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Breast (Edinburgh, Scotland) Dec 2023Breast cancer is the most common malignancy, and the majority of the patients are diagnosed at an early disease stage. Breast conservation is the preferred locoregional... (Review)
Review
Breast cancer is the most common malignancy, and the majority of the patients are diagnosed at an early disease stage. Breast conservation is the preferred locoregional approach, and oncoplastic breast conservation surgery is becoming more popular. This narrative review aims to discuss the challenges and uncertainties in target volume definition for postoperative radiation after these procedures, to improve radiation therapy decisions and encourage multidisciplinary.
Topics: Humans; Female; Breast Neoplasms; Mastectomy, Segmental; Mastectomy; Breast; Radiotherapy, Adjuvant; Mammaplasty
PubMed: 37783134
DOI: 10.1016/j.breast.2023.103584 -
Journal of Surgical Oncology Jun 2016A number of factors have contributed to a paradigm shift in US post-mastectomy breast reconstruction. The increasing numbers of contralateral prophylactic mastectomies... (Review)
Review
A number of factors have contributed to a paradigm shift in US post-mastectomy breast reconstruction. The increasing numbers of contralateral prophylactic mastectomies strongly correlated to a rise in implant-based reconstructions. Autologous reconstruction, however, has faced a number of barriers including technically complicated perforator flaps and declining reimbursements. As such, a market concentration has developed within high volume microsurgical centers. As more patients receive radiation, the timing and method of reconstruction has become a controversial topic. J. Surg. Oncol. 2016;113:891-894. © 2016 Wiley Periodicals, Inc.
Topics: Breast Implants; Breast Neoplasms; Female; Humans; Mammaplasty; Mastectomy; Radiotherapy
PubMed: 26876921
DOI: 10.1002/jso.24201 -
Revista Brasileira de Ginecologia E... Jun 2020The present paper reports on the local treatment of breast cancer from a historical perspective. A search for articles written in English was made in the Medline and... (Review)
Review
The present paper reports on the local treatment of breast cancer from a historical perspective. A search for articles written in English was made in the Medline and EMBASE databases, and 40 papers were selected. Over the past 10 years, various randomized, controlled clinical trials on the local treatment of breast cancer indicated that patients with the same molecular subtype may receive different individualized surgical treatments aimed at optimizing systemic adjuvant therapy. With a view to retaining the gains made in disease-free and overall survival, surgical techniques have advanced from radical surgery to conservative mastectomies, thus reducing sequelae, while adjuvant and neoadjuvant therapies have contributed toward controlling the disease, both distant metastases and local recurrence. Current studies evaluate whether future breast cancer therapy may even succeed in eliminating surgery to the breast and axilla altogether.
Topics: Breast Neoplasms; Chemotherapy, Adjuvant; Female; Humans; Mastectomy, Segmental; Neoadjuvant Therapy; Randomized Controlled Trials as Topic
PubMed: 32604439
DOI: 10.1055/s-0040-1712125 -
Revista Da Associacao Medica Brasileira... 2024The radical change in the treatment of breast cancer has promoted the necessity for more comprehensive training of the professionals involved, ensuring the preservation... (Review)
Review
OBJECTIVE
The radical change in the treatment of breast cancer has promoted the necessity for more comprehensive training of the professionals involved, ensuring the preservation of oncological safety while also allowing for cosmetic interventions to benefit breast cancer survivors. The aim of this study was to present the methods employed in the training of breast surgeons, highlighting the importance of oncoplasty and breast reconstruction.
METHODS
A literature review was conducted in two databases, identifying articles related to medical education in the context of oncoplastic surgery and breast reconstruction. We also assessed the Brazilian experience in oncoplastic centers.
RESULTS
The basis for educational discussions was derived from 16 articles. We observed approaches that included hands-on courses utilizing simulator models, porcine models, cadaver labs, and fellowship programs. Positive outcomes were observed in Brazil, a fact based on seven oncoplasty training centers for senior mastologists and five training centers for junior mastologists. From 2009 to 2023, an estimated 452 seniors and 42 juniors received training, representing approximately 30% of mastologists in Brazil who have acquired training and experience in oncoplasty.
CONCLUSION
Despite the limited number of publications on training methods, oncoplastic centers have made significant progress in Brazil, establishing a successful model that can be replicated in other countries.
Topics: Humans; Mammaplasty; Female; Breast Neoplasms; Brazil; Mastectomy; Clinical Competence
PubMed: 38865539
DOI: 10.1590/1806-9282.2024S119 -
Annals of Surgical Oncology Aug 2023Modified radical mastectomy (MRM) still is largely performed in inpatient settings. This study sought to determine the value (expenditures and complications) of...
BACKGROUND
Modified radical mastectomy (MRM) still is largely performed in inpatient settings. This study sought to determine the value (expenditures and complications) of ambulatory MRM.
METHODS
Health Care Utilization Project (HCUP) state databases from 2016 were queried for patients who underwent MRM. The study examined rates of 30-day readmission for surgical-site infection (SSI) or hematoma, charges by index care setting, and predictors of 30-day readmission.
RESULTS
Overall, 8090 patients underwent MRM: 5113 (63 %) inpatient and 2977 (37 %) ambulatory patients. Compared with the patients who underwent inpatient MRM, those who underwent ambulatory MRM were older (61 vs. 59 years), more often white (66 % vs. 57 %), in the lowest income quartile (28 % vs. 21 %), insured by Medicare (43 % vs. 33 %) and residents in a small metro area (6 % vs. 4 %) (all p < 0.01). Of the 5113 patients treated as inpatients, 126 (2.5 %) were readmitted, whereas 50 (1.7 %) of the ambulatory patients were readmitted (p = 0.02). The adjusted charge for inpatient MRM without readmission was $113,878 (range, $107,355-120,402) compared with $94,463 (range, $86,021-102,907) for ambulatory MRM, and the charge for inpatient MRM requiring readmission was $159,355 (range, $147,142-171,568) compared with $139,940 (range, $125,808-154,073) for ambulatory MRM (all p < 0.01). This difference remained significant after adjustment for hospital length of stay. Adjusted logistic regression showed that the ambulatory setting was protective for readmission (odds ratio, 0.49; 95 % confidence interval, 0.35-0.70; p < 0.01).
CONCLUSIONS
The analyses suggest that ambulatory MRM is both safe and less expensive. The findings advocate that MRM, a last holdout of inpatient care within breast surgical oncology, can be transitioned to the ambulatory setting for appropriate patients.
Topics: Humans; Aged; United States; Female; Mastectomy, Modified Radical; Breast Neoplasms; Mastectomy; Medicare; Hospitalization; Patient Readmission; Retrospective Studies; Ambulatory Surgical Procedures
PubMed: 37166742
DOI: 10.1245/s10434-023-13588-z -
Current Oncology (Toronto, Ont.) Mar 2024Breast cancer is diagnosed in nearly 3 million people worldwide. Radiation therapy is an integral component of disease management for patients with breast cancer, and is... (Review)
Review
Breast cancer is diagnosed in nearly 3 million people worldwide. Radiation therapy is an integral component of disease management for patients with breast cancer, and is used after breast-conserving surgery or a mastectomy to reduce the risk of a local recurrence. The following review describes the methods used to personalize radiation therapy by optimizing patient selection, using advanced treatment techniques to lessen the radiation dose to normal organs, and using hypofractionation in order to shorten the duration of radiation treatment.
Topics: Humans; Female; Breast Neoplasms; Mastectomy; Mastectomy, Segmental
PubMed: 38534954
DOI: 10.3390/curroncol31030121 -
Tidsskrift For Den Norske Laegeforening... Feb 2020Oncoplastic breast-conserving surgery extends the indication for breast-conserving surgery. Oncoplastic techniques are used to reshape or replace breast tissue during...
Oncoplastic breast-conserving surgery extends the indication for breast-conserving surgery. Oncoplastic techniques are used to reshape or replace breast tissue during cancer surgery, in order to retain quality of life and a natural breast that also tolerates necessary post-surgical treatment. This treatment is considered to be oncologically safe, compared to traditional breast-conserving surgery and mastectomy.
Topics: Breast Neoplasms; Humans; Mammaplasty; Mastectomy; Mastectomy, Segmental; Quality of Life
PubMed: 32105024
DOI: 10.4045/tidsskr.19.0371 -
Scientific Reports Jun 2023To explore the superiority of breast conservation surgery (BCS) to mastectomy in treating early-stage adenoid cystic carcinoma of the breast (BACC). Patients with...
To explore the superiority of breast conservation surgery (BCS) to mastectomy in treating early-stage adenoid cystic carcinoma of the breast (BACC). Patients with surgically treated stage I/II BACC were enrolled between 2000 and 2019 in the SEER database; they were divided into the BCS and mastectomy groups. Overall survival (OS) and disease-specific survival (DSS) were compared between the two groups, and Cox hazard regression models were used to determine the independent predictors. Of the 583 patients in the study, 386 were included in the BCS group. The 10-year OS rates for the BCS and mastectomy groups were 78% (95% CI: 74-82%) and 76% (95% CI: 70-82%), respectively, but the difference was not statistically significant (p = 0.968). The 10-year DSS rates for the BCS and mastectomy groups were 95% (95% CI: 93-97%) and 89% (95% CI: 85-93%), respectively, and the difference was statistically significant (p = 0.002). Pathological examination of regional lymph nodes and adjuvant treatment were not associated with improved OS or DSS, but age, disease grade, and lymph node metastasis were independent prognostic factors. For stage I/II BACC, BCS can achieve more satisfactory 10-year OS and DSS than mastectomy.
Topics: Humans; Female; Mastectomy; Mastectomy, Segmental; Carcinoma, Adenoid Cystic; Breast Neoplasms; Proportional Hazards Models; Retrospective Studies
PubMed: 37353590
DOI: 10.1038/s41598-023-36644-w -
Revista Da Associacao Medica Brasileira... Jan 2018
Review
Topics: Breast Neoplasms; Evidence-Based Medicine; Female; Guideline Adherence; Humans; Prophylactic Mastectomy
PubMed: 29561933
DOI: 10.1590/1806-9282.64.01.3 -
Plastic and Reconstructive Surgery Feb 2023High-deductible health plans (HDHPs) are used within the United States to curb unnecessary health care spending; however, the resulting increased out-of-pocket (OOP)...
BACKGROUND
High-deductible health plans (HDHPs) are used within the United States to curb unnecessary health care spending; however, the resulting increased out-of-pocket (OOP) costs may be associated with financial toxicity. The aim was to assess the impact of HDHPs on use and seasonality of mastectomy and breast reconstruction procedures. The hypothesis is that the high OOP costs of HDHPs will lead to decreased overall service use and greater fourth-quarter use after the deductible has been met.
METHODS
MarketScan was queried from 2014 to 2017 for episodes of mastectomy, breast reconstruction (immediate and delayed), breast revision, and reduction. Only patients continuously enrolled for the full calendar year after the index operation were included. HDHPs and low-deductible health plans (LDHPs) were compared based on OOP cost sharing. Outcomes included surgery use rates, seasonality of operations, and median/mean OOP costs.
RESULTS
Annual mastectomy and breast reconstruction use rates varied little between LDHPs and HDHPs. Mastectomies, delayed breast reconstruction, and elective breast procedures (P < 0.001) all showed significant increases in fourth-quarter use, whereas immediate breast reconstruction did not. Regardless of timing and reconstruction method, HDHPs had significantly greater median OOP costs compared to LDHPs (all P < 0.001).
CONCLUSIONS
Mastectomy and breast reconstruction rates did not differ between LDHPs and HDHPs, but seasonality for all breast procedures was measured with the exception of immediate breast reconstruction, suggesting that women are rational economic actors. Regardless of service timing and reconstruction modality, HDHP patients had greater OOP costs compared to LDHP patients, which serves as a good starting point for provider engagement in financial toxicity.
Topics: Humans; Female; United States; Deductibles and Coinsurance; Financial Stress; Breast Neoplasms; Mastectomy; Health Expenditures; Mammaplasty
PubMed: 36696302
DOI: 10.1097/PRS.0000000000009823