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Applicability of Oncoplastic Breast Conserving Surgery in Asian Breast Cancer Patients

  • Lim, Geok-Hoon (Department of Breast Surgery, KK Women's and Children's Hospital) ;
  • Pineda, Lea Angela (Department of Breast Surgery, KK Women's and Children's Hospital)
  • Published : 2016.07.01

Abstract

Background: There are limited studies on oncoplastic breast conserving surgery in Asian women. We aimed to determine the applicability and safety of oncoplastic surgery, highlighting the specific circumstances when it will be most useful and compare our preferred technique with the worldwide practice of oncoplastic approaches. Materials and Methods: Breast cancer patients who underwent oncoplastic breast conserving surgery at a single institution from 1st May 2014-31st March 2015 were included. Data on patient demographics, tumor characteristics and the type of oncoplastic surgery performed were collected. Results: Nineteen breast cancer patients were identified. 42.1% of patients had grade I ptosis. The indications for surgery included a large tumor to breast size ratio (52.6%), multifocal/multicentric lesions (36.8%) and asymmetric breasts (10.6%), averting a mastectomy in 89.4%. Round block was the commonest technique in 63% of patients, in contrast to the inverted T pattern most frequently used in renowned institutions in the West. Mean and median tumor size and weight of specimen were 29.4/25mm (11 - 75mm) and 77g/64g (10 - 246g) respectively. Re-excision rate was 10.5%. Complete mastectomy was performed for one patient. One patient developed wound dehiscence which was treated conservatively. Cosmetic outcome was rated as excellent/good by 94.7% of patients. The patients remained clinically well after a median 16 months follow up. Conclusions: Oncoplastic breast conserving surgery is useful in a specific subgroup of Asian patients with a relatively small breast volume and minimal ptosis. Round block was the commonest technique in our series, in contrast to the worldwide utility of oncoplastic techniques. It is oncologically safe and has good cosmetic outcomes.

Keywords

References

  1. Acosta-Marin V, Acosta-Freites V, Contreras A, et al (2014). Oncoplastic breast surgery: initial experience at the Centro Clinico de Estereotaxia-CECLINES, Caracas, Venezuela. Ecancermedicalscience, 8, 470.
  2. Benelli L (1990). A new periareolar mammaplasty: the “round block technique. Aesthetic Plastic Surgery, 14, 93-100. https://doi.org/10.1007/BF01578332
  3. Chakravorty A, Shrestha AK, Sanmugalingam N, et al (2012). How safe is oncoplastic breast conservation? Comparative analysis with standard breast conserving surgery. Eur J Surg Oncol, 38, 395-8. https://doi.org/10.1016/j.ejso.2012.02.186
  4. Chan SWW, Chueng PSY, Lam SH (2010). Cosmetic outcome and percentage of breast volume excision in oncoplastic breast conserving surgery. World J Surg, 34, 1447-52. https://doi.org/10.1007/s00268-009-0278-x
  5. Chang G, Chan CW, Hartman M (2011). A commentary on delayed presentation of breast cancer in Singapore. Asian Pac J Cancer Prev, 12, 1635-9.
  6. Chen DR (2014). An optimized technique for all quadrant oncoplasty in women with small- to medium-sized breasts. Eur Rev Med Pharmacological Sci, 18, 1748-54.
  7. Clough KB, Kaufman GJ, Nos C, Buccimazza I, Sarfati IM (2010). Improving breast cancer surgery: A classification and quadrant per quadrant atlas for oncoplastic surgery. Ann Surg Oncol, 17, 1375-91. https://doi.org/10.1245/s10434-009-0792-y
  8. 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, 2483-93. https://doi.org/10.1200/JCO.1997.15.7.2483
  9. Fitoussi AD, Berry MG, Fama F, et al (2010). Oncoplastic breast surgery for cancer: Analysis of 540 consecutive cases. Plastic Reconstruct Surg J, 125, 454-62. https://doi.org/10.1097/PRS.0b013e3181c82d3e
  10. Gentilini O, Botteri E, Rotmensz N et al (2009). Conservative surgery in patients with multifocal/multicentric breast cancer. Breast Cancer Res Treat, 113, 577-83. https://doi.org/10.1007/s10549-008-9959-7
  11. Ha S, Kim TH, Lee A, et al (2015). Cosmetic outcomes and patients' satisfaction of oncoplastic surgery in Korean patient with breast cancer. Korean J Clin Oncol, 11, 67-73. https://doi.org/10.14216/kjco.15012
  12. Kaviani A, Safavi A, Mohammadzadeh N, et al (2014). Oncoplastic surgery in breast conservation: A prospective evaluation of the patients, techniques and oncologic outcomes. Am J Surg, 208, 727-34. https://doi.org/10.1016/j.amjsurg.2014.04.005
  13. Losken A, Dugal CS, Styblo TM, Carlson GW (2014). A metaanalysis comparing breast conservation therapy alone to the oncoplastic technique. Ann Plastic Surg, 72, 145-9. https://doi.org/10.1097/SAP.0b013e3182605598
  14. Losken A, Styblo TM, Carlson GW, Jones GE, Amerson BJ (2007). Management algorithm and outcome evaluation of partial mastectomy defects treated using reduction or mastopexy techniques. Ann Plastic Surg, 59, 235-42. https://doi.org/10.1097/SAP.0b013e31802ec6d1
  15. McCulley SJ, Macmillan RD (2005). Therapeutic mammaplastyanalysis of 50 consecutive cases. Br J Plastic Surg, 58, 902-7. https://doi.org/10.1016/j.bjps.2005.03.007
  16. Neuschatz A, DiPetrillo T, Steinhoff M, et al (2002). The value of breast lumpectomy margin assessment as a predictor of residual tumor burden in ductal carcinoma in situ of the breast. Cancer, 94, 1917-24. https://doi.org/10.1002/cncr.10460
  17. Ogawa, Tomoko (2014). Usefulness of breast-conserving surgery using the round block technique or modified round block technique in Japanese females. Asian J Surg, 37, 8-14. https://doi.org/10.1016/j.asjsur.2013.07.007
  18. Petit JY, Rietjens M, Garusi C, Greuze M, Perry C (1998). Integration of plastic surgery in the course of breastconserving surgery for cancer to improve cosmetic results and radicality of tumor excision. Recent Results Cancer Res, 152, 202-11.
  19. Yang JD, Bae SG, Chung HY, et al (2011). The usefulness of oncoplastic volume displacement techniques in the superiorly located breast cancers for Korean patients with small to moderate-sized breasts. Ann Plastic Surg, 67, 474-80. https://doi.org/10.1097/SAP.0b013e318201fdf4
  20. Yang JD, Lee JW, Kim WW, Jung JH, Park HY (2011). Oncoplastic surgical techniques for personalized breast conserving surgery in breast cancer patient with small to moderate sized breast. J Breast Cancer, 14, 253-61. https://doi.org/10.4048/jbc.2011.14.4.253
  21. Zaha H, Onomura M, Unesoko M (2013). A new scarless oncoplastic breast-conserving surgery: modified round block technique. Breast, 22, 1184-8. https://doi.org/10.1016/j.breast.2013.07.056
  22. Zucca-Matthes G, Manconi A, da Costa Viera RA, Michelli RAD, Matthes ADCS (2013). The evolution of mastectomies in the oncoplastic breast surgery era. Gland Surg, 2, 102-6.