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Systematic Reviews Jun 2024Breast cancer is the most common malignancy among women in the UK. Following mastectomy, reconstruction is now integral to the surgical management of breast cancer, of...
Does the use of acellular dermal matrices (ADM) in women undergoing pre-pectoral implant-based breast reconstruction increase operative success versus non-use of ADM in the same setting? A systematic review protocol.
BACKGROUND
Breast cancer is the most common malignancy among women in the UK. Following mastectomy, reconstruction is now integral to the surgical management of breast cancer, of which implant-based reconstruction (IBBR) is the most common type. IBBR initially evolved from pre-pectoral to post-pectoral due to complications, but with developments in oncoplastic techniques and new implant technology, interest in pre-pectoral IBBR has increased. Many surgeons use acellular dermal matrices (ADM); however, there is little evidence in literature as to whether this improves surgical outcomes in terms of complications, failure and patient satisfaction. This review aims to assess the available evidence as to whether there is a difference in surgical outcomes for breast reconstructions using ADM versus non-use of ADM.
METHODS
A database search will be performed using Ovid MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews and Clinicaltrials.org. The search timeframe will be 10 years. Studies will be screened using inclusion and exclusion criteria and data extracted into a standardised spreadsheet. Risk of bias will be assessed. Screening, extraction and risk-of-bias assessments will be performed independently by two reviewers and discrepancies discussed and rectified. Data analysis and meta-analysis will be performed using Microsoft Excel and R software. Forest plots will be used for two-arm studies to calculate heterogeneity and p-value for overall effect.
DISCUSSION
With the renaissance of pre-pectoral IBBR, it is important that surgeons have adequate evidence available to assist operative decision-making. Assessing evidence in literature is important to help surgeons determine whether using ADM for IBBR is beneficial compared to non-use of ADM. This has potential impacts for patient complications, satisfaction and cost to healthcare trusts.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO 2023 CRD42023389072.
Topics: Humans; Acellular Dermis; Systematic Reviews as Topic; Female; Breast Neoplasms; Mammaplasty; Mastectomy; Breast Implantation; Breast Implants; Patient Satisfaction
PubMed: 38849880
DOI: 10.1186/s13643-024-02564-7 -
Cancer Medicine Jun 2024Lung cancer (LC) and breast cancer (BC) are the most common causes of brain metastases (BMs). Time from primary diagnosis to BM (TPDBM) refers to the time interval...
PURPOSE
Lung cancer (LC) and breast cancer (BC) are the most common causes of brain metastases (BMs). Time from primary diagnosis to BM (TPDBM) refers to the time interval between initial LC or BC diagnosis and development of BM. This research aims to identify clinical, molecular, and therapeutic risk factors associated with shorter TPDBM.
METHODS
We retrospectively reviewed all diagnosed LC and BC patients with BM at Harbin Medical University Cancer Hospital from 2016 to 2020. A total of 570 patients with LC brain metastasis (LCBM) and 173 patients with breast cancer brain metastasis (BCBM) patients who met the inclusion criteria were enrolled for further analysis. BM free survival time curves were generated using Kaplan-Meier analyses. Univariate and multivariate Cox regression analyses were applied to identify risk factors associated with earlier development of BM in LC and BC, respectively.
RESULTS
The median TPDBM was 5.3 months in LC and 44.4 months in BC. In multivariate analysis, clinical stage IV and M1 stage were independent risk factors for early development of LCBM. LC patients who received chemotherapy, targeted therapy, pulmonary radiotherapy, and pulmonary surgery had longer TPDBM. For BC patients, age ≥ 50 years, Ki67 ≥ 0.3, HER2 positive or triple-negative breast cancer subtype, advanced N stage, and no mastectomy were correlated with shorter TPDBM.
CONCLUSIONS
This single-institutional study helps identify patients who have a high risk of developing BM early. For these patients, early detection and intervention could have clinical benefits.
Topics: Humans; Female; Lung Neoplasms; Brain Neoplasms; Middle Aged; Breast Neoplasms; Retrospective Studies; Risk Factors; Aged; Male; Time Factors; Adult; Neoplasm Staging
PubMed: 38847084
DOI: 10.1002/cam4.7364 -
Journal of Biomedical Optics Jun 2024Of patients with early-stage breast cancer, 60% to 75% undergo breast-conserving surgery. Of those, 20% or more need a second surgery because of an incomplete tumor...
SIGNIFICANCE
Of patients with early-stage breast cancer, 60% to 75% undergo breast-conserving surgery. Of those, 20% or more need a second surgery because of an incomplete tumor resection only discovered days after surgery. An intraoperative imaging technology allowing cancer detection on the margins of breast specimens could reduce re-excision procedure rates and improve patient survival.
AIM
We aimed to develop an experimental protocol using hyperspectral line-scanning Raman spectroscopy to image fresh breast specimens from cancer patients. Our objective was to determine whether macroscopic specimen images could be produced to distinguish invasive breast cancer from normal tissue structures.
APPROACH
A hyperspectral inelastic scattering imaging instrument was used to interrogate eight specimens from six patients undergoing breast cancer surgery. Machine learning models trained with a different system to distinguish cancer from normal breast structures were used to produce tissue maps with a field-of-view of classifying each pixel as either cancer, adipose, or other normal tissues. The predictive model results were compared with spatially correlated histology maps of the specimens.
RESULTS
A total of eight specimens from six patients were imaged. Four of the hyperspectral images were associated with specimens containing cancer cells that were correctly identified by the new pathology technique. The images associated with the remaining four specimens had no histologically detectable cancer cells, and this was also correctly predicted by the instrument.
CONCLUSIONS
We showed the potential of hyperspectral Raman imaging as an intraoperative breast cancer margin assessment technique that could help surgeons improve cosmesis and reduce the number of repeat procedures in breast cancer surgery.
Topics: Humans; Breast Neoplasms; Female; Spectrum Analysis, Raman; Mastectomy, Segmental; Hyperspectral Imaging; Mastectomy; Breast; Middle Aged; Machine Learning
PubMed: 38846676
DOI: 10.1117/1.JBO.29.6.065004 -
Eplasty 2024Abdominal donor site complications in bilateral pedicled transverse rectus abdominis muscle (TRAM) have been a concern when compared with bilateral deep inferior...
BACKGROUND
Abdominal donor site complications in bilateral pedicled transverse rectus abdominis muscle (TRAM) have been a concern when compared with bilateral deep inferior epigastric perforator (DIEP) flap breast reconstruction. This study aimed to assess the strength, endurance, and motor control in patients undergoing DIEP and TRAM flaps.
METHODS
A prospective, cohort study was performed at a single institution including patients who underwent pedicled TRAM and DIEP flap reconstruction after mastectomy from August 2017 to August 2018. Patients underwent pre- and postoperative testing involving rectus abdominis, prone plank, side bridge, and trunk flexor tests. Descriptive analyses and multivariate linear regressions were performed.
RESULTS
The final analysis included a total of 9 patients, 4 of whom underwent TRAM flap reconstruction while 5 underwent DIEP flap reconstruction. The tests were not statistically significant between the TRAM versus DIEP groups, including rectus abdominis mean time decrease (0.25 vs 0.60 sec, = .51), prone plank time increase (1.38 vs 1.38 sec, = .51), right side bridge time increase (7.54 sec vs 32.15 sec, = 1.00), left side bridge time increase (2.14 vs 44.5 sec, = .37), and trunk flexor time decrease (4.68 vs 1.68 sec, = .44). Overall complications were similar between the 2 groups.
CONCLUSIONS
No significant difference in abdominal donor site morbidity was found when comparing the 2 groups. This article provides a point of conversation with patients when discussing available reconstruction options.
PubMed: 38846507
DOI: No ID Found -
Cureus May 2024The presence of papillary structures inside the tumor is a unique and uncommon characteristic of breast cancer, and it is known as papillary carcinoma. In contrast to...
The presence of papillary structures inside the tumor is a unique and uncommon characteristic of breast cancer, and it is known as papillary carcinoma. In contrast to other forms of breast cancer, this variant usually manifests as a well-defined mass in imaging investigations and is frequently linked to a good prognosis. We present a case of a 72-year-old female with papillary carcinoma of the breast identified after presenting with a palpable breast lump. Following a left simple mastectomy and adjuvant treatment, the presence of papillary structures inside the tumor was verified by a histopathological study. Understanding the clinical and pathological characteristics of breast papillary carcinoma is crucial for precise diagnosis and suitable therapy strategizing. More research is required to further understand the molecular traits and best practices for treating this uncommon subtype of breast cancer.
PubMed: 38846248
DOI: 10.7759/cureus.59795 -
Gland Surgery May 2024The surgical management of breast cancer has evolved tremendously over the last century and now includes oncoplastic techniques that improve both cosmetic and oncologic... (Review)
Review
The surgical management of breast cancer has evolved tremendously over the last century and now includes oncoplastic techniques that improve both cosmetic and oncologic outcomes for patients. The purpose of this review is to provide the reader with a broad overview of the history of oncoplastic breast surgery in the United States (USA), and to summarize important patient factors and technical innovations for optimal operative planning in the era of multimodal treatment of breast cancer. The indications for oncoplastic surgery (OPS) have broadened significantly as more women pursue breast conservation with preservation of their native breast tissue. The operative philosophy of OPS is based on fundamental reconstructive principles, with technique selection based largely on tumor size and location. Reduction mammoplasty and mastopexy techniques have become some of the most utilized procedures in OPS due to their versatility to address tumors in almost all areas of the breast. Volume replacement techniques with locoregional perforator flaps continue to gain popularity as a single-stage reconstructive option for women with large tumor to breast ratios, especially with specialized plastic surgeons at high volume, academic centers. The oncologic advantages of OPS have allowed women to avoid mastectomy with improved margin control, re-excision rates, and equivalent overall survival all while preserving the aesthetic outcomes for these patients. Despite the proven benefits of OPS, numerous healthcare systems barriers including insurance status, geographic location, referral patterns, and racial disparities all continue to play a role in access to surgical sub-specialized breast oncology care demonstrating the need for ongoing research and education about oncoplastic principles.
PubMed: 38845836
DOI: 10.21037/gs-23-363 -
Gland Surgery May 2024The high prevalence of breast cancer survivors makes it very relevant to investigate late morbidity following the treatment. Oncoplastic breast conserving surgery (OPS)... (Review)
Review
BACKGROUND AND OBJECTIVE
The high prevalence of breast cancer survivors makes it very relevant to investigate late morbidity following the treatment. Oncoplastic breast conserving surgery (OPS) has gained great popularity over the past years, and evidence-based knowledge suggest better prognosis for treatment with breast conserving surgery (BCS) compared to mastectomy. The aim was to investigate if OPS causes late effects on an acceptable level compared to what we know about breast surgery causing late effects.
METHODS
Using the Medical Subject Headings (MeSH) terms "Breast Neoplasms", "shoulder", "oncoplast*", and "reconstruct*", the databases PubMed, Embase, and Scopus were searched on the 6 of June 2023. The literature search was managed in Covidence. We focused on studies describing late effects especially shoulder function including restrictions in mobility, reduced strength, as well as functional impairment.
KEY CONTENT AND FINDINGS
Nine studies fulfilled the inclusion criteria. Different kinds of oncoplastic procedures were described-most of them described volume replacement procedures. The knowledge of shoulder morbidity following OPS is limited. The heterogeneity in the selected studies was broad. Some of the studies were small and there was a considerable variation in follow-up time. They described shoulder function based on several different evaluation methods [range of motion (ROM), Disabilities of the Arm, Shoulder, and Hand (DASH), Quick-DASH (Q-DASH), Shoulder Pain and Disability Index (SPADI), health-related quality of life (HRQoL), and non-validated subjective questionnaires]. All studies found acceptable levels of shoulder morbidity.
CONCLUSIONS
The requisite knowledge of late effects following OPS is still not available for unambiguous recommendations. This narrative review has elucidated the knowledge and has reached a conclusion based on review of the existing literature of this item. We found that the risk of decreased shoulder function caused by OPS-volume displacement as well as volume replacement-does not exceed the risk of shoulder problems seen after BCS and mastectomy with or without immediate reconstruction. Therefore, OPS can be considered if conventional BCS is not possible. But the knowledge of shoulder function after OPS is limited, and studies comparing shoulder function after OPS, BCS and mastectomy with or without immediate reconstruction are warranted.
PubMed: 38845834
DOI: 10.21037/gs-23-530 -
Gland Surgery May 2024Perforator flaps have revolutionized autologous breast reconstruction, introducing both free and pedicled options as well as the potential for combining flaps. These... (Review)
Review
BACKGROUND AND OBJECTIVE
Perforator flaps have revolutionized autologous breast reconstruction, introducing both free and pedicled options as well as the potential for combining flaps. These versatile techniques can be utilized in massive weight loss (MWL) patients, effectively addressing both functional and aesthetic challenges by using their excess skin. This review aims to explore literature on combined pedicled and free perforator flaps for total breast reconstruction, and share our own experience in the field.
METHODS
A PubMed search up to June 2023 employed Medical Subject Headings (MeSH) terms such as (("combined") OR ("stacked") OR ("conjoined") AND ("perforator flaps")) AND ("breast reconstruction"). Publications in English and Scandinavian languages were manually screened for relevance, and supplemental sources were also reviewed.
KEY CONTENT AND FINDINGS
Limited studies exist on using combined pedicled and free flaps for total breast reconstruction, although combined free flaps are more common. Perforators around the breast base, offer multiple flap options for single or combined use. In our series of 10 women, four underwent total breast reconstruction with a combination of flip-over internal mammary artery perforator (IMAP) flap and thoracodorsal artery perforator (TDAP) flap. Another subset of four, who were MWL patients, received combined TDAP and superior epigastric artery perforator (SEAP) flaps, along with body contouring procedures such as upper body lifts and vertical abdominoplasties, addressing excess skin and improving silhouette. One remaining MWL patient had deflated breasts restored using TDAP and SEAP flaps, along with an upper and lower body lift and vertical abdominoplasty. The last MWL patient underwent a risk-reducing mastectomy, also reconstructed with TDAP and SEAP flaps, and received an upper body lift and vertical abdominoplasty.
CONCLUSIONS
Combined perforator flap techniques for combined body contouring and breast reconstruction seems safe and especially suitable for MWL patients. They offer a surgical alternative merging body contouring and breast reconstruction in cases where free flap procedures seem less favorable due to skin laxity and deflation of donor sites. However, limited literature on the topic calls for further studies.
PubMed: 38845826
DOI: 10.21037/gs-23-397 -
Journal of Reconstructive Microsurgery Jun 2024Decreased autologous flap vascular perfusion can lead to secondary procedures. Fluorescence angiography during surgery reduces the probability of repeat surgery but...
BACKGROUND
Decreased autologous flap vascular perfusion can lead to secondary procedures. Fluorescence angiography during surgery reduces the probability of repeat surgery but suffers from interpretation variability. Recently, the OnLume Avata System was developed, which evaluates real-time vascular perfusion in ambient light. This study aims to predict complications in autologous breast reconstruction using measures of relative intensity (RI) and relative area (RA).
METHODS
Patients undergoing autologous breast reconstruction underwent intraoperative tissue perfusion assessment using the OnLume Avata System. Post-hoc image annotation was completed by labeling areas of the flap interpreted to be "Well Perfused," "Questionably Perfused," and "Under Perfused." RIs and RAs were calculated for the marked areas. Primary complications of interest were overall complication rate, fat and mastectomy skin flap necrosis, and surgical revision. Logistic regression was applied to determine the odds of developing a complication based on RI and RA for each image.
RESULTS
A total of 25 patients (45 flaps) were included. In total, 17 patients (68%) developed at least one complication. Patients who developed any complication ( = 0.02) or underwent a surgical revision for complications ( = 0.02) had statistically lower RI of under-perfused portions of the flap. Patients with greater areas of under-perfused flap had a significantly higher risk of developing fat necrosis (odds ratio [OR]: 5.71, = 0.03) and required a revision operation (OR: 1.10, = 0.01).
CONCLUSION
Image-based interpretation using the OnLume Avata System correlated with the risk of developing postoperative complications that standard fluorescence imaging systems may not appreciate. This information can benefit surgeons to improve perfusion assessment and intraoperative decision-making.
PubMed: 38838710
DOI: 10.1055/s-0044-1787267 -
Cureus May 2024We present the case of a 42-year-old female with a history of human epidermal growth factor 2 (HER2) receptor-positive breast cancer status post bilateral mastectomy...
We present the case of a 42-year-old female with a history of human epidermal growth factor 2 (HER2) receptor-positive breast cancer status post bilateral mastectomy with metastasis to the spine and to the brain, who underwent transesophageal echocardiography (TEE) after outpatient transthoracic echocardiography (TTE) was suggestive of right atrial thrombus in transit. TEE revealed an atrial mass with a pedunculated stalk attached to the inferior right atrium near the inferior vena cava with a necrotic center. These findings were suggestive of an endocardial metastatic mass secondary to her primary breast cancer. The pericardium is the most common site of cardiac metastasis; meanwhile, endocardial involvement is infrequent, occurring in less than 5% of all cardiac metastases. Right atrial masses may cause evidence of right heart failure and thromboembolism of the pulmonary arteries. Treatment focuses on targeted chemotherapy, radiation therapy, and interventions as indicated. In this case, following the diagnosis of a right atrial mass, the patient was discharged the same day to begin outpatient chemotherapy.
PubMed: 38836153
DOI: 10.7759/cureus.59673