Abstract
Background
Therapeutic mammaplasty (TM) for breast cancer is a widely practiced oncoplastic technique. Patient selection criteria and method of margin assessment are not clearly established. The aim of our review was to analyse oncological and aesthetic outcomes over a 7 year period.
Methods
We conducted a retrospective review of 251 breast cancer patients who underwent TM from 2002 to 2009 at the Netcare Breast Care Centre, Johannesburg. Primary chemotherapy was used to downsize large tumours. Intraoperative margin assessment was performed. Statistical analysis was performed using Kaplan–Meier estimates. Cosmetic outcomes were assessed by an independent review panel using photographic material.
Results
Mean tumour size was 15.4 mm. Mean resection weight was 237 g. Sixty-four (25.5 %) patients received primary chemotherapy. Mean margin taken was 15 mm. The back-to-theatre rate was 2 % (5 cases). A total of 222 patients underwent bilateral procedures. Contralateral occult disease was identified in six cases (2.4 %). The early (<2 months) complication rate was 3.2 %. Late complications were related to adjuvant radiotherapy (20.7 %). Mean follow-up was 50 months. The recurrence rate was 4 %. Five of six patients with locoregional recurrence had DCIS at initial surgery. The mortality rate was 3.2 %. The overall survival rate was 96.4 % and the metastasis-free survival rate was 94.6 %. Acceptable aesthetic results were achieved in 96 % of the patients.
Conclusions
Primary chemotherapy allowed for TM in patients with large tumours. Intraoperative margin assessment decreased reoperation rate. Contralateral matching procedures resulted in histological detection of occult disease. TM is an oncologically appropriate and cosmetically favourable technique.
Similar content being viewed by others
References
Ferlay J, Shin HR, Bray F et al (2010) Estimates of worldwide burden of cancer 2008: GLOBOCAN 2008. Int J Cancer 127:2893–2917
Vorobiof D, Sitas F, Vorobiof G (2001) Breast cancer incidence in South Africa. J Clin Oncol 19:125–127
Halsted WS (1894) The results of operations for cure of cancer of the breast performed at the Johns Hopkins Hospital from June 1889 to January 1894. Ann Surg 20:497
Fisher B, Anderson S, Bryant J et al (2002) Twenty-year follow-up of a randomised trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med 347:1233–1241
Veronesi U, Cascinelli N, Mariani L et al (2002) Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med 347:1227–1232
Van Dongen J, Voogd A, Fentiman I et al (2000) Long-term results of a randomised trial comparing breast-conserving therapy with mastectomy: European Organisation for Research and Treatment of Cancer 10801 Trial. J Natl Cancer Inst 92:1143
Arriagada R, Le M, Rochard F et al (1996) Conservative treatment versus mastectomy in early breast cancer: patterns of failure with 15 years of follow-up data. J Clin Oncol 14:1558
Jacobson J, Danforth D, Cowan K et al (1995) Ten-year results of comparison of conservation with mastectomy in the treatment of stage I and II breast cancer. N Engl J Med 332:907
Fisher B, Dignam J, Wolmark N et al (1998) Lumpectomy and radiation therapy for the treatment of intraductal breast cancer: findings from National Surgical Adjuvant Breast and Bowel Project B-17. J Clin Oncol 16:441–452
Solin LJ, Kurtz J, Fourquet A et al (1996) Fifteen year results of breast conserving surgery and definitive breast irradiation for the treatment of ductal carcinoma in situ of the breast. J Clin Oncol 14:754–763
Fisher B, Brown A, Mamounas E et al (1997) Effect of preoperative chemotherapy on local-regional disease in women with operable breast cancer: findings from National Surgical Adjuvant Breast and Bowel Project B-18. J Clin Oncol 15:2483–2493
Schwartz GF, Birchansky CA, Komarnicky LT et al (1994) Induction chemotherapy followed by breast conservation for locally advanced carcinoma of the breast. Cancer 73:362–369
Dewar JA, Benhamou S, Benhamou E et al (1988) Cosmetic results following lumpectomy axillary dissection and radiotherapy for small breast cancers. Radiother Oncol 12:273–280
Petit JY, Rigaut L, Zekri A et al (1989) Poor aesthetic results after conservative treatment of breast cancer. Techniques of partial breast reconstruction. Ann Chir Plast Esthet 34:103–108
Sacchini V, Luini A, Tana S et al (1991) Quantitative and qualitative cosmetic evaluation after conservative treatment for breast cancer. Eur J Cancer 27:1395–1400
Amichetti M, Busana L, Caffo O (1995) Long-term cosmetic outcome and toxicity in patients treated with quadrantectomy and radiation therapy for early-stage breast cancer. Oncology 52:177–181
Rose MA, Olivotto I, Cady B et al (1989) Conservative surgery and radiation therapy for early breast cancer. Long-term cosmetic results. Arch Surg 124:153–157
Abner AL, Recht A, Vicini FA et al (1991) Cosmetic results after surgery, chemotherapy, and radiation therapy for early breast cancer. Int J Radiat Oncol Biol Phys 21:331–338
Moro G, Ciambellotti E (1993) Evaluation of the esthetic results of conservative treatment of breast cancer. Tumori 79:258–261
Clough K, Cuminet J, Fitoussi A et al (1998) Cosmetic sequelae after conservative treatment for breast cancer: classification and results of surgical correction. Ann Plast Surg 41:471–481
Clough KB, Lewis JS, Couturaud B et al (2003) Oncoplastic techniques allow extensive resections for breast-conserving therapy of breast carcinomas. Ann Surg 237:26–34
Audretsch W, Rezai M, Kolotas C et al (1998) Tumor-specific immediate reconstruction in breast cancer patients. Perspect Plast Surg 11:71–100
Clough K, Thomas S, Fitoussi A et al (2004) Reconstruction after conservative treatment for breast cancer: cosmetic sequelae classification revisited. Plast Reconstr Surg 114:1743
Rietjens M, Petit JY, Contesso G et al (1997) The role of reduction mammaplasty in oncology. Eur J Plast Surg 20:246–250
Waljee J, Hu E, Ubel P et al (2008) Effect of esthetic outcome after breast-conserving surgery on psychosocial functioning and quality of life. J Clin Oncol 26:3331
Keith D, Walker M, Walker L et al (2003) Women who wish breast reconstruction: characteristics, fears, and hopes. Plast Reconstr Surg 111:1051–1056
Al-Ghazal SK, Fallowfield L, Blamey RW (2000) Comparison of psychological aspects and patient satisfaction following breast conserving surgery, simple mastectomy and breast reconstruction. Eur J Cancer 36:1938–1943
Rowland JH, Desmond KA, Meyerowitz BE et al (2000) Role of breast reconstructive surgery in physical and emotional outcomes among breast cancer survivors. J Natl Cancer Inst 92:1422–1429
Kaur N, Petit JY, Rietjens M et al (2005) Comparative study of surgical margins in oncoplastic surgery and quadrantectomy in breast cancer. Ann Surg Oncol 12:1–7
Petit JY, Rietjens M, Contesso G et al (1997) Contralateral mastoplasty for breast reconstruction: a good opportunity for glandular exploration and occult carcinomas diagnosis. Ann Surg Oncol 4:511–515
Losken A, Elwood E, Styblo T et al (2002) The role of reduction mammaplasty in reconstructing partial mastectomy defects. Plast Reconstr Surg 109:968
Petit JY, Garusi C, Greuse M et al (2002) One hundred and eleven cases of breast conservation treatment with simultaneous reconstruction at the European Institute of Oncology (Milan). Tumori 88:41–47
Brierley J, Paterson I, Lallemand R et al (1991) The influence of breast size on late radiation reaction following excision and radiotherapy for early breast cancer. Clin Oncol 3:6–9
Gray JR, McCormick B, Cox L et al (1991) Primary breast irradiation in large-breasted or heavy women: analysis of cosmetic outcome. Int J Radiat Oncol Biol Phys 21:347–354
Moody AM, Mayles WP, Bliss JM et al (1994) The influence of breast size on late radiation effects and association with radiotherapy dose inhomogeneity. Radiother Oncol 33:106–112
Zierhut D, Flentje M, Frank C et al (1994) Conservative treatment of breast cancer: modified irradiation technique for women with large breasts. Radiother Oncol 31:256
Clarke D, Martinez A, Cox R (1983) Analysis of cosmetic results and complications in patients with stage I and II breast cancer treated by biopsy and irradiation. Int J Radiat Oncol Biol Phys 9:1807–1813
Ray GR, Fish VJ (1983) Biopsy and definitive radiation in stage I and II adenocarcinoma of the female breast: analysis of cosmesis and the role of electron beam supplementation. Int J Radiat Oncol Biol Phys 9:813–818
Losken A, Hamdi M (2009) Partial breast reconstruction: current perspectives. Plast Reconstr Surg 124:722
Spear S, Pelletiere C, Wolfe A et al (2003) Experience with reduction mammaplasty combined with breast conservation therapy in the treatment of breast cancer. Plast Reconstr Surg 111:1102
Clough K, O’Donoghue J, Fitoussi A et al (2001) Prospective evaluation of late cosmetic results following breast reconstruction: I. Implant reconstruction. Plast Reconstr Surg 107:1702
Khatcheressian JL, Wolff AC, Smith TJ et al (2006) American Society of Clinical Oncology 2006 update of the breast cancer follow-up and management guideline in the adjuvant setting. J Clin Oncol 24:5081–5097
Lyman GH, Giuliano AE, Somerfield MR et al (2005) American society of clinical oncology guideline recommendations for sentinel lymph node biopsy in early-stage breast cancer. J Clin Oncol 23:7703–7720
Carlson RW, Allred DC, Anderson BO et al (2009) Breast Cancer. Clinical practice guidelines in oncology. J Natl Compr Canc Netw 7:122–192
Schwartz G, Veronesi U, Clough K et al (2005) Consensus conference on breast conservation, Milan, Italy, April 28–May 1, 2005. Breast J 12:398–407
Cserni G, Rajtar M, Boross G et al (2002) Comparison of vital dye-guided lymphatic mapping and dye plus gamma probe-guided sentinel node biopsy in breast cancer. World J Surg 26:592–597. doi:10.1007/s00268-001-0274-2
Miltenburg DM, Miller C, Karamlou TB et al (1999) Meta-analysis of sentinel lymph node biopsy in breast cancer. J Surg Res 84:138–142
Edge SB, Byrd DR, Compton CC (2910) AJCC cancer staging handbook: from the AJCC cancer staging manual. Springer, New York
Clough K, Nos C, Salmon RJ et al (1995) Conservative treatment of breast cancers by mammaplasty and irradiation: a new approach to lower quadrant tumours. Plast Reconstr Surg 96(2):363–370
Sabel MS (2011) Surgical considerations in early-stage breast cancer: lessons learned and future directions. Semin Radiat Oncol 21:10–19
Regano S, Hernanz F, Ortega E et al (2009) Oncoplastic techniques extend breast-conserving surgery to patients with neoadjuvant chemotherapy response unfit for conventional techniques. World J Surg 33:2082–2086. doi:10.1007/s00268-009-0152-x
Luu HH, Otis CN, Reed WP et al (1999) The unsatisfactory margin in breast cancer surgery. Am J Surg 178:362–366
McCulley S, Macmillan R (2005) Therapeutic mammaplasty—analysis of 50 consecutive cases. Br J Plast Surg 58:902–907
Losken A, Styblo T, Carlson G et al (2007) Management algorithm and outcome evaluation of partial mastectomy defects treated using reduction or mastopexy techniques. Ann Plast Surg 59:235
Rietjens M, Urban C, Rey P et al (2007) Long-term oncological results of breast conservative treatment with oncoplastic surgery. Breast 16:387–395
Nos C, Fitoussi A, Bourgeois D et al (1998) Conservative treatment of lower pole breast cancers by bilateral mammoplasty and radiotherapy. Eur J Surg Oncol 24:508–514
Meretoja TJ, Svarvar CS, Jahkola TA (2010) Outcome of oncoplastic breast surgery in 90 prospective patients. Am J Surg 200:224–228
Fitoussi AD, Berry MG, Fama F et al (2010) Oncoplastic breast surgery for cancer: analysis of 540 consecutive cases. Plast Reconstr Surg 125:454
Ramanah R, Pivot X, Sautiere JL et al (2008) Predictors of re-excision for positive or close margins in breast-conservation therapy for pT1 tumours. Am J Surg 195:770–774
Schnitt SJ, Abner A, Gelman R et al (1994) The relationship between microscopic margins of resection and the risk of local recurrence in patients treated with breast conserving surgery and radiation therapy. Cancer 74:1746–1751
Meric F, Mirza NQ, Vlastos G (2003) Positive surgical margins and ipsilateral breast tumour recurrence predicts disease-specific survival after breast conserving therapy. Cancer 97:926–933
Cothier-Savey I, Otmezguine Y, Calitchi E et al (1996) Value of reduction mammoplasty in the conservative treatment of breast neoplasms. Apropos of 70 cases. Ann Chir Plast Esthet 41:346–353
Bonadonna G, Veronesi U, Brambilla C et al (1990) Primary chemotherapy to avoid mastectomy in tumours with diameters of three centimetres or more. J Natl Cancer Inst 82:1539–1545
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Grubnik, A., Benn, C. & Edwards, G. Therapeutic Mammaplasty for Breast Cancer: Oncological and Aesthetic Outcomes. World J Surg 37, 72–83 (2013). https://doi.org/10.1007/s00268-012-1786-7
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00268-012-1786-7