Abstract: There are a number of dermatologic conditions than can present on the breast. Patients and their physicians are often concerned that these skin changes may represent underlying breast cancer and, as a result, may be seen in a routine breast surgery practice. These conditions can be designated into malignant, infectious, and inflammatory categories. To thoroughly evaluate these skin concerns, a complete history, physical exam, and breast imaging should be completed to exclude malignancies. Attention should be paid to any history of autoimmune diseases, patient’s other health conditions, family medical history, medication list and immunization status. A skin punch biopsy can be useful in the diagnostic evaluation of these skin disorders. Most of the malignancies affecting the skin of the breast are related to underlying breast cancers and would be treated accordingly. Early involvement by a dermatologist may be helpful in evaluation and treatment of these patients with benign dermatologic conditions of the breast.
{"title":"Is it breast cancer? —common dermatologic disorders found on the breast","authors":"A. Throckmorton","doi":"10.21037/ABS-20-97","DOIUrl":"https://doi.org/10.21037/ABS-20-97","url":null,"abstract":"Abstract: There are a number of dermatologic conditions than can present on the breast. Patients and their physicians are often concerned that these skin changes may represent underlying breast cancer and, as a result, may be seen in a routine breast surgery practice. These conditions can be designated into malignant, infectious, and inflammatory categories. To thoroughly evaluate these skin concerns, a complete history, physical exam, and breast imaging should be completed to exclude malignancies. Attention should be paid to any history of autoimmune diseases, patient’s other health conditions, family medical history, medication list and immunization status. A skin punch biopsy can be useful in the diagnostic evaluation of these skin disorders. Most of the malignancies affecting the skin of the breast are related to underlying breast cancers and would be treated accordingly. Early involvement by a dermatologist may be helpful in evaluation and treatment of these patients with benign dermatologic conditions of the breast.","PeriodicalId":72212,"journal":{"name":"Annals of breast surgery : an open access journal to bridge breast surgeons across the world","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45262239","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
K. Grover, A. Marano, Alexandra J. Lin, Anya Peysakhovich, W. Castillo, C. Rohde
{"title":"The modified Wise-pattern superomedial pedicle reduction mammoplasty for benign macromastia: a nine-year case series","authors":"K. Grover, A. Marano, Alexandra J. Lin, Anya Peysakhovich, W. Castillo, C. Rohde","doi":"10.21037/abs-21-102","DOIUrl":"https://doi.org/10.21037/abs-21-102","url":null,"abstract":"","PeriodicalId":72212,"journal":{"name":"Annals of breast surgery : an open access journal to bridge breast surgeons across the world","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45497600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
J. Prigoff, Maximilian Staebler, R. Rao, B. Taback, L. Wiechmann, M. Accordino
: The COVID-19 pandemic has caused significant changes in cancer care delivery. This report describes the Breast Surgical Oncology Division’s experience at a quaternary care hospital within the geographic epicenter of the COVID-19 outbreak in the United States. This is a cohort study of patients scheduled for breast surgery at a single academic institution in New York City (NYC) between March 23 –April 21, 2020. Patients who were scheduled for surgery were prospectively tracked in a surgical database. The primary outcome was the proportion of cases actually performed. Secondary outcomes were the clinical characteristics of the patients who received surgery and the perioperative methods used in this group. Of the 43 cases scheduled, 0% were emergent, 39.5% urgent, and 60.5% elective, and 15 (34.9%) actually had surgery during the study period. Thirty-two patients (74.4%) experienced a surgical delay. The mean delay of an urgent case was 3 days. Two of the patients had a change in surgical plan from bilateral mastectomy with reconstruction and sentinel lymph node biopsy (SLNB) to lumpectomy with SLNB. Only two patients were admitted postoperatively. Of the 17 patients who had localization, the planned localization method differed from the actual method in 7 (42%) patients. Of the 28 patients who did not have surgery during the study period, 8 (28.6%) initiated neoadjuvant endocrine therapy as a bridge to their eventual surgery. We conclude that the surgical management of patients with breast cancer has been significantly impacted at the height of the COVID-19 pandemic in NYC.
{"title":"The impact of COVID-19 on breast surgery during the height of the New York City pandemic","authors":"J. Prigoff, Maximilian Staebler, R. Rao, B. Taback, L. Wiechmann, M. Accordino","doi":"10.21037/abs-20-55","DOIUrl":"https://doi.org/10.21037/abs-20-55","url":null,"abstract":": The COVID-19 pandemic has caused significant changes in cancer care delivery. This report describes the Breast Surgical Oncology Division’s experience at a quaternary care hospital within the geographic epicenter of the COVID-19 outbreak in the United States. This is a cohort study of patients scheduled for breast surgery at a single academic institution in New York City (NYC) between March 23 –April 21, 2020. Patients who were scheduled for surgery were prospectively tracked in a surgical database. The primary outcome was the proportion of cases actually performed. Secondary outcomes were the clinical characteristics of the patients who received surgery and the perioperative methods used in this group. Of the 43 cases scheduled, 0% were emergent, 39.5% urgent, and 60.5% elective, and 15 (34.9%) actually had surgery during the study period. Thirty-two patients (74.4%) experienced a surgical delay. The mean delay of an urgent case was 3 days. Two of the patients had a change in surgical plan from bilateral mastectomy with reconstruction and sentinel lymph node biopsy (SLNB) to lumpectomy with SLNB. Only two patients were admitted postoperatively. Of the 17 patients who had localization, the planned localization method differed from the actual method in 7 (42%) patients. Of the 28 patients who did not have surgery during the study period, 8 (28.6%) initiated neoadjuvant endocrine therapy as a bridge to their eventual surgery. We conclude that the surgical management of patients with breast cancer has been significantly impacted at the height of the COVID-19 pandemic in NYC.","PeriodicalId":72212,"journal":{"name":"Annals of breast surgery : an open access journal to bridge breast surgeons across the world","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46269574","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Oncoplastic breast-conserving surgery is becoming more widely accepted as a standard of care in management of breast cancer, with both oncologic and aesthetic benefits for patients. Significant geographic and specialty-specific variability exists regarding the availability, understanding, and application of oncoplastic reconstructive techniques. Providing high-quality care for patients with breast cancer requires streamlined multi-disciplinary communication; care of patients undergoing oncoplastic breast-conserving surgery is no exception, as surgeons from different specialties are often called upon to work together in order to optimize oncologic efficacy and aesthetic results. Standardization of oncoplastic terminology and classification systems as well as a shared understanding of available outcomes data will help patients undergoing these procedures achieve the best possible results regardless of their geographic location or health care system. In this article, we review oncoplastic standards and highlight variations with regard to terminology, classification systems, and training in oncoplastic techniques. Regional differences regarding the preference for and involvement of plastic surgery providers are highlighted. Safety, efficacy, and patient satisfaction outcomes are presented with the goal of establishing a commonly understood baseline to aid in pre-operative patient counseling. With increased acceptance and generalizability of oncoplastic standards, high-quality oncoplastic reconstructive procedures will be available to a more diverse patient population.
{"title":"Standards in oncoplastic breast-conserving surgery","authors":"Peter W. Thompson, A. Chatterjee, A. Losken","doi":"10.21037/abs-21-33","DOIUrl":"https://doi.org/10.21037/abs-21-33","url":null,"abstract":"Oncoplastic breast-conserving surgery is becoming more widely accepted as a standard of care in management of breast cancer, with both oncologic and aesthetic benefits for patients. Significant geographic and specialty-specific variability exists regarding the availability, understanding, and application of oncoplastic reconstructive techniques. Providing high-quality care for patients with breast cancer requires streamlined multi-disciplinary communication; care of patients undergoing oncoplastic breast-conserving surgery is no exception, as surgeons from different specialties are often called upon to work together in order to optimize oncologic efficacy and aesthetic results. Standardization of oncoplastic terminology and classification systems as well as a shared understanding of available outcomes data will help patients undergoing these procedures achieve the best possible results regardless of their geographic location or health care system. In this article, we review oncoplastic standards and highlight variations with regard to terminology, classification systems, and training in oncoplastic techniques. Regional differences regarding the preference for and involvement of plastic surgery providers are highlighted. Safety, efficacy, and patient satisfaction outcomes are presented with the goal of establishing a commonly understood baseline to aid in pre-operative patient counseling. With increased acceptance and generalizability of oncoplastic standards, high-quality oncoplastic reconstructive procedures will be available to a more diverse patient population.","PeriodicalId":72212,"journal":{"name":"Annals of breast surgery : an open access journal to bridge breast surgeons across the world","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47643845","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background and Objective: Hereditary breast cancer is associated with young age of onset. However, a recent study showed that the prevalence of genetic mutations in postmenopausal breast cancer patients was 3.5%, which was significantly higher when compared to 1.3% in cancer-free women. This posed the question of whether genetic testing should be extended to older patients. This literature review aimed to highlight the controversies of genetic testing for older breast cancer patients, and their subsequent management after a positive genetic test. Methods: Literature search was performed targeting published papers in English from year 2000 onwards in PubMed. Key Content and Findings: In BRCA mutation carriers, breast cancer incidence rapidly increases from early adulthood until 50 years old, then it reduced with age. Nonetheless, older BRCA mutation carriers have a higher breast cancer incidence when compared to non-carriers. The implementation of genetic testing in elderly breast cancer patients should take into account the chance of underdiagnoses, the benefits of identifying a genetic mutation and balancing it with increased medical cost and patient anxiety. Recent data suggested that BRCA1/2 mutation detection rate in postmenopausal breast cancer patients until 65 years old could be higher than what was traditionally expected, at 2%, while breast cancer patients who were 65 or above had a detection rate of about 1%. Benefits of risk-reducing contralateral mastectomy for primary breast cancer could be less in older patients due to competing causes of mortality, and a lower risk of contralateral breast cancer when compared to their younger counterparts. Conclusions: Current management guidelines for BRCA mutation carriers were based on evidence targeting younger population; there were no specific guidelines or studies targeting older mutation carriers. Individual factors such as comorbidity, competing causes of mortality, cancer risks and personal preference should all be considered when managing elderly mutation carriers. of
{"title":"Does genetic testing have any role for elderly breast cancer patients? A narrative review","authors":"Y. Chang, A. Kwong","doi":"10.21037/abs-21-122","DOIUrl":"https://doi.org/10.21037/abs-21-122","url":null,"abstract":"Background and Objective: Hereditary breast cancer is associated with young age of onset. However, a recent study showed that the prevalence of genetic mutations in postmenopausal breast cancer patients was 3.5%, which was significantly higher when compared to 1.3% in cancer-free women. This posed the question of whether genetic testing should be extended to older patients. This literature review aimed to highlight the controversies of genetic testing for older breast cancer patients, and their subsequent management after a positive genetic test. Methods: Literature search was performed targeting published papers in English from year 2000 onwards in PubMed. Key Content and Findings: In BRCA mutation carriers, breast cancer incidence rapidly increases from early adulthood until 50 years old, then it reduced with age. Nonetheless, older BRCA mutation carriers have a higher breast cancer incidence when compared to non-carriers. The implementation of genetic testing in elderly breast cancer patients should take into account the chance of underdiagnoses, the benefits of identifying a genetic mutation and balancing it with increased medical cost and patient anxiety. Recent data suggested that BRCA1/2 mutation detection rate in postmenopausal breast cancer patients until 65 years old could be higher than what was traditionally expected, at 2%, while breast cancer patients who were 65 or above had a detection rate of about 1%. Benefits of risk-reducing contralateral mastectomy for primary breast cancer could be less in older patients due to competing causes of mortality, and a lower risk of contralateral breast cancer when compared to their younger counterparts. Conclusions: Current management guidelines for BRCA mutation carriers were based on evidence targeting younger population; there were no specific guidelines or studies targeting older mutation carriers. Individual factors such as comorbidity, competing causes of mortality, cancer risks and personal preference should all be considered when managing elderly mutation carriers. of","PeriodicalId":72212,"journal":{"name":"Annals of breast surgery : an open access journal to bridge breast surgeons across the world","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41341928","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Secondary upper limb lymphedema may progress in a deleterious condition that affects the quality of life of breast cancer survivors. Post-mastectomy patients, who also suffer from refractory lymphedema, often require a simultaneous breast reconstruction and lymphedema treatment. Autologous breast reconstruction, which remains the gold standard, can be combined with a free vascularized lymph node transfer to restore the impaired lymphatic circulation. Here we describe the algorithmic approach which is used in our department when managing post-mastectomy lymphedema patients, based on lymphedema stage, and body characteristics. Methods: We analyze the parameters that should be considered in order to select the appropriate breast-reconstruction method, including body characteristics, breast size, previous radiotherapy, availability of donor lymph nodes and characteristics of the lymphedematous affected limb. We also present our data on simultaneous breast and lymphedema reconstruction, during the period 2011–2020. Method for breast reconstruction, donor site of lymph node flap, number of lymph nodes contained into the flap, affected limb volume improvement and infection episodes, need for secondary operations at the breast or limb, postoperative complications and patients’ satisfaction level, are recorded and analyzed. Results: A total of 69 mastectomy and upper limb lymphedema patients were included in the study, 35 underwent partial breast reconstruction with local flaps or lipofilling, coupled with autologous lymph node transfer, while 34 underwent a combined procedure of lymphedema and total breast reconstruction (deep inferior epigastric perforator flaps n=24, fat-augmented latissimus dorsi flaps n=8, implants n=2). Inguinal lymph nodal flaps were used in all cases; a mean of 4.1 lymph nodes were contained in the flaps. The need for secondary surgeries was assessed as 1.4 per patient. A mean volume reduction of 54.8% between upper limbs was documented (52.9% for Stage I, 54.3% for Stage II and 61% for Stage III lymphedema) at the mean 4years and 8 months follow-up; mean infection episodes were reduced from 1.2 to 0.2 per patient. All patients confirmed their subjective satisfaction. Conclusions: Simultaneous breast and lymphedema reconstruction is an effective combined procedure for addressing both mastectomy and upper-limb lymphedema in a single operation. Given the complexity and technical requirements of these demanding surgeries, the use of algorithms may help reconstructive surgeons to make a systematic approach and appropriate planning of the procedure, in order to obtain better postoperative results.
{"title":"A comprehensive treatment algorithm for patients requiring simultaneous breast and lymphedema reconstruction based on lymph node transfer","authors":"D. Dionyssiou, E. Demiri","doi":"10.21037/abs-20-142","DOIUrl":"https://doi.org/10.21037/abs-20-142","url":null,"abstract":"Background: Secondary upper limb lymphedema may progress in a deleterious condition that affects the quality of life of breast cancer survivors. Post-mastectomy patients, who also suffer from refractory lymphedema, often require a simultaneous breast reconstruction and lymphedema treatment. Autologous breast reconstruction, which remains the gold standard, can be combined with a free vascularized lymph node transfer to restore the impaired lymphatic circulation. Here we describe the algorithmic approach which is used in our department when managing post-mastectomy lymphedema patients, based on lymphedema stage, and body characteristics. Methods: We analyze the parameters that should be considered in order to select the appropriate breast-reconstruction method, including body characteristics, breast size, previous radiotherapy, availability of donor lymph nodes and characteristics of the lymphedematous affected limb. We also present our data on simultaneous breast and lymphedema reconstruction, during the period 2011–2020. Method for breast reconstruction, donor site of lymph node flap, number of lymph nodes contained into the flap, affected limb volume improvement and infection episodes, need for secondary operations at the breast or limb, postoperative complications and patients’ satisfaction level, are recorded and analyzed. Results: A total of 69 mastectomy and upper limb lymphedema patients were included in the study, 35 underwent partial breast reconstruction with local flaps or lipofilling, coupled with autologous lymph node transfer, while 34 underwent a combined procedure of lymphedema and total breast reconstruction (deep inferior epigastric perforator flaps n=24, fat-augmented latissimus dorsi flaps n=8, implants n=2). Inguinal lymph nodal flaps were used in all cases; a mean of 4.1 lymph nodes were contained in the flaps. The need for secondary surgeries was assessed as 1.4 per patient. A mean volume reduction of 54.8% between upper limbs was documented (52.9% for Stage I, 54.3% for Stage II and 61% for Stage III lymphedema) at the mean 4years and 8 months follow-up; mean infection episodes were reduced from 1.2 to 0.2 per patient. All patients confirmed their subjective satisfaction. Conclusions: Simultaneous breast and lymphedema reconstruction is an effective combined procedure for addressing both mastectomy and upper-limb lymphedema in a single operation. Given the complexity and technical requirements of these demanding surgeries, the use of algorithms may help reconstructive surgeons to make a systematic approach and appropriate planning of the procedure, in order to obtain better postoperative results.","PeriodicalId":72212,"journal":{"name":"Annals of breast surgery : an open access journal to bridge breast surgeons across the world","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44234880","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
: UK breast services have changed beyond recognition in 3 decades, improving standards of care and optimising results. Breast surgery has transformed from being a somewhat unattractive subspecialty activity of general surgeons to one of the most popular career options of young surgical trainees today. The variety of surgical techniques available has escalated enormously, with many new oncoplastic (OP) procedures now provided free of charge by the National Health Service. General surgeons subspecialising in breast surgery are now expected to acquire a range of reconstructive skills, while plastic surgeons subspecialising in breast reconstruction must demonstrate competence in the oncological principles and surgical aspects of breast cancer management. Inter-speciality training has been the key factor behind the acquisition of these new skills, in a programme backed up by new national audits, prospective cohort studies and guidelines. These activities are providing valuable data to inform the future configuration of OP surgery- which for many will inevitably result in a ‘stand alone’ specialty of OP Breast Surgery. In future, a range of developments will be needed to secure the viability and affordability of OP breast surgery. More objective decision-making tools are being developed to inform case and technique selection, together with standardised methods to measure clinical, aesthetic and patient-reported outcomes. The escalating costs of these procedures will need to be justified, backed up by the growing popularity and the oncological safety of OP conservation techniques that also avoid both the risks and the expense of implant-based and more major autologous procedures.
{"title":"The development of oncoplastic breast surgery in the UK","authors":"R. Rainsbury","doi":"10.21037/abs-21-75","DOIUrl":"https://doi.org/10.21037/abs-21-75","url":null,"abstract":": UK breast services have changed beyond recognition in 3 decades, improving standards of care and optimising results. Breast surgery has transformed from being a somewhat unattractive subspecialty activity of general surgeons to one of the most popular career options of young surgical trainees today. The variety of surgical techniques available has escalated enormously, with many new oncoplastic (OP) procedures now provided free of charge by the National Health Service. General surgeons subspecialising in breast surgery are now expected to acquire a range of reconstructive skills, while plastic surgeons subspecialising in breast reconstruction must demonstrate competence in the oncological principles and surgical aspects of breast cancer management. Inter-speciality training has been the key factor behind the acquisition of these new skills, in a programme backed up by new national audits, prospective cohort studies and guidelines. These activities are providing valuable data to inform the future configuration of OP surgery- which for many will inevitably result in a ‘stand alone’ specialty of OP Breast Surgery. In future, a range of developments will be needed to secure the viability and affordability of OP breast surgery. More objective decision-making tools are being developed to inform case and technique selection, together with standardised methods to measure clinical, aesthetic and patient-reported outcomes. The escalating costs of these procedures will need to be justified, backed up by the growing popularity and the oncological safety of OP conservation techniques that also avoid both the risks and the expense of implant-based and more major autologous procedures.","PeriodicalId":72212,"journal":{"name":"Annals of breast surgery : an open access journal to bridge breast surgeons across the world","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47401551","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Since the introduction of the radical mastectomy, surgical treatment for breast cancer has evolved significantly including advancements in breast reconstruction, resulting in improvements in both oncologic and aesthetic outcomes. Nipple-sparing mastectomy (NSM), in which the nipple-areolar complex is preserved along with skin, has become an oncological option for several groups of patients including patients with low body mass index (BMI), minimal ptosis, small breasts and non-smokers. Recently, patients who were initially deemed poor candidates for this procedure—such as women with macromastia or highgrade ptosis—have undergone NSM and reconstruction with successful outcomes due to the utilization of staged surgical techniques. In this review, options for staging reconstruction after mastectomy are outlined for both therapeutic and prophylactic NSMs. For therapeutic mastectomies, patients may undergo breast envelope shaping with either reduction mammoplasty, mastopexy, or oncoplastic reconstruction in a first stage, followed later by NSM and definitive reconstruction. Alternatively, NSM can be completed in the initial stage either with or without immediate breast reconstruction, followed by breast envelope shaping in a later stage. For prophylactic mastectomies, similar strategies may be employed with either breast envelope shaping or NSM up-front. Here, strategies for the various staging approaches are reviewed along with several techniques for nipple delay, and an algorithm for treatment of these patients is proposed.
{"title":"Staged breast reconstruction before nipple-sparing mastectomy with reconstruction","authors":"An-Jen Lin, Afaaf Shakir, Rebecca M. Garza","doi":"10.21037/ABS-20-95","DOIUrl":"https://doi.org/10.21037/ABS-20-95","url":null,"abstract":"Since the introduction of the radical mastectomy, surgical treatment for breast cancer has evolved significantly including advancements in breast reconstruction, resulting in improvements in both oncologic and aesthetic outcomes. Nipple-sparing mastectomy (NSM), in which the nipple-areolar complex is preserved along with skin, has become an oncological option for several groups of patients including patients with low body mass index (BMI), minimal ptosis, small breasts and non-smokers. Recently, patients who were initially deemed poor candidates for this procedure—such as women with macromastia or highgrade ptosis—have undergone NSM and reconstruction with successful outcomes due to the utilization of staged surgical techniques. In this review, options for staging reconstruction after mastectomy are outlined for both therapeutic and prophylactic NSMs. For therapeutic mastectomies, patients may undergo breast envelope shaping with either reduction mammoplasty, mastopexy, or oncoplastic reconstruction in a first stage, followed later by NSM and definitive reconstruction. Alternatively, NSM can be completed in the initial stage either with or without immediate breast reconstruction, followed by breast envelope shaping in a later stage. For prophylactic mastectomies, similar strategies may be employed with either breast envelope shaping or NSM up-front. Here, strategies for the various staging approaches are reviewed along with several techniques for nipple delay, and an algorithm for treatment of these patients is proposed.","PeriodicalId":72212,"journal":{"name":"Annals of breast surgery : an open access journal to bridge breast surgeons across the world","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43032887","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Rindom, L. Hölmich, G. Gunnarsson, Jens A. Sørensen, J. Thomsen
Objective: The aim of this paper is to give an overview of the available evidence on shoulder-related morbidity associated with the thoracodorsal artery (TDA) flaps when used for breast reconstruction. Background: The pedicled TDA flaps are well described for breast reconstruction with the myocutaneous latissimus dorsi (LD) flap being the standard procedure. This flap is well described and considered a safe and reliable reconstructive method. However, use of the flap may be associated with a risk of donor site morbidity—most importantly shoulder dysfunction. Muscle sparring alternatives, including the muscle sparring LD (MS-LD) flap and the thoracodorsal artery perforator (TDAP) flap, has been introduced based on the hypothesis that these would reduce post-operative sequelae. Methods: We conducted a review presenting the available literature on donor site morbidity after TDA flap harvest with focus on shoulder dysfunction. We found 12 papers dealing with shoulder dysfunction after breast reconstruction with the TDA flaps. Level of evidence (LOE) are highest for LD flaps and lower for the muscle sparring versions. Conclusions: The available evidence on shoulder morbidity after breast reconstruction with the TDA flaps is scarce and has a low LOE. Furthermore, outcome measures and follow-up time are not uniform and most of the publish studies either lack a control group or simply do not compare the relevant outcomes between groups. However, there is a clear trend showing low functional impairment after reconstruction with the muscle sparring flap types.
{"title":"Donor site morbidity associated with thoracodorsal artery flap breast reconstruction: a narrative review","authors":"M. Rindom, L. Hölmich, G. Gunnarsson, Jens A. Sørensen, J. Thomsen","doi":"10.21037/abs-21-31","DOIUrl":"https://doi.org/10.21037/abs-21-31","url":null,"abstract":"Objective: The aim of this paper is to give an overview of the available evidence on shoulder-related morbidity associated with the thoracodorsal artery (TDA) flaps when used for breast reconstruction. Background: The pedicled TDA flaps are well described for breast reconstruction with the myocutaneous latissimus dorsi (LD) flap being the standard procedure. This flap is well described and considered a safe and reliable reconstructive method. However, use of the flap may be associated with a risk of donor site morbidity—most importantly shoulder dysfunction. Muscle sparring alternatives, including the muscle sparring LD (MS-LD) flap and the thoracodorsal artery perforator (TDAP) flap, has been introduced based on the hypothesis that these would reduce post-operative sequelae. Methods: We conducted a review presenting the available literature on donor site morbidity after TDA flap harvest with focus on shoulder dysfunction. We found 12 papers dealing with shoulder dysfunction after breast reconstruction with the TDA flaps. Level of evidence (LOE) are highest for LD flaps and lower for the muscle sparring versions. Conclusions: The available evidence on shoulder morbidity after breast reconstruction with the TDA flaps is scarce and has a low LOE. Furthermore, outcome measures and follow-up time are not uniform and most of the publish studies either lack a control group or simply do not compare the relevant outcomes between groups. However, there is a clear trend showing low functional impairment after reconstruction with the muscle sparring flap types.","PeriodicalId":72212,"journal":{"name":"Annals of breast surgery : an open access journal to bridge breast surgeons across the world","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45163437","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The development of autologous breast reconstruction and the impact of enhanced recovery after surgery (ERAS): a narrative review","authors":"C. Bonde, Jens B Højvig","doi":"10.21037/abs-21-26","DOIUrl":"https://doi.org/10.21037/abs-21-26","url":null,"abstract":"","PeriodicalId":72212,"journal":{"name":"Annals of breast surgery : an open access journal to bridge breast surgeons across the world","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44993395","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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