpose of this study is to test the hypothesis that residual dose inhomogeneity is sufficient to explain the association. Methods: Patients previously treated after breast conservation surgery with whole breast radiotherapy using 3D dosimetry and followed up in the UK FAST hypofractionation trial were selected for this analysis. The residual level of dose inhomogeneity across the whole breast treatment volume was used to test for association between residual dosimetry and post-treatment change in breast appearance at 2 years post-radiotherapy. Results: At 2 years, 201/279 (72%) of women had no change in photographic breast appearance, 61 (22%) had mild change and 17 (6%) had marked change. Breast size and dosimetry were both significantly associated with late effects in univariate analyses, but only breast size remained an independent significant risk factor for change in breast appearance when included in a multiple regression model together with other prognostic factors (p = 0.006 for trend). Conclusion: Large-breasted women are more likely to suffer change in breast size and shape after whole breast radiotherapy delivered using 3D dosimetry, but residual dose inhomogeneity is insufficient to explain the association.Ó 2011 Elsevier Ireland Ltd. All rights reserved. Radiotherapy and Oncology xxx (2011) xxx-xxxThere is retrospective evidence that breast size is a risk factor for late adverse effects following breast conservation surgery and adjuvant radiotherapy for early breast cancer [1][2][3][4][5][6][7][8][9]. Body mass index, correlated to breast size and brassiere size, has also been linked to the risk of acute skin reactions and to late cosmesis [10][11][12]. Not all studies are confirmatory, but the weight of evidence suggests that the association between the size of the breast and the risk of early and late adverse effects in the breast is real [13][14][15][16]. Analyses are based on assessments of late adverse effects made in clinic or from photographs, focusing on changes in breast size and shape, breast oedema and telangiectasia. Marked acute skin reactions in the inframammary fold of heavy-breasted patients may explain part of the association via an increased risk of consequential late effects.Suboptimal dosimetry is thought to explain at least part of the association between breast size and risk of late normal tissue damage after radiotherapy delivered using 2D techniques [1,2,4,6,17]. A cause and effect relationship is supported by the 5-year results of a randomised trial (N = 306) comparing 2D and 3D radiation dosimetry [18], but not so far by the 2-year results of a larger confirmatory study [19]. Assuming dose distribution matters, it is not known if residual dose inhomogeneity in patients treated using 3D dosimetry explains a significant component of late adverse effects in large breasted w...

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confidence: 99%

Large breast size as a risk factor for late adverse effects of breast radiotherapy: Is residual dose inhomogeneity, despite 3D treatment planning and delivery, the main explanation?

Goldsmith

Haviland

Tsang

et al. 2011

Radiotherapy and Oncology

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“…Problems related to diagnosis, surgical treatment and radiotherapy applications of breast cancer in women with large breasts are well-known (7,24). The tumor field cannot be fully determined in these patients and higher doses of RT are required, which result in sharpening of breast boundaries due to extensive fibrosis and elevation of the breast mound on the chest wall, thus, breast aesthetics is impaired (43)(44)(45).…”

Section: Obs Advantagesmentioning

confidence: 99%

“…Poor cosmetic result rate in OBS application has been reported as 5-15% (45,47). Patients should be informed on possible problems such as scar and asymmetry, as well as the rare NAC necrosis.…”

Section: Disadvantagesmentioning

confidence: 99%

“…Fitoussi et al reported the cosmetic results of patient satisfaction rate as 98% at postoperative 1 year, and as 90% at 5 years (68). Development of more fibrosis in large or heavy breasts, especially after RT, leads to breast reduction and as a result reduces esthetic appreciation rate in 5 years (69). Over time, the high aesthetic appreciation rate in the first period declines due to RT, weight gain and so on.…”

Section: Oncologic and Esthetic Evaluationmentioning

confidence: 99%

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The Role of Oncoplastic Breast Surgery in Breast Cancer Treatment

Emiroğlu¹,

Sert²,

Inal

2015

J Breasth Health

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The aim of this study is to discuss indications, advantages, disadvantages, oncologic and aesthetic results of Oncoplastic Surgery (OBS). Pubmed and Medline database were searched for articles published between 1998 and 2014 for keywords: oncoplastic breast surgery, therapeutic mammoplasty, oncoplastic breast reduction, synchrenous reconstructions. Role of OBS in breast cancer surgery, its aspects to be considered, its value and results have been interpreted. This technique has advantages by providing more extensive tumourectomy, yielding better aesthetic results compared with breast conserving surgery, allowing oncoplastic reduction in breast cancer patients with macromastia, with higher patient satisfaction and quality of life and by being inexpensive due to single session practice. As for its disadvantages are: re-excision is more difficult, risk for mastectomy is higher, it is depent on the Surgeron's experience, it has a risk for delay in adjuvant therapies and its requirement for additional imaging studies during management. Main indications are patients with small tumour / breast volume, macromastia, multifocality, procedures which can disrupt breast cosmesis such as surgeries for upper inner breas tquadrient tumours. Contraindications are positive margin problems after wide excision, diffuse malign microcalsifications, inflammatory breast cancer, history of radiotherapy and patients' preferences. Despite low evidence level, Oncoplastic Breast Surgery seems to be both reliable and acceptable in terms of oncologic and aesthetic aspects. Oncoplastic Breast Surgery increase the application rate of breast conserving surgery by obviating practical limitations and improve the results of breast conserving surgery. Correct patient and technique choice in OBS is vital for optimization of post surgical

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“…Additionally as the procedures are performed in an immediate setting, a reduction in the complications related to adjuvant radiotherapy is avoided [11]. Since OPS reduces the amount of breast tissue, radiotherapy delivery may in fact be simplified [12].…”

Section: Introductionmentioning

confidence: 99%

A Comparison Between Oncoplastic Breast Conserving Surgery andStandard Wide Local Excision: A UK Experience

Khawaja¹,

Saiyed²,

Thayabaran³

et al. 2016

Breast Can Curr Res

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Breast Cancer: Current ResearchBr ea s t C a n ce r: Curre nt R e se ar ch Khawaja et al., Breast Can Curr Res 2015, 1:1 Keywords: Breast conserving surgery; Oncoplastic breast surgery;Wide local excision; Breast cancer; Cosmesis IntroductionIn women with early stage unifocal breast cancer, breast conserving surgery followed by radiotherapy is the recommended choice. However, in some women, lesions are difficult to excise without the risk of cosmetic deformity or inadequate margin clearance. These women often present with large tumors in relatively small breasts requiring an excision of approximately 15% to 20% of the breast volume or more than 30% in large breasts. Another factor affecting poor cosmesis after breast conserving surgery is tumors located in aesthetically sensitive areas such as the central, medial, and inferior quadrants [1,2].In recent years, oncoplastic breast conserving surgery (OPS) has increased in popularity. OPS combines the principles of oncologic and plastic surgery techniques to gain oncologically and aesthetically pleasing results [3]. As these techniques become more accepted there is a demand for surgeons to become familiar with the indications and skills required to make oncoplastic surgery safe and effective [4].The choice between different oncoplastic techniques are determined mainly by the site of the tumor in the breast, tumor characteristics, extent of resection, breast characteristics (size, shape and glandular density), previous surgery, and the expectations and wishes of the patient [5].OPS can be classified into two main approaches according to the reconstruction technique used. Volume displacement techniques are applied to correct quadrantectomy defects in medium to large breasts [6]. They are of particular benefit to those patients who present with ptotic dense glandular breasts. The breast glandular tissue is advanced, rotated or transpositioned to fill the defect [7]. Since this may result in a smaller sized breast, contralateral surgery may be required. Conversely, AbstractBackground: The goal of breast conserving surgery is to achieve complete excision of the tumor with adequate surgical margins, while preserving the natural shape and appearance of the breast. This is a retrospective study which compared operative outcomes in oncoplastic (OPS; n=54) versus standard wide local excision (WLE; n=265) populations. A total of 319 consecutive patients were included in the study. The primary outcomes were the size of the tumor, weight of the specimen and margin clearance. The secondary outcomes were patient satisfaction, local recurrence rates and operative time.

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Primary breast irradiation in large-breasted or heavy women: Analysis of cosmetic outcome

Cited by 192 publications

References 17 publications

Large breast size as a risk factor for late adverse effects of breast radiotherapy: Is residual dose inhomogeneity, despite 3D treatment planning and delivery, the main explanation?

Large breast size as a risk factor for late adverse effects of breast radiotherapy: Is residual dose inhomogeneity, despite 3D treatment planning and delivery, the main explanation?

The Role of Oncoplastic Breast Surgery in Breast Cancer Treatment

A Comparison Between Oncoplastic Breast Conserving Surgery andStandard Wide Local Excision: A UK Experience

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