Health-Related Quality of Life After Nipple-Sparing Mastectomy: Results From the INSPIRE Registry.

INTRODUCTION: Nipple-sparing mastectomy (NSM) with immediate breast reconstruction (IBR) is increasingly used for both breast cancer (TNSM) and risk reduction (RRNSM). The aim of the study is to report the results of the INSPIRE registry assessing health-related quality of life (HRQoL) comparing baseline and 1-year follow-up, regarding surgical indications and chemotherapy (CT) received. METHODS: INSPIRE is a prospective database including women undergoing NSM and IBR from 18 countries. HRQoL was measured using EORTC QLQC30 and QLQ-BR23 before surgery and after 1 year. RESULTS: A total of 677 women were included, of whom 537 (79.3%) underwent TNSM and 140 (21.6%) RRNSM: in total, 806 NSM (556 TNSM and 250 RRNSM). Nipple involvement was present in 7.73% of TNSM and incidental carcinoma in 1.2% of the RRNSM group. Out of the overall 537 patients with systemic treatment, 177 (32.96%) received neoadjuvant chemotherapy (NCT) and 118 (21.92%) adjuvant chemotherapy (CT). A total of 227 patients (28.16%) developed at least one complication postoperatively, 164 (29.5%) in the TNSM group and 63 (25.2%) in the RRNSM group. The TNSM group improved in global health status and emotional functioning after 1 year. No differences were found when comparing HRQoL at 1 year between patients who received NCT and those who received adjuvant CT. The RRNSM group showed improvement in HRQoL, with better emotional functioning and fatigue after 1 year. CONCLUSIONS: This registry reports HRQoL findings after NSM. The impact of CT on worse HRQoL is independent from its timing. Patients with RRNSM showed an improved HRQoL at 1-year follow-up. Discussion of HRQoL outcomes with patients will facilitate the informed decision-making when considering NSM.

Advanced Oncoplastic Breast Conserving Surgery: Single Institution Experience with 823 Patients.

Background: Oncoplastic breast conserving surgery (BCS) becomes the standard of care in multidisciplinary breast cancer treatment. From our perspective, the aim of oncoplastic BCS is the best oncological, aesthetic and functional surgical treatment results. The study's objective is to present our approaches to the selection of surgical techniques and determine operative and oncological outcomes of oncoplastic surgery. Methods: This retrospective study presents a single institution experience with patients who underwent oncoplastic BCS for breast cancer between 2007 and December 2020. Demographic and clinicopathologic characteristics as well as postoperative complications were analyzed. The analysis was performed by taking into account the types of procedures. Surgeries were categorized into two types: 1. volume displacement (level 1; advanced parenchyma displacements; therapeutic mammaplasties) and 2. volume replacement techniques (regional flaps with wide base, regional island perforant flaps). We consider as oncoplastic all the operations that are planned and performed taking into account an optimal aesthetic result regardless of the specific technique. Results: There were 833 surgeries performed for 823 cancer patients. In 153 cases, patients had symmetrized procedures. The average weight of specimens was 112,9 g (2-1034 g); the average size of tumors was 2,8 cm (0,2-15,8 cm). 106 patients (12,7%) had multifocal/multicentric tumors. In (3,8%) 32 cases involved margins were found and re-excision was required. 793 (96,4%) patients were on follow up. The median follow-up period was 48 months (6 164 months). Local recurrence was found in 10 (1,2%) patients, regional axillary recurrence in 2 (0,3%), systemic progression in 87 (11,0%) patients and 50 (6,2%) of them have died. Complications were observed in 190 (23,1%) patients, mostly seromas and ischemic disorders. Conclusions: We present our approaches to oncoplastic breast conserving surgery with focusing on the aesthetic results of the procedures. Oncological outcomes demonstrate the safety of advanced oncoplastic BCS in the framework of multidisciplinary teamwork.

Oncoplastic Breast Conservation for Central Tumors: Definition, Classification, and the Analysis of Single Institution Experience.

Background: Tumors in the central part of the breast are usually considered more aggressive and technically difficult, which limits breast conservation. The definition of central tumors from a surgical point of view, classification of the techniques for partial breast reconstruction, and conceptual algorithm of choice based on tumor and breast characteristics are proposed, along with the estimation of surgical and oncological safety. Methods: This is a retrospective analysis of the single-institution experience, with a focus on the decision-making process for choosing the oncoplastic breast-conserving surgery technique. To evaluate the safety of breast conservation for central tumors, a comparative analysis of early surgical complications and oncological long-term results of treatment in patients with central breast tumor location and other breast tumor locations was performed. Results: A total of 940 lumpectomies were performed in 926 patients during 15 years. The central breast tumor location group included 128 patients with 130 lumpectomies (13.8%), and the other breast tumor locations group included 798 patients with 810 lumpectomies (86.2%). We did not find any significant differences in the rate of early surgical complications and involved margins, local and systemic recurrence rates, time to progression, or overall survival between the groups. Conclusions: Oncoplastic breast-conserving surgery is a safe procedure for the treatment of central tumors. In our opinion, the proposed classification of partial breast reconstruction techniques and an algorithm of their choice allow for effective restoration of the breast shape and volume according to the parameters of the tumor, breast, surgeon, and patient preferences.

Modifications of the LICAP/LTAP Flap Technique in Partial Breast Reconstruction for Difficult Tumor Locations.

SUMMARY: The authors propose modifications of the lateral thoracic artery perforator/lateral intercostal artery perforator flap partial breast reconstruction that can help achieve improved aesthetic results, especially for centrally and medially located tumors. Lumpectomy is performed using the retromammary approach through lateral contour access without skin mobilization from parenchyma. This minimizes trauma and scarring of parenchyma and skin in the lateral part of the breast. In case of central or medial location of the tumor, the authors propose moving the flap into the tumor bed through a cut ("window") in the musculus pectoralis major. This helps stabilize the flap in an optimal position and redistribute the tissue without compression on the flap pedicle or bulge in the lateral sector of the gland. The authors have used this modification in 18 patients. The average tumor size was 2.8 cm (range, 1.2 to 5.4 cm) and the average weight of the specimens was 46.6 g (range, 14 to 110 g). Two patients had a tumor in the upper-inner quadrant close to the breast meridian, two in a central-lateral tumor location, and 14 in the upper-outer quadrant. Early complications occurred in four cases: two seromas of the wound, one partial flap necrosis with revision and resection of the flap, and one cellulite in the axillary region after axillary dissection because of long-standing lymphorrhea and drainage. The proposed modification of the lateral thoracic artery perforator/lateral intercostal artery perforator flap technique in partial breast reconstruction can lead to better aesthetic results and improved safety.

Modern Breast Cancer Surgery 1st Central-Eastern European Professional Consensus Statement on Breast Cancer.

This text is based on the recommendations accepted by the 4th Hungarian Consensus Conference on Breast Cancer, modified on the basis of the international consultation and conference within the frames of the Central-Eastern European Academy of Oncology. The recommendations cover non-operative, intraoperative and postoperative diagnostics, determination of prognostic and predictive markers and the content of cytology and histology reports. Furthermore, they address some specific issues such as the current status of multigene molecular markers, the role of pathologists in clinical trials and prerequisites for their involvement, and some remarks about the future.

Invisible Surgery Concept and Scenario Strategy: How to Get the Best Aesthetic Results in Oncoplastic Breast-Conserving Surgery.

SUMMARY: The authors believe that oncoplastic breast surgery has to achieve the best possible aesthetic results. In this article, they propose the concept of "invisible surgery." This is a combination of certain oncoplastic techniques that allows for restoration of the original appearance of the breast without obvious scars on the breast. Further, the authors classify the techniques as follows: the "level 1 technique," with contour approach; the "from inside" technique; the lateral parenchymal flap; the axillary subcutaneous adipofascial flap; the rotational lateral thoracic flap; regional island perforator flaps (lateral intercostal artery perforator, lateral thoracic artery perforator, anterior intercostal artery perforator, and medial intercostal artery perforator flaps); and the nipple-sparing mastectomy with immediate expander reconstruction. These techniques were combined by internal logic-one can move from one to another according to the preoperative planning and margins status during the operation. They call their approach the "scenario strategy." The authors have performed 138 operations in 137 patients using this approach. Most of them involved the "from inside" technique and perforator flaps. The average tumor size was 2.4 cm, and the average specimen weight was 43.2 g. The total rate of complications was 14.6 percent. According to this concept, the surgery should be performed in such way that breast appearance will not change. It should be planned as one would plan a staged procedure, taking into account possible changes in the scenario during the operation to achieve the best possible aesthetic result.