• 고신대학교 의과대학 학술지
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• 제33권3호
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• pp.289-296
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• 2018

Objectives: In these days, patients with stage I breast cancer have increased by regular health examination and diagnostic tool development. The aim of this retrospective study is to identify systemic recurrence related factors after breast conserving surgery (BCS) for stage I breast cancer. Methods: In this study, we analyzed the correlation between systemic recurrence and pathologic factors. We reviewed 223 patients who underwent BCS for stage I breast cancer. Postoperative pathologic factors, recurrent rates and sites were studied. In addition, preoperative patients'data were also collected. Statistical analysis was done by using PASW 16.0 (SPSS Inc., Chicago, IL, USA). Results: Systemic recurrence was found in 16 patients (7.17%) within 5 years after primary surgery. 5 patients had lymphatic invasion and 6 patients had vascular invasion. Lymphatic and vascular invasion had statistical correlation with systemic recurrence (P = 0.004, P = 0.001). Conclusions: In this retrospective study, we can conclude that vascular invasion and lymphatic invasion are related systemic recurrence after BCS for stage I patients. Further studies with large cohort will be required to fully understand the risk factors of systemic recurrence for stage I breast cancer patients.

• Archives of Plastic Surgery
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• 제41권5호
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• pp.520-528
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• 2014

Background As the breast cancer incidence has increased, breast-conserving surgery has replaced total mastectomy as the predominant procedure. However, centrally located breast cancers pose significant challenges to successful breast-conserving surgeries. Therefore, we performed partial mastectomy and oncoplastic procedures on centrally located breast cancer as a means of partial breast reconstruction. The authors examined and evaluated the functional and aesthetic usefulness of this reconstruction method. Methods From January 2007 to June 2011, 35 patients with centrally located breast cancers who underwent various oncoplastic procedures based on the breast size and resection volume. The oncoplastic procedures performed included volume displacement surgical techniques such as purse-string suture, linear suture, and reduction mammaplasty. Other oncoplastic procedures included volume replacement procedures with an adipofascial, thoracoepigastric, intercostal artery perforator, thoracodorsal artery perforator, or latissimus dorsi flap. Results Mean patient age was 49 years, and mean follow-up period was 11 months. In cases of small to moderate-sized breasts and resection volumes <50 g, volume displacement procedures were performed. In cases of resection volumes >50 g, volume replacement procedures were performed. In cases of larger breasts and smaller resection volumes, glandular reshaping was performed. Finally, in cases of larger breasts and larger resection volumes, reduction mammaplasty was performed. This reconstruction method also elicits a high patient satisfaction rate with no significant complications. Conclusions In centrally located breast cancer, oncoplastic surgery considering breast size and resection volume is safe and provides appropriate aesthetic outcomes. Therefore, our method is advisable for breast cancer patients who elect to conserve their breasts and retain a natural breast shape.

• Archives of Plastic Surgery
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• 제45권1호
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• pp.29-36
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• 2018

Background The emergence of breast-conserving surgery combined with radiotherapy as the treatment of choice for early stage breast cancer has resulted in greater focus on oncoplastic breast surgery. The use of perforator flaps has particularly gained in reputation for its effectiveness in the reconstruction of partial breast defects in Korean women. Herein, we present our experience with the use of thoracodorsal artery perforator (TDAP) and lateral intercostal artery perforator (LICAP) flaps. Methods This study included 33 patients who underwent breast reconstruction using TDAP or LICAP flaps at our hospital from January 2011 to December 2014. Data from patient medical records, and patient satisfaction surveys, which were conducted 12 months postoperatively, were retrospectively evaluated. Results TDAP and LICAP flap-based reconstructions were performed in 14 and 19 patients, respectively. Five patients developed complications that required additional intervention. Overall patient satisfaction was observed to be excellent in 15 (46%) patients, and good in 12 (36%). Conclusions Based on our experience, oncoplastic breast surgery using TDAP or LICAP flap is an effective remodeling technique for small-to-moderate breast defects in Korean women with smaller breasts.

• Archives of Plastic Surgery
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• 제44권6호
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• pp.502-508
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• 2017

Background Breast-conserving therapy is defined as a breast-conserving wide local excision (WLE) of a mammary tumour combined with postoperative radiotherapy. Immediate restoration of the mammary shape by use of breast reduction techniques (volume displacement) or tissue replacement techniques (volume replacement) is gaining popularity to prevent breast malformation. Methods To date, using the internal mammary artery perforator (IMAP) flap has been suggested for immediate volume replacement after WLE, but has never been evaluated in a published study. Results We applied this flap in 12 women (mean age, 56.1 years) after WLE (mean specimen weight, 46.5 g) of the medial aspect of the breast. Over a median follow-up of 35.3 months (standard deviation, 1.2 months), 4 women needed repeated surgery for dog-ear correction of the donor site. Conclusions In our experience, the use of an IMAP flap was a reliable technique with good cosmetic outcomes after oncoplastic reconstruction. In this series, donor site revision often proved necessary initially, but we showed that this may easily be prevented.

• Asian Pacific Journal of Cancer Prevention
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• 제16권10호
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• pp.4261-4264
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• 2015

The aim of the study was to evaluate the level of anxiety and pain in women with breast cancer. Patients who had been treated with modified radical mastectomy or breast conserving surgery were included. Data were gathered using the state-trait anxiety inventory and the visual analog scale. The pain levels and analgesic consumption of the patients were evaluated after surgery. The study sample consisted of 150 women. The mean age of the participants was $50.54{\pm}10.02$. Most of the patients (58%) received breast conserving surgery. The mean state anxiety score was $44.74{\pm}11.91$, and the mean trait anxiety score was $48.78{\pm}9.48$ before surgery. The mean pain level on the first day following surgery was $3.26{\pm}1.91$ and analgesic consumption was $2.98{\pm}1.08$. There was no correlation between patient pain and anxiety levels. There was very slightly positive correlation between trait anxiety and total analgesic consumption. Assessing the levels of anxiety in breast cancer patients before surgery may contribute to the determination of postoperative pain.

• Archives of Plastic Surgery
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• 제35권6호
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• pp.680-686
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• 2008

Purpose: Breast conserving surgery(BCS) for breast cancer has a common treatment protocol. Oncoplastic surgery represents a form of BCS which combines both a cosmetic mammoplasty approach and oncologic resection for the treatment of breast cancer. Depending on the tumor site, BCS can make an unsatisfactory cosmetic result, especially in inferiorly placed tumors. This study describes the use of oncoplastic techniques for inferiorly located breast tumors in immediate partial mastectomy reconstruction. Methods: From September of 2006 to February of 2008, these techniques were used in 11 patients at the ${\bigcirc}{\bigcirc}$ hospital. After BCS was preceded, breast reshaping by oncoplastic techniques were selected depending on the location and size of the tumor within the breast as well as the size of breast itself. Oncoplastic techniques after partial mastectomy included 'Wise pattern (inverted T)' reduction mammoplasty, 'vertical pattern' mammoplasty, 'J-pattern' mammoplasty. In order to improve the cosmetic outcome, repositioning of the nipple areola complex(NAC) or reshaping of the contralateral breast may be considered additionally. Results: These techniques have been used in 11 patients. The mean age was 51 and the average follow-up period was 8 months. Eleven of these patients underwent the 'Wise pattern(inverted T)' reduction mammoplasty(n=6), 'vertical pattern' mammoplasty(n=3) and 'J-pattern' mammoplasty(n=2). There was one wound dehiscence during the follow-up periods. This complication was treated by conservative approach. The overall cosmetic result was evaluated in 6 months. The majority of patients were satisfied at the cosmetic result. Conclusion: Oncoplastic techniques in inferiorly located breast tumors could be a reasonable and safe option for breast cancer patients who desire conserving surgery with esthetical breast.

• Asian Pacific Journal of Cancer Prevention
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• 제14권1호
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• pp.547-552
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• 2013

To investigate patient, cancer and treatment characteristics in females with breast cancer from more remote areas of Australia, to better understand reasons for their poorer outcomes, bi-variable and multivariable analyses were undertaken using the National Breast Cancer Audit database of the Society of Breast Surgeons of Australia and New Zealand. Results indicated that patients from more remote areas were more likely to be of lower socio-economic status and be treated in earlier diagnostic epochs and at inner regional and remote rather than major city centres. They were also more likely to be treated by low case load surgeons, although this finding was only of marginal statistical significance in multivariable analysis (p=0.074). Patients from more remote areas were less likely than those from major cities to be treated by breast conserving surgery, as opposed to mastectomy, and less likely to have adjuvant radiotherapy when having breast conserving surgery. They had a higher rate of adjuvant chemotherapy. Further monitoring will be important to determine whether breast conserving surgery and adjuvant radiotherapy utilization increase in rural patients following the introduction of regional cancer centres recently funded to improve service access in these areas.

• Archives of Plastic Surgery
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• 제47권6호
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• pp.574-582
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• 2020

Background Several oncoplastic approaches have been implemented in recent years to enhance cosmetic results and to reduce complications. The round block technique is a volume displacement technique for breast reconstruction after breast-conserving surgery (BCS). However, its indications are currently limited according to tumor location, and its cosmetic results and complications have not been clearly established. We hypothesized that the round block technique could produce favorable cosmetic results without major complications regardless of tumor location or nipple-tumor distance, below a certain resected tumor volume and tumor-breast volume ratio. Methods All breast reconstructions using the round block technique after BCS were included in this analysis. Patients' data were reviewed retrospectively to investigate complications during follow-up, and clinical photos were used to evaluate cosmetic results. The relationships of tumor location, nipple-tumor distance, tumor volume, and the tumor-breast volume ratio with cosmetic results were investigated. Results In total, 108 breasts were reconstructed. The mean resected tumor volume was 30.2±15.0 mL. The cosmetic score was 4.5±0.6 out of 5. Tumor location, nipple-tumor distance, tumor volume, tumor-breast volume ratio, radiotherapy, and chemotherapy had no significant effects on cosmetic results or complications. There were no major complications requiring reoperation. Conclusions Breast reconstruction using the round block technique after BCS can lead to good cosmetic results without major complications regardless of the tumor location, nippletumor distance, radiotherapy, or chemotherapy. Below the maximum tumor volume (79.2 mL) and the maximum tumor-breast volume ratio (14%), favorable results were consistently obtained.

• Asian Pacific Journal of Cancer Prevention
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• 제15권4호
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• pp.1621-1626
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• 2014

Background: Breast cancer is the most common malignant tumor in females worldwide. Many differences exist in clinico-pathological characteristics of breast cancer patients between China and Western countries. This study aimed to analyze clinico-pathological characteristics of breast cancer from central China. Methods: Clinico-pathological information on breast cancer from three hospitals in central China was collected and analyzed. Results: From 1994 to 2012, 2,525 patients with a median age 50 years were included in this study. The 45-49-year age group and invasive ductal carcinoma not otherwise specified accounted for the highest proportions (19.1%, 480/2,525 and 81.0%, 1,982/2,446). Stages 0-I, II and III accounted for 28.0% (682/2,441), 48.4% (1,180/2,441), and 23.7% (578/2,441), respectively. Distribution of N stage showed that N0 accounted for 53.2% (1,344/2,525), and proportion of N0 rose from 51.1% (157/307) in 30-39-year age group to 64.3% (110/171) in ${\geq}$ 70-year age group, with an average increase of 2.1% in each age group. Modified radical mastectomy, radical mastectomy, breast-conserving surgery and simple mastectomy were performed for 71.8% (1,812/2,525), 18.0% (454/2,525), 5.2% (131/2,525) and 2.6% (66/2,525), respectively. Proportions of breast-conserving surgery in age ${\leq}$ 44-year group (68/132, 51.5%) and simple mastectomy in age ${\geq}$ 60-year group (57/89, 64.0%) were higher than in the other age groups. Breast cancers positive for estrogen receptor accounted for 53.0% (1,107/ 2,112). The comparisons among this study and other reports showed higher proportion of younger patients, lower proportion of breast-conserving surgery and positive estrogen receptor patients in China than western countries. Conclusions: Clinico-pathological characteristics in this study demonstrated clear differences between the center of China than Western countries. Additional classification systems should be developed to guide grading of early breast cancer more accurately, especially for N0 patients. Invasive ductal carcinoma is a focus for intensive research.

• Radiation Oncology Journal
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• 제26권3호
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• pp.142-148
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• 2008

목 적: 조기유방암의 치료에 있어 과거에는 유방 전적출술이 주된 치료였으나 현재는 유방보존술이 표준 치료방법으로 정립되었다. 저자들은 서울대학교병원에서 유방보존수술 및 방사선치료를 받은 환자의 임상적 특성을 조사하고 치료결과 및 예후인자를 분석하고자 하였다. 대상 및 방법: 1992년 2월부터 2002년 1월까지 침윤성 유방암으로 유방보존수술 및 수술 후 방사선치료를 받은 424명을 대상으로 후향적으로 분석하였다. 대부분의 환자는 사분절제술 및 액와림프절 청소술을 시행 받았다(396명, 93.4%). 302명이 T1이었고 122명은 T2 병기였으며, 림프절 전이는 107명에서 확인되었다. 방사선치료는 전체 유방에 28회에 걸쳐 50.4 Gy를 조사한 후 종양이 있었던 부위에 10 Gy의 추가조사를 실시하였다. 영역림프절 조사는 57명에서 시행되었다. 항암화학요법은 231명에서 시행되었으며, 그 중 170명이 cyclophosphamide, methotrexate 및 5-fluorouracil을 투여 받았다. 중앙추적기간은 64개월이었다. 결 과: 전체 환자의 5년 국소제어율은 95.6%이었다. 추적관찰 중 15명의 환자에서 국소재발이 확인되었다. 5년 생존율은 93.1%이었고, 병기에 따른 5년 생존율은 I기 94.8%, IIA기 95.0%, IIB기 91.1%, IIIA기 75.9%, IIIC기 57.1%이었다. 5년 무병생존율은 88.7%이었고, 병기별로는 I기 93.1%, IIA기 89.4%, IIB기 82.8%, IIIA기 62.0%, IIIC기 28.6%이었다. 예후인자 분석에서는 N 병기(p=0.0483)가 생존율에, 연령(p=0.0284)과 N 병기(p=0.0001)가 무병생존율에 각각 유의한 영향을 보였다. 결 론: 조기유방암에서 유방보존수술 및 수술 후 방사선치료는 우수한 국소제어율 및 생존율을 기대할 수 있는 치료법임을 확인할 수 있었다.