Description of oncoplastic techniques in locally advanced breast cancer surgery
Keywords:
cáncer de mama localmente avanzado, cirugía sanitaria, oncoplastia, colgajo, injertoAbstract
Introduction: Locally advanced breast cancer includes bulky, invasive tumors, the most common form of which are advanced stages of primary and nodal disease, with no evidence of distant metastases. Surgical treatment includes extensive hygienic-palliative resections of the breast and chest wall, with immediate reconstruction.
Objective: To describe oncoplastic techniques as a solution to the absence of tissue, secondary to health surgery for locally advanced breast cancer.
Methods: Descriptive, longitudinal and prospective study in patients admitted to the General Surgery Service of the Clinical Surgical Hospital "Hermanos Ameijeiras" who required postmastectomy surgical closure by the Plastic Surgery Service, in the period between September 2016 and December 2019.
Results: Patients over 51 years of age predominated (43 %). In 93 % of the total, the tumor was located in the whole breast; and in the remaining 7 %, in the lower outer quadrant. The size of the post-mastectomy defect was 200 to 400 cm2 in 93 % of the sample. Only 21% had a history of radiotherapy. The most commonly used plasty was the thoracoabdominal dermograft flap (97 %), followed by the edge-to-edge closure and advancement flap (3 %). In 11 % of the cases a skin graft was performed as a complementary technique. Eighteen percent of the cases presented complications, distributed as follows: infection, 10 %; distal flap necrosis, 7 %; and wound dehiscence, 1 %.
Conclusions: The application of oncoplastic principles solves and gives immediate coverage to the absence of tissues secondary to sanitary surgery for locally advanced breast cancer, which improves the quality of life of patients.
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References
Coughlin SS. Epidemiology of Breast Cancer in Women. Adv Exp Med Biol. 2019;1152:9-29. DOI: https://doi.org/10.1007/978-3-030-20301-6_2
Fahad M. Breast Cancer: Current Perspectives on the Disease Status. Adv Exp Med Biol. 2019;1152:51-64. DOI: https://doi.org/10.1007/978-3-030-20301-6_4
Bodet ML, Roosen A, Hequet D, Rouzier R. Therapeutic de-escalation in breast cancer surgery. Bull Cancer. 2021;108(12):1145-54. DOI: https://doi.org/10.1016/j.bulcan.2021.06.017
Milosevic M, Jankovic D, Milenkovic A, Stojanov D. Early diagnosis and detection of breast cancer. Technol Health Care. 2018;26(4):729-59. DOI: https://doi.org/10.3233/THC-181277
Aebi S, Karlsson P, Wapnir IL. Locally advanced breast cancer. Breast. 2022;62(1):S58-62. DOI: https://doi.org/10.1016/j.breast.2021.12.011
Wang M, Chen H, Wu K, Ding A, Zhang M, Zhang P. Evaluation of the prognostic stage in the 8th edition of the American Joint Committee on Cancer in locally advanced breast cancer: An analysis based on SEER 18 database. Breast. 2018;37:56-63. DOI: https://doi.org/10.1016/j.breast.2017.10.011
Gouveia PF, Costa J, Morgado P, Kates R, Pinto D, Mavioso C, et al. Breast cancer surgery with augmented reality. Breast. 2021;56:14-7. DOI: https://doi.org/10.1016/j.breast.2021.01.004
Dumitru D, Khan A, Catanuto G, Rocco N, Nava MB, Benson JR. Axillary surgery in breast cancer: the beginning of the end. Minerva Chir. 2018;73(3):314-21. DOI: https://doi.org/10.23736/S0026-4733.18.07728-3
Pan H, Zhang K, Wang M, Ling L, Zhou W, Wang S. Palliative Local Surgery for Locally Advanced Breast Cancer Depending on Hormone Receptor Status in Elderly Patients. Clin Breast Cancer. 2019;19(1):e247-60. DOI: https://doi.org/10.1016/j.clbc.2018.09.007
Weber WP, Morrow M, Boniface J, Pusic A, Montagna G, Kappos EA. Knowledge gaps in oncoplastic breast surgery. Lancet Oncol. 2020;21(8):e375-85. DOI: https://doi.org/10.1016/S1470-2045(20)30084-X
Rancati A, Angrigiani C, Dorr J, Irigo M, Nava MB, Catanuto G, et al. Visualized oncoplastic surgery of the breast I: inferior and medial quadrantectomy. Gland Surg. 2019;8(4):S281-6. DOI: https://doi.org/10.21037/gs.2019.04.02
Taqi K, Pao JS, Chen L, Ma C, Zhang M, McKevitt E, et al. Immediate breast reconstruction in locally advanced breast cancer: is it safe? Breast Cancer Res Treat. 2021;190(2):175-82. DOI: https://doi.org/10.1007/s10549-021-06366-6
Zhygulin A, Fedosov A, Palytsia V, Vinnytska D, Nedielchev V, Uspenskyi M, et al. Advanced Oncoplastic Breast Conserving Surgery: Single Institution Experience with 823 Patients. Chirurgia (Bucur). 2021;116(2):59-72. DOI: http://dx.doi.org/10.21614/chirurgia.116.2 Suppl.S59
Oberhauser I, Zeindler J, Ritter M, Levy J, Montagna G, Mechera R, et al. Impact of Oncoplastic Breast Surgery on Rate of Complications, Time to Adjuvant Treatment, and Risk of Recurrence. Breast Care (Basel). 2021;16(5):452-60. DOI: https://doi.org/10.1159/000511728
Offodile AC, Gu C, Boukovalas S, Coroneos CJ, Chatterjee A, Largo RD, et al. Enhanced recovery after surgery (ERAS) pathways in breast reconstruction: systematic review and meta-analysis of the literature. Breast Cancer Res Treat. 2019;173(1):65-77. DOI: https://doi.org/10.1007/s10549-018-4991-8
Shrestha B, Dunn L. The Declaration of Helsinki on Medical Research involving Human Subjects: A Review of Seventh Revision. J Nepal Health Res Counc. 2020;17(4):548-52. DOI: https://doi.org/10.33314/jnhrc.v17i4.1042
Sánchez L, Leng Y, Martín LE, García DD. Reconstrucción mamaria inmediata con expansores tisulares. Rev Cubana Cir. 2019 [acceso 09/07/2020];58(3):e868. Disponible en: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S0034-74932019000300005&lng=es
Villarreal C, López EA, Muñoz JF, Unger K. Locally advanced breast cancer in young women in Latin America. Ecancermedicalscience. 2019;13:894. DOI: https://doi.org/10.3332/ecancer.2019.894
Lin YN, Ou F, Hsieh MC, Lee SS, Huang SH, Chuang CH, et al. Use of Extended Pedicled Transverse Rectus Abdominis Myocutaneous Flap for Extensive Chest Wall Defect Reconstruction After Mastectomy for Locally Advanced Breast Cancer. Ann Plast Surg. 2020;84(1):S34-9. DOI: https://doi.org/10.1097/SAP.0000000000002188
Chidley P, Foroudi F, Tacey M, Khor R, Yeh J, Bevington E, et al. Neoadjuvant radiotherapy for locally advanced and high-risk breast cancer. J Med Imaging Radiat Oncol. 2021;65(3):345-53. DOI: https://doi.org/10.1111/1754-9485.13180
Tomita S, Matsunaga N, Fujita Y, de Kerckhove M, Fujii M, Honda Y, et al. Safety evaluation of immediate breast reconstruction for locally advanced breast cancer in Japanese patients. J Plast Reconstr Aesthet Surg. 2022;15(22):206-16. DOI: https://doi.org/10.1016/j.bjps.2022.04.021
Friedman O, Fliss E, Inbal A, Arad E, Frand J, Barnea Y. Latissimus Dorsi Flap: A Winning Hand for Breast Reconstruction Salvage. Isr Med Assoc J. 2019 [acceso 09/07/2020];21(4):260-4. Disponible en: https://pubmed.ncbi.nlm.nih.gov/31032568
Ross GL. One stage breast reconstruction following prophylactic mastectomy for ptotic breasts: the inferior dermal flap and implant. J Plast Reconstr Aesthet Surg. 2012;65(9):1204-8. DOI: https://doi.org/10.1016/j.bjps.2012.03.040
Irwin GW, Black A, Refsum SE, McIntosh SA. Skin-reducing mastectomy and one-stage implant reconstruction with a myodermal flap: a safe and effective technique in risk-reducing and therapeutic mastectomy. J Plast Reconstr Aesthet Surg. 2013;66(9):1188-94. DOI: https://doi.org/10.1016/j.bjps.2013.04.048
Moretti EA, Camargo J, Settecasi J, Falzone S. Experiencia con colgajos toracoabdominales en reconstrucción mamaria. Clasificación personal y variantes. Cir. plást. Iberolatinoam. 2020;46(4):401-10. DOI: https://doi.org/10.4321/S0376-78922020000400004
Min K, Choi EJ, Lee YH, Eom JS, Son BH, Ahn SH, et al. Single vertical incision thoracoabdominal flap for chest wall reconstruction following mastectomy of locally advanced breast cancer. Ann Surg Treat Res. 2019;97(4):168-75. DOI: https://doi.org/10.4174/astr.2019.97.4.168
Teoh LY, Lai LL, Hanim A, Teh MS, Jamaris S, Yahya A, et al. Oncological safety and postoperative complications in oncoplastic breast surgery among Asian women: A single institutional review. Breast J. 2020;26(11):2208-12. DOI: https://doi.org/10.1111/tbj.14060
Imahiyerobo TA, Pharmer LA, Swistel AJ, Talmor M. A Comparative Retrospective Analysis of Complications After Oncoplastic Breast Reduction and Breast Reduction for Benign Macromastia: Are These Procedures Equally Safe? Ann Plast Surg. 2015;75(4):370-5. DOI: https://doi.org/10.1097/SAP.0000000000000159
Shankhdhar VK, Jaiswal D, Bhansali C, Despande R, Yadav PS, Mathews S, et al. Reduction Mammoplasty Approach to Oncoplasty-Zone-Wise Planning in Indian Patients. Indian J Plast Surg. 2021;54(3):264-71. DOI: https://doi.org/10.1055/s-0041-1735426
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