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Annals of Surgical Oncology Jul 2020Women with an increased hereditary risk of breast cancer can undergo prophylactic mastectomy (PM), which provides a significant, but not total, risk reduction. There is...
BACKGROUND
Women with an increased hereditary risk of breast cancer can undergo prophylactic mastectomy (PM), which provides a significant, but not total, risk reduction. There is an ongoing discussion about how much skin and subcutaneous tissue should be resected to perform an adequate PM while leaving viable skin flaps.
METHODS
Forty-five women who had undergone PM were examined with magnetic resonance tomography (MRT), ultrasound (US) and clinical examination (CE) by a plastic surgeon and a general surgeon to estimate skin flap thickness.
RESULTS
The estimated mean skin flap thickness after PM was 13.3 (± 9.6), 7.0 (± 3.3), 6.9 (± 2.8) and 7.4 (± 2.8) mm following MRT, US, and CE performed by a plastic surgeon and a general surgeon, respectively. The mean difference in estimated skin flap thickness was significant between MRT and the other measuring methods, while there was no significant difference between US and CE, nor between CE performed by the surgeons. The mean skin flap thickness was significantly affected by the age at PM. Following PM, necrosis was detected in 7/23 (30.4%) of the breasts in skin flaps ≤ 5 mm and in 5/46 (10.9%) of the breasts in skin flaps > 5 mm (OR 6.29; CI 1.20-32.94; p = 0.03).
CONCLUSION
The odds of getting postoperative necrosis was > 6 times higher in skin flaps ≤ 5 mm. Thus, if the degree of remaining glandular tissue is acceptably low, it is desirable to create skin flaps thicker than 5 mm to prevent wound healing problems after the PM procedure.
Topics: Breast Neoplasms; Female; Humans; Magnetic Resonance Spectroscopy; Mammaplasty; Mastectomy; Postoperative Complications; Prophylactic Mastectomy; Tomography
PubMed: 31907748
DOI: 10.1245/s10434-019-08157-2 -
Current Oncology (Toronto, Ont.) Mar 2023Female pathogenic variant carriers have an increased lifetime risk for breast and ovarian cancer. Cancer-unaffected women who are newly diagnosed with this pathogenic... (Review)
Review
Female pathogenic variant carriers have an increased lifetime risk for breast and ovarian cancer. Cancer-unaffected women who are newly diagnosed with this pathogenic variant may experience psychological distress because of imminent health threat. No comprehensible review on psychological morbidity in cancer-unaffected pathogenic variant carriers is currently available. This review aims to give an overview about all available the studies in which psychological outcomes have been assessed in cancer-unaffected pathogenic variant carriers, whether as a primary outcome or secondary measurement. A systematic search across four databases (Web of Science, PubMed, ScienceDirect, and EBSCO) was conducted. Studies had to report on cancer-unaffected pathogenic variant carriers (exclusively or separately) and use a validated measure of psychological morbidity to be eligible. Measures were only included if they were used in at least three studies. The final review consisted of 45 studies from 13 countries. Distress measures, including anxiety and cancer worry, were most often assessed. Most studies found a peak of distress immediately after genetic test result disclosure, with a subsequent decline over the following months. Only some studies found elevated distress in carriers compared to non-carriers in longer follow-ups. Depression was frequently investigated but largely not found to be of clinical significance. Quality of life seemed to be largely unaffected by a positive genetic test result, although there was some evidence that younger women, especially, were less satisfied with their role functioning in life. Body image has been infrequently assessed so far, but the evidence suggested that there may be a decrease in body image after genetic test result disclosure that may decrease further for women who opt for a prophylactic mastectomy. Across all the outcomes, various versions of instruments were used, often limiting the comparability among the studies. Hence, future research should consider using frequently used instruments, as outlined by this review. Finally, while many studies included cancer-unaffected carriers, they were often not reported on separately, which made it difficult to draw specific conclusions about this population.
Topics: Female; Humans; BRCA1 Protein; Quality of Life; Breast Neoplasms; BRCA2 Protein; Mastectomy
PubMed: 37185387
DOI: 10.3390/curroncol30040274 -
Prophylactic antibiotic use in acellular dermal matrix-assisted implant-based breast reconstruction.Annals of the Royal College of Surgeons... Mar 2021Prophylactic antibiotics are used in acellular dermal matrix-assisted implant-based breast reconstructions. However, there are no universally accepted guidelines...
BACKGROUND
Prophylactic antibiotics are used in acellular dermal matrix-assisted implant-based breast reconstructions. However, there are no universally accepted guidelines regarding the best regimen. This retrospective, multicentre study was designed to compare the different prophylactic antibiotic regimens in these patients in three hospitals across two NHS trusts over a five-year period.
METHODS
Case notes and electronic records were reviewed for all patients undergoing acellular dermal matrix-assisted implant-based breast reconstructions between January 2010 and December 2014. Prophylactic antibiotic regimens, duration of use, wound infection, implant loss, seroma and therapeutic antibiotic use was recorded. Patients were divided into groups based on prophylactic antibiotic regimen and actual duration of use. Intergroup analysis was performed using Stata 13.0. Implant loss due to infection was the primary outcome measure.
RESULTS
A total of 105 patients had 122 breast reconstructions performed over the study period. Four prophylactic antibiotic regimens were identified: single dose ( = 20), three doses ( = 17), antibiotics for five-seven days ( = 51) and antibiotics until drains removed ( = 32). There was no statistically significant difference (> 0.05) between the various regimens in implant loss, wound infection, therapeutic antibiotic prescription or seroma rates. Based on the actual duration of prophylactic antibiotics usage, three groups were identified: prophylactic antibiotics given for one day ( = 26), antibiotics for up to one week ( = 76) and for more than one week ( = 13). Again, no statistically significant difference was observed in the groups for any outcome measure.
CONCLUSION
The study demonstrated no difference in outcomes between different prophylactic antibiotic regimens in acellular dermal matrix-assisted implant-based breast reconstructions.
Topics: Acellular Dermis; Anti-Bacterial Agents; Antibiotic Prophylaxis; Breast Implantation; Breast Neoplasms; Device Removal; Duration of Therapy; Female; Humans; Mammaplasty; Mastectomy; Middle Aged; Prophylactic Mastectomy; Prosthesis-Related Infections; Retrospective Studies; Seroma; Skin Transplantation; Surgical Wound Infection
PubMed: 33645273
DOI: 10.1308/rcsann.2020.7017 -
Molecular Genetics and Genomics : MGG May 2022The aim of this study was to assess the prevalence of germline variants in cancer-predisposing genes by either targeted (BRCA1/2) or multigene NGS panel in a high-risk...
The aim of this study was to assess the prevalence of germline variants in cancer-predisposing genes by either targeted (BRCA1/2) or multigene NGS panel in a high-risk Hereditary Breast and Ovarian Cancer (HBOC) cohort. Samples from 824 Caucasian probands were retrospectively collected and the impact of genetic diagnosis and genetic variants epidemiology in this cohort was evaluated. Performance of risk-reducing prophylactic measures, such as prophylactic mastectomy and/or prophylactic oophorectomy, was assessed through clinical follow-up of patients with a positive genetic result. Pathogenic variants predisposing to HBOC were identified in 11.9% (98/824) individuals at BRCA2 (47/98), BRCA1 (24/98), PALB2 (8/51), ATM (7/51), CHEK2 (6/51) MSH6, (2/51), RAD51C (2/51) and TP53 (2/386). Of them, 11 novel pathogenic variants and 12 VUS were identified, characterized, and submitted to ClinVar. Regarding clinical impact, the risk of developing basal or Her2 breast cancer was increased 15.7 times or 37.5 times for BRCA1 and MSH6 pathogenic variants respectively. On the contrary, the risk of developing basal or luminal A breast cancer was reduced to 81% or 77% for BRCA2 and BRCA1 pathogenic variants, respectively. Finally, 53.2% of individuals testing positive for class IV/V variants underwent prophylactic surgery (mastectomy, oophorectomy or both) being significantly younger at the cancer diagnosis than those undertaking prophylactic measures (p = 0.008). Of them, 8 carried a pathogenic/likely pathogenic variant in other genes different from BRCA1 and BRCA2, and the remaining (46.7%) decided to continue with clinical follow-up. No differences in pathogenicity or risk of developing cancer were found for BRCA1/2 between targeted and multigene sequencing strategies; however, NGS was able to resolve a greater proportion of high-risk patients.
Topics: Breast Neoplasms; DNA-Binding Proteins; Female; Genetic Predisposition to Disease; Germ-Line Mutation; Humans; Mastectomy; Ovarian Neoplasms; Retrospective Studies; Spain
PubMed: 35451682
DOI: 10.1007/s00438-022-01891-5 -
Cancer Medicine Nov 2020An increasing number of patients undergo contralateral prophylactic mastectomy (CPM) for unilateral breast cancer. However, the benefit of CPM has not been quantified in...
BACKGROUND
An increasing number of patients undergo contralateral prophylactic mastectomy (CPM) for unilateral breast cancer. However, the benefit of CPM has not been quantified in the setting of contemporary breast cancer therapy.
METHODS
We performed an analysis of 180 068 patients in the Surveillance, Epidemiology, and End Results (SEER) database, diagnosed with unilateral ductal breast carcinoma between 1998 and 2013 and treated with unilateral mastectomy (UM) or CPM. UM was performed in 146 213 patients (81.2%); CPM was performed in 33 855 patients (19.8%). Primary outcome of interest was cumulative incidence of a second primary breast cancer in the ipsilateral or contralateral breast greater than 3 months after initial diagnosis. Cumulative incidence analysis was based on a Cox proportional model to generate curves of second primary breast cancer in any breast, ipsilateral breast only, or contralateral breast only.
RESULTS
Patients who underwent CPM had a significantly reduced incidence of second primary breast cancer 10 and 15 years after surgery (CPM 0.93% [0.73%, 1.12%] vs UM 4.44% [4.28%, 4.60%]). Patients who underwent CPM had significantly lower adjusted hazard of second primary breast cancer when compared with UM (HR 0.38 vs 1.0, P < .0001).
CONCLUSIONS
CPM offers some protection from a second primary breast cancer, attributable to a reduced incidence in the contralateral breast. These findings provide additional information to providers and patients as they make decisions regarding surgical management. They should also be interpreted in the context of the absolute incidence of second primary breast cancer after UM and previous literature demonstrating no survival benefit.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Carcinoma, Ductal, Breast; Databases, Factual; Female; Humans; Incidence; Mastectomy; Middle Aged; Neoplasms, Second Primary; Prophylactic Mastectomy; SEER Program; Time Factors; Treatment Outcome; Unilateral Breast Neoplasms; United States; Young Adult
PubMed: 32918537
DOI: 10.1002/cam4.3394 -
Annals of Translational Medicine Mar 2023Tissue expansion (TE) has attracted significant attention from researchers over the past decade. However, there are currently no bibliometric analyses in this field. We...
BACKGROUND
Tissue expansion (TE) has attracted significant attention from researchers over the past decade. However, there are currently no bibliometric analyses in this field. We aimed to quantitatively and visually analyze the literature to explore the hotspots and frontiers in TE research.
METHODS
We extracted all the documents on this topic published from the Web of Science Core Citation (WOSCC) database between 2012 and 2021. CiteSpace (version 5.8 R3) and VOSviewer (version 1.6.18) were used to perform the visualization analysis.
RESULTS
A total of 1,085 documents were included in the analysis. The publication trend fluctuated over time. The United States led the research, and Harvard University was the most productive institution. published the largest number of documents and had the most citations. Kim JYS was the most prolific and most cited author. The high-frequency keywords were "complications", "breast reconstruction", "outcomes", "tissue expander", "mastectomy", and "acellular dermal matrix" (ADM). "Surgical site infection", "tissue expander/implant", "bilateral prophylactic mastectomy", and "activated controlled expansion" were the keywords with the strongest citation bursts until 2021.
CONCLUSIONS
This study provided a complete analysis of the research on TE. The effect of ADM on the complication rates after breast reconstruction is the current hotspot of TE research in surgery. Patient-activated controlled expansion might be a promising future research direction for TE.
PubMed: 37007555
DOI: 10.21037/atm-22-3643 -
Cureus Jun 2023Although prophylactic antibiotic use following autologous breast reconstruction post-mastectomy is a common practice, there is no consensus in the literature regarding... (Review)
Review
Although prophylactic antibiotic use following autologous breast reconstruction post-mastectomy is a common practice, there is no consensus in the literature regarding its duration. Antibiotic stewardship is important to minimise multi-resistant organisms as well as mitigate the associated side effects. Currently, there are no published guidelines regarding the duration of prophylactic antibiotics in autologous breast reconstruction surgery following mastectomy. The authors searched the online literature regarding the administration of antibiotics for autologous breast reconstruction surgery post-mastectomy. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were followed. The primary outcome measure was the incidence of surgical site infections (SSIs). Three studies met the inclusion criteria and included a total of 1,400 patients. Overall, 101 (7.2%) SSIs were observed. There was no significant difference in the rate of SSIs when comparing the use of antibiotics for less than or longer than 24 hours postoperatively (odds ratio = 1.434, p = 0.124). There is no significant difference between SSIs with the use of antibiotics for longer than 24 hours when compared to less than 24 hours. Further studies in the form of randomised controlled trials are required to assess the effects of prophylactic antibiotic duration in autologous breast reconstruction following mastectomy.
PubMed: 37476125
DOI: 10.7759/cureus.40631 -
CMAJ : Canadian Medical Association... Feb 2024
Topics: Humans; Decision Making; Withholding Treatment; Genetic Predisposition to Disease; Genes, BRCA2; Genes, BRCA1; Genetic Counseling; Prophylactic Mastectomy
PubMed: 38378220
DOI: 10.1503/cmaj.230750 -
Cancer Cell International Sep 2021Unilateral breast cancer (UBC) patients with germline pathogenic BRCA1/2 variants have a higher risk of developing contralateral breast cancer (CBC) and need... (Review)
Review
BACKGROUND
Unilateral breast cancer (UBC) patients with germline pathogenic BRCA1/2 variants have a higher risk of developing contralateral breast cancer (CBC) and need contralateral risk-reducing local treatments, including contralateral risk-reducing mastectomy (CRRM) and prophylactic irradiation (CPI). The aim of our study was to systematically explore the efficacy of CRRM and CPI in reducing CBC risk and increasing survival.
METHODS
A search was done, and eligible randomized trials and cohort studies should include and compare UBC patients with germline pathogenic BRCA1/2 variants who have and have not received contralateral risk-reducing local treatment. Random-effects meta-analysis was used in this study. Primary outcomes of the studies included overall survival (OS) and the incidence of contralateral breast cancer (CBC), and secondary outcomes included breast cancer-specific survival (BCSS).
RESULTS
A total of five studies with 1769 UBC patients with germline pathogenic BRCA1/2 variants were enrolled in our meta-analysis. CRRM was correlated with a lower risk of CBC in UBC patients with germline pathogenic BRCA1/2 variants (summary RR = 0.07; 95%CI 0.03-0.13, I = 3%), a significantly increased OS (summary RR, 1.15; 95%CI 1.04-1.26, I = 26%) and a significantly increased BCSS (summary RR, 1.18; 95%CI 1.07-1.31, I = 64%) compared with surveillance. CPI also decreased the risk of CBC (RR 0.02; 95%CI 0.05-0.88) but did not significantly improve OS (RR 0.97; 95%CI 0.90-1.05) and BCSS (RR 0.97; 95%CI 0.90-1.05) compared with surveillance.
CONCLUSIONS
CRRM reduces CBC risk and increases OS and BCSS in UBC patients with germline pathogenic BRCA1/2 variants, and could be offered as a risk-reducing local treatment. For those who oppose CRRM, CPI could be offered for CBC-risk reduction, while its survival benefit is still uncertain.
PubMed: 34563200
DOI: 10.1186/s12935-021-02194-2 -
The Breast Journal 2022Patients with unilateral breast cancer carrying pathogenic variants in have the option to undergo contralateral prophylactic mastectomy (CPM). However, differences in...
BACKGROUND
Patients with unilateral breast cancer carrying pathogenic variants in have the option to undergo contralateral prophylactic mastectomy (CPM). However, differences in CPM use and survival outcomes following CPM are poorly understood in this high-risk population, in part due to a lack of data from contemporary clinical cohorts. The objective of this study was to evaluate post-CPM overall survival (OS) and related racial/ethnic differences in a contemporary clinical cohort.
METHODS
We retrospectively reviewed the medical records of women with a personal history of unilateral breast cancer carrying pathogenic variants in who were diagnosed between 1996 and 2012. Genetic test results, self-reported demographic characteristics, and clinical factors were abstracted from electronic medical records.
RESULTS
Of 144 BRCA-positive patients, the majority were White (79.2%, = 114). Overall, 56.1% ( = 81) of all carriers chose to undergo CPM, with no racial/ethnic difference in CPM election ( = 0.78). Of 81 patients who underwent CPM, there is strong evidence of a difference in survival between the racial/ethnic groups, with White patients having the highest OS compared to non-White patients ( = 0.001). Of the 63 patients who did not undergo CPM, there is no racial/ethnic difference in overall survival ( = 0.61). In multivariable cox regression, adjusted for demographic and clinical characteristics, OS was significantly lower among non-Whites than in Whites (HR = 0.39, = 0.04).
CONCLUSIONS
Evaluation of a contemporary clinical cohort of BRCA-positive women with unilateral breast cancer showed no racial/ethnic difference in CPM use, but there was a significant difference in post-CPM overall survival.
Topics: Humans; Female; Mastectomy; Prophylactic Mastectomy; Retrospective Studies; Unilateral Breast Neoplasms; Breast Neoplasms; BRCA1 Protein
PubMed: 36685664
DOI: 10.1155/2022/1447545