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Journal of Plastic Surgery and Hand... Oct 2017Most women who have their breast reconstructed are offered NAC reconstruction. Nonetheless, it is unclear what scientific evidence there is for the procedure. The aims... (Review)
Review
BACKGROUND
Most women who have their breast reconstructed are offered NAC reconstruction. Nonetheless, it is unclear what scientific evidence there is for the procedure. The aims of the present systematic review were to evaluate the quality of evidence for benefits and risks with NAC reconstruction, and to examine the evidence for different techniques.
METHODS
Relevant databases were searched. Inclusion criteria were controlled studies comprising ≥20 patients and a case series of ≥50 patients. Included articles had to meet criteria defined in a PICO (Patient, Intervention, Comparison, and Outcome). Data extraction and collection were performed according to the QUADAS tool. The level of evidence of the selected articles was assessed according to the Oxford Centre for Evidence-Based Medicine 2009 guidelines, and total evidence for the different research questions was graded according to the GRADE-system.
RESULTS
A total of 362 abstracts were retrieved following the search. Of these 325 did not meet the inclusion criteria and were excluded, leaving 37 studies to be included in the review. Among these, 36 were case series and one a small randomised non-blinded study Conclusions: The existing quality of evidence for risks and benefits of the operation is very low. It is unclear what the complication frequencies are after the reconstruction, and what effect on quality-of-life the operation has. Prospective studies of high quality are needed to evaluate the health effects and risks with NAC reconstruction.
Topics: Breast Neoplasms; Esthetics; Evidence-Based Medicine; Female; Humans; Mammaplasty; Mastectomy; Nipples; Risk Assessment; Treatment Outcome
PubMed: 27885878
DOI: 10.1080/2000656X.2016.1251935 -
Annals of Surgery Dec 2014To examine whether contralateral prophylactic mastectomy (CPM) is associated with improved survival, incidence of contralateral breast cancer (CBC), and recurrence in... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To examine whether contralateral prophylactic mastectomy (CPM) is associated with improved survival, incidence of contralateral breast cancer (CBC), and recurrence in patients with unilateral breast cancer (UBC).
BACKGROUND
Despite conflicting data, CPM rates continue to increase. Here we present the first meta-analysis to assess post-CPM outcomes in women with UBC.
METHODS
We searched 5 databases and retrieved papers' bibliographies for relevant studies published through March 2012. Fixed- and random-effects meta-analyses were conducted on the basis of tests of study heterogeneity. We examined potential confounding via stratification and meta-regression. We report pooled relative risks (RRs) and risk differences (RDs) with 95% confidence intervals (CIs) at 2-tailed P < 0.05 significance.
RESULTS
Of 93 studies reviewed, 14 were included in meta-analyses. Compared with nonrecipients, CPM recipients had higher rates of overall survival [OS; RR = 1.09 (95% CI: 1.06, 1.11)] and lower rates of breast cancer-specific mortality [BCM; RR = 0.69 (95% CI: 0.56, 0.85)] but saw no absolute reduction in risk of metachronous CBC (MCBC). Among patients with elevated familial/genetic risk (FGR, ie, BRCA carrier status and/or family history of breast cancer), both relative and absolute risks of MCBC were significantly decreased among CPM recipients [RR = 0.04 (95% CI: 0.02, 0.09); RD = -24.0% (95% CI: -35.6%, -12.4%)], but there was no improvement in OS or BCM.
CONCLUSIONS
CPM is associated with decreased MCBC incidence but not improved survival among patients with elevated FGR. The superior outcomes observed when comparing CPM recipients with nonrecipients in the general population are likely not attributable to a CPM-derived decrease in MCBC incidence. UBC patients without known FGR should not be advised to undergo CPM.
Topics: Breast Neoplasms; Female; Global Health; Humans; Incidence; Mastectomy; Neoplasm Recurrence, Local; Risk Factors
PubMed: 24950272
DOI: 10.1097/SLA.0000000000000769 -
Journal of Plastic, Reconstructive &... Dec 2014There are many known breast cancer risk factors, but traditionally the list has not included breast size. The aim of this study was to synthesize the literature on... (Review)
Review
BACKGROUND
There are many known breast cancer risk factors, but traditionally the list has not included breast size. The aim of this study was to synthesize the literature on breast size as a risk factor for breast carcinoma by examining studies addressing this question both directly and indirectly.
METHODS
A systematic review was performed searching MEDLINE from 1950 to November 2010, and updated again in February 2014. Literature was sought to assess the relationship between the following variables and breast cancer: 1) breast size; 2) breast reduction; 3) breast augmentation; and 4) prophylactic subcutaneous mastectomy. Findings were summarized and the levels of evidence were assessed.
RESULTS
50 papers were included in the systematic review. Increasing breast size appears to be a risk factor for breast cancer, but studies are limited by their retrospective nature, imperfect size measurement techniques and confounding variables. The evidence is stronger for risk reduction with breast reduction, including prophylactic subcutaneous mastectomy at the extreme. Generally the breast augmentation population has a lower risk of breast cancer than the general population, but it is unclear whether or not this is related to the bias of small breasts in this patient population and the presence of other confounders.
CONCLUSIONS
There is direct and indirect evidence that breast size is an important factor in the risk of developing breast cancer. Plastic surgeons are in a unique position to observe this effect. Well-designed prospective studies are required to further assess this risk factor.
Topics: Breast; Breast Neoplasms; Female; Humans; Mammaplasty; Mastectomy, Subcutaneous; Organ Size; Risk Factors
PubMed: 25456291
DOI: 10.1016/j.bjps.2014.10.001 -
The American Surgeon Dec 2023There is no level 1a evidence testing quilting suture (QS) technique after mastectomy on wound outcomes. The aim of this systematic review and meta-analysis evaluates QS... (Meta-Analysis)
Meta-Analysis
BACKGROUND
There is no level 1a evidence testing quilting suture (QS) technique after mastectomy on wound outcomes. The aim of this systematic review and meta-analysis evaluates QS and association with surgical site occurrences as compared to conventional closure (CC) for mastectomy.
METHODS
MEDLINE, PubMed, and Cochrane Library were systematically searched to include adult women with breast cancer undergoing mastectomy. The primary endpoint was postoperative seroma rate. Secondary endpoints included rates of hematoma, surgical site infection (SSI), and flap necrosis. The Mantel-Haenszel method with random-effects model was used for meta-analysis. Number needed to treat was calculated to assess clinical relevance of statistical findings.
RESULTS
Thirteen studies totaling 1748 patients (870 QS and 878 CC) were included. Seroma rates were statistically significantly lower in patients with QS (OR [95%CI] = .32 [.18, .57]; < .0001) than CC. Hematoma rates (OR [95%CI] = 1.07 [.52, 2.20]; = .85), SSI rates (OR [95%CI] = .93 [.61, 1.41]; = .73), and flap necrosis rates (OR [95%CI] = .61 [.30, 1.23]; = .17) did not significantly vary between QS and CC.
CONCLUSION
This meta-analysis found that QS was associated with significantly decreased seroma rates when compared to CC in patients undergoing mastectomy for cancer. However, improvement in seroma rates did not translate into a difference in hematoma, SSI, or flap necrosis rates.
Topics: Adult; Humans; Female; Mastectomy; Breast Neoplasms; Seroma; Surgical Flaps; Drainage; Surgical Wound Infection; Suture Techniques; Hematoma; Necrosis; Postoperative Complications
PubMed: 37144600
DOI: 10.1177/00031348231173995 -
Breast (Edinburgh, Scotland) Aug 2016Conduct a systematic review of quantitative and qualitative studies exploring patient reported factors and psychological variables influencing the decision to have... (Review)
Review
OBJECTIVE
Conduct a systematic review of quantitative and qualitative studies exploring patient reported factors and psychological variables influencing the decision to have contralateral prophylactic mastectomy (CPM), and satisfaction with CPM, in women with early stage breast cancer.
METHODS
Studies were identified via databases: Medline, CINAHL, Embase and PsycINFO. Data were extracted by one author and crosschecked by two additional authors for accuracy. The quality of included articles was assessed using standardised criteria by three authors.
RESULTS
Of the 1346 unique citations identified, 17 were studies that met the inclusion criteria. Studies included were primarily cross-sectional and retrospective. No study utilised a theoretical framework to guide research and few studies considered psychological predictors of CPM. Fear of breast cancer was the most commonly cited reason for CPM, followed by cosmetic reasons such as desire for symmetry. Overall, women appeared satisfied with CPM, however, adverse/diminished body image, poor cosmetic result, complications, diminished sense of sexuality, emotional issues and perceived lack of education regarding alternative surveillance/CPM efficacy were cited as reasons for dissatisfaction.
CONCLUSION
Current literature has begun to identify patient-reported reasons for CPM; however, the relative importance of different factors and how these factors relate to the process underlying the decision to have CPM are unknown. Of women who considered CPM, limited information is available regarding differences between those who proceed with or ultimately decline CPM.
Topics: Body Image; Breast Neoplasms; Choice Behavior; Emotions; Fear; Female; Humans; Patient Education as Topic; Patient Satisfaction; Prophylactic Mastectomy; Sexuality
PubMed: 27290619
DOI: 10.1016/j.breast.2016.04.005 -
Breast (Edinburgh, Scotland) Feb 2017Oncological concerns have risen around the safety of adipose fat transfer (AFT) after breast cancer surgery. In this article, we present the clinical and molecular... (Review)
Review
OBJECTIVES
Oncological concerns have risen around the safety of adipose fat transfer (AFT) after breast cancer surgery. In this article, we present the clinical and molecular evidences, and discuss the current contradiction between them.
MATERIALS AND METHODS
Every clinical trial and experimental study on AFT and its oncological influences was screened. Between September 2014 and September 2016, 856 articles from four databases were found. 105 core articles were selected.
RESULTS
A total of 18 clinical studies have been published. The loco-regional recurrence (LRR) incidence rates range between 0 and 3.90% per year. For the mastectomy and breast conservative therapy group separately, a LRR per year between 0 and 1.62% and 0-3.90 has been reported, respectively. Some studies included a matched control group and found no significant difference between cases and controls, with the exception of a subgroup of patients with intraepithelial breast carcinoma. Adipose derived mesenchymal stem cells have a potential oncogenic effect on residual cancer cells after breast cancer surgery. Numerous signalling proteins and pathways have been described that can stimulate tumour initiation and growth.
CONCLUSION
There is a contradiction between experimental and clinical findings. Numerous adipokines have been discovered that could potentially promote tumour initiation and growth, but clinical studies fail to point out a significant increase in LRR in patients who receive AFT after breast cancer surgery. More prospective studies are needed with a sufficient follow-up time and analysis of some critical factors, such as adjuvant radiotherapy and hormonal therapy, the origin and volume of the injected fat, and genetic influences.
Topics: Adipose Tissue; Breast Neoplasms; Female; Humans; Mammaplasty; Mastectomy, Segmental; Neoplasm Recurrence, Local
PubMed: 27837706
DOI: 10.1016/j.breast.2016.11.001 -
Journal of Perianesthesia Nursing :... Apr 2023To summarize and analyze available evidence on perioperative accelerated rehabilitation programs for patients diagnosed with breast cancer that have had a radical... (Review)
Review
PURPOSE
To summarize and analyze available evidence on perioperative accelerated rehabilitation programs for patients diagnosed with breast cancer that have had a radical mastectomy.
DESIGN
This article is a systematic review of literature based on evidence-based methodology.
METHODS
The '6S' evidence resource pyramid model was used to systematically search a range of databases.
FINDINGS
A total of 19 articles were extracted from the literature and used in this study, including 9 clinical decisions, 4 systematic evaluations, 4 expert consensuses, and 2 guidelines. We summarized a total of 47 lines of evidence with regard to various aspects, including preoperative, intraoperative, and postoperative nursing measures.
CONCLUSIONS
In this systematic review, an evidence-based methodology was used to summarize and analyze the best suggestions for perioperative accelerated rehabilitation nursing programs for breast cancer inpatients undergoing radical mastectomy. We aimed to provide a good reference value and evidence-based guidelines for the continuous improvement and development of nursing practice for the breast cancer patient population.
Topics: Humans; Female; Breast Neoplasms; Mastectomy; Mastectomy, Radical
PubMed: 36464572
DOI: 10.1016/j.jopan.2022.06.008 -
Annals of Surgical Oncology Jun 2022Seroma after mastectomy and/or axillary lymph node dissection (ALND) is among the most common issue surgeons have to face in the early postoperative management of breast... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Seroma after mastectomy and/or axillary lymph node dissection (ALND) is among the most common issue surgeons have to face in the early postoperative management of breast cancer. Using quilting sutures (QS) to aid in tissue approximation and decrease dead space is proposed as a simple technique to reduce seroma rate. We aimed to perform a systematic review, and analyse, in a meta-analytical model, the role of QS in improving wound outcomes and decrease volume, duration of drainage, and length of stay in hospital.
METHODS
The study was registered with PROSPERO. A systematic search of the PubMed, EMBASE, and SCOPUS databases was performed for all comparative studies examining surgical outcomes in patients who underwent QS versus conventional closure (CC) after mastectomy ± ALND.
RESULTS
Twenty-one studies with a total of 3473 patients (1736 in the study group and 1737 in the control group) were included based on the selection criteria. The study group showed significantly lower rates of seroma (p < 0.00001), total volume of drainage (p < 0.0001), days to drain removal (p < 0.00001), and length of stay (p < 0.00001) compared with the control group, while wound complication rates (surgical site infection, flap necrosis, hematoma, skin dimpling) were comparable between the two groups.
CONCLUSIONS
QS are a reliable intraoperative technique that decrease seroma formation, volume of postoperative drainage, duration of drainage and length of hospital stay, and should be considered in mastectomies with or without ALND.
Topics: Breast Neoplasms; Drainage; Female; Humans; Mastectomy; Postoperative Complications; Seroma; Surgical Flaps; Suture Techniques; Sutures; Treatment Outcome
PubMed: 35103890
DOI: 10.1245/s10434-022-11350-5 -
Translational Cancer Research Oct 2023We conducted a comprehensive systematic review of the literature and meta-analysis of the oncologic outcomes of breast reconstruction (BR) after mastectomy and...
BACKGROUND
We conducted a comprehensive systematic review of the literature and meta-analysis of the oncologic outcomes of breast reconstruction (BR) after mastectomy and mastectomy only. This study aimed to analyze the impact of BR on the prognosis of patients with breast cancer.
METHODS
A systematic search of MEDLINE and EMBASE databases was performed using the following keywords: breast cancer, mastectomy, and BR. Inclusion criteria were studies reporting the survival data of patients after mastectomy only and mastectomy with BR. Event-free survival (EFS), breast cancer-specific survival (BCSS), and overall survival (OS) were considered the indicators of oncological outcomes. As all the included studies were non-randomized trials, we used the Newcastle-Ottawa Scale (NOS) for risk of bias assessment. The effect of BR on survival was measured using the effect size of the hazard ratio (HR). Data from each study were analyzed using the Review Manager.
RESULTS
Fifteen studies with 20,948 cases of BR and 63,358 cases of mastectomy were included. The pooled HRs for EFS and BCSS were 1.07 [95% confidence interval (CI): 0.78-1.47, P=0.65] and 0.84 (95% CI: 0.64-1.11, P=0.22), respectively. The patients who underwent BR after mastectomy had similar EFS and BCSS scores. Furthermore, patients who received BR had better OS (HR =0.73; 95% CI: 0.61-0.88, P=0.001) than those who underwent mastectomy only.
CONCLUSIONS
The data showed that BR after mastectomy had similar EFS and BCSS and better OS than mastectomy alone. Our meta-analysis suggests that BR is a practicable and safe treatment option for patients with breast cancer.
PubMed: 37969403
DOI: 10.21037/tcr-23-706 -
Plastic and Reconstructive Surgery May 2023The perioperative use of tranexamic acid (TXA) has become popular among plastic surgeons for a variety of surgical procedures. The aim of this study was to perform a... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The perioperative use of tranexamic acid (TXA) has become popular among plastic surgeons for a variety of surgical procedures. The aim of this study was to perform a systematic review and meta-analysis on the results reported in the literature regarding the effect of perioperative systemic TXA administration in breast surgery.
METHODS
The PubMed, MEDLINE, Embase, CENTRAL, and CINAHL databases were searched for both randomized clinical trials and observational studies. Effect estimates were pooled across studies using random effects models and presented as weighted odds ratio with corresponding 95% confidence interval.
RESULTS
A total of five studies encompassing 1139 patients undergoing mastectomy with or without immediate implant or free flap-based breast reconstruction or breast-conserving surgery with or without axillary lymph node dissection were included. Perioperative intravenous administration of TXA significantly reduced the risk for hematoma (7.3% versus 12.9%; OR, 0.43; 95% CI, 0.23 to 0.81) and seroma formation (11.5% versus 19.9%; OR, 0.57; 95% CI, 0.35 to 0.92) in comparison to the control group. In the studies measuring the postoperative drainage amount, the mean difference was 132 mL (95% CI, 220 to 44 mL). No thromboembolic event occurred in either group. The weighted surgical-site infection rate was higher in the control group (3.1% versus 1.5%). However, these data were too sparse to perform comparative meta-analysis.
CONCLUSION
Evidence of this study suggests that perioperative administration of TXA significantly reduces the risk for postoperative hematoma and seroma formation in breast surgery, whereas the risk for thromboembolic events and postoperative infection is not increased.
Topics: Humans; Female; Tranexamic Acid; Antifibrinolytic Agents; Seroma; Breast Neoplasms; Mastectomy; Thromboembolism; Hematoma; Blood Loss, Surgical
PubMed: 36729428
DOI: 10.1097/PRS.0000000000010071