Oncoplastic breast-conserving therapy and intraoperative radiotherapy for management of carcinoma in situ of the breast: A single-center experience.

Intraoperative radiation therapy (IORT) has been shown to reduce local recurrence rates among women with early-stage invasive ductal carcinoma, but data regarding its use among women with in situ carcinoma are limited. In this single-institution study, 50 women with in situ carcinoma were treated with oncoplastic breast-conserving surgery (OPS) and single-dose IORT. All 50 patients had "no tumor on ink," but 9 (16%) had margins < 2 mm and required additional therapy. No local recurrences were observed after a median follow-up of 46 months. Single-dose IORT is an efficacious treatment for well-selected patients with DCIS.

Oncoplastic Central Partial Mastectomy and Neoareolar Reduction Mammoplasty with Immediate Nipple Reconstruction: An Initial Report of a Novel Option for Breast Conservation in Patients with Subareolar Tumors.

BACKGROUND: Breast-conserving therapy (BCT) has been associated with better quality of life and cosmetic outcomes than mastectomy. However, subareolar cancers abutting the nipple-areolar complex (NAC) present a unique cosmetic and oncologic challenge. Oncoplastic central partial mastectomy and neoareolar reduction mammoplasty with immediate nipple reconstruction is a novel technique that can permit BCT for these patients. METHODS: This study enrolled consecutive patients with central tumors during 2017-2018 who underwent central partial mastectomy reconstructed with neoareolar reduction mammoplasty and immediate nipple reconstruction. Patient demographics, imaging and pathology size, margin width, mastectomy and reexcision rates, and cosmesis were evaluated. RESULTS: The study identified 23 sequential patients. The average patient age was 60.5 ± 12.3 years, and the average body mass index was 29.4 ± 5.7 kg/m2. The mean lesion size was 51.5 ± 43.0 mm on preoperative imaging, and the average disease span shown by the final pathology was 59.5 ± 45.3 mm. "No ink on tumor" was achieved for 22 patients (95.7%). In 13 patients (56.5%), the margins were inadequate for ductal carcinoma in situ (DCIS) (n = 12) or invasive cancer (n = 1). Good to excellent cosmetic results were achieved for 21 patients (95.5%). Complications occurred for six patients (26.1%), including three patients with ischemia of the reconstructed NAC. CONCLUSION: The single-stage operation described in this report can allow patients with cancers abutting the NAC to consider BCT. This technique allows patients to avoid mastectomy and to minimize the number of operations required for reconstruction while maximizing cosmetic outcomes. In the study cohort, the presence of extensive DCIS resulted in a significant need for reexcision, which could be performed successfully without compromise to cosmetic outcome.

Oncoplastic Breast-Conserving Surgery Reduces Mastectomy and Postoperative Re-excision Rates.

BACKGROUND: Oncoplastic breast-conserving surgery (BCS) integrates partial mastectomy with plastic surgery techniques to facilitate breast cancer resection with clear surgical margins and preservation of breast cosmesis. In 2011, oncoplastic BCS was adopted as standard surgical treatment for breast cancer patients at Virginia Mason Medical Center, Seattle, WA. METHODS: This single-institution retrospective review evaluates the mastectomy and postoperative re-excision rates before and after adoption of oncoplastic BCS. All patients undergoing surgical treatment of breast cancer were identified from institutional databases for the periods January 2009 through December 2010 [standard surgery group (SS)] and January 2013 through September 2014 [oncoplastic surgery group (OS)]. RESULTS: A total of 812 patients were evaluated; 425 patients were treated in the SS group compared with 387 patients in the OS group. The mastectomy rate in the SS group was 34% compared with 15% in the OS group (p < 0.001), and the average tumor size for patients undergoing BCS was 12.7 mm in the SS group compared with 15.4 mm in the OS group (p = 0.04). Despite the larger average tumor size, the postoperative re-excision rate for patients undergoing BCS in the SS group was 32% as opposed to 18% in the OS group (p < 0.001). CONCLUSIONS: Oncoplastic BCS significantly reduced the rates of mastectomy and postoperative re-excision in breast cancer patients while treating larger cancers. This study suggests that use of OS techniques can effectively treat larger cancers while maximizing breast cosmesis and minimizing the need to resort to mastectomy.

Intraoperative radiation therapy in early-stage breast cancer: Presence of lobular features is not associated with increased rate of requiring additional therapy.

BACKGROUND: There is a paucity of data regarding the application of IORT to the treatment of carcinomas with lobular features. METHODS: This study includes women with invasive breast cancer who underwent breast conservation in combination with IORT from February 2011 to October 2016. Patients whose final pathology did not satisfy inclusion criteria or had inadequate margins were recommended to undergo additional therapy (AT) with WBRT as well as re-excision of inadequate margins. RESULTS: 243 invasive breast cancers were treated with IORT. The lobular features (LF) group comprised 62 patients and the invasive ductal carcinoma (IDCA) group consisted of 172 patients. Rate of AT was similar between groups (LF 19 patients, 30.6%, vs IDCA 56 patients, 32.6%, p = 0.87) groups. Lobular histology was not associated with a need for AT. Local recurrence rate for the cohort was 1.2% with a median follow up of 46 months. There was no difference in recurrence or survival after 46 months of follow-up. CONCLUSIONS: IORT is an effective treatment option for well-selected patients with early breast cancer and can be considered for patients with lobular histology.

Oncoplastic breast conserving surgery is associated with a lower rate of surgical site complications compared to standard breast conserving surgery.

BACKGROUND: Oncoplastic breast conserving surgery (OBCS) integrates plastic surgery techniques in the resection of breast cancer and lowers the rate of re-excision while improving breast cosmesis. The goal of this study is to compare the surgical site complication rate of OBCS with that of standard BCS. METHODS: A single institution chart review evaluated all patients undergoing BCS for treatment of breast cancer. Patients treated from January 2009 to December 2010, prior to adoption of oncoplastic techniques, were identified as the standard surgery (SS) group. Patients treated with OBCS from January 2013 to July 2015 were identified as the oncoplastic surgery (OS) group. All surgical site complications were recorded. RESULTS: Overall, 561 patients were evaluated. The SS group comprised 273 patients compared with 288 patients in the OS group. Surgical site complications occurred in 49 patients (17.9%) in the SS group compared with 23 patients (8.0%) in the OS group (p < 0.001). DISCUSSION: Overall, BCS has a low rate of significant surgical site complications. OBCS has a lower rate of surgical site complications compared to standard BCS.

Oncoplastic reduction mammaplasty, an effective and safe method of breast conservation.

INTRODUCTION: Oncoplastic breast conserving surgery (BCS) can enhance both cosmetic and oncologic breast cancer outcomes. This study evaluates the outcomes and complications associated with oncoplastic reduction mammaplasty performed by surgical breast oncologists. METHODS: A single institution retrospective chart review of patients undergoing oncoplastic reduction mammaplasty by a surgical breast oncologist for the treatment of breast cancer. RESULTS: Seventy-one patients were identified. The average patient age was 59.6 years (range 37-77 years). Average lesion span was 31.4 mm (range 3-166 mm). Six (8.5%) patients required additional surgery to obtain adequate margins. One (1.4%) patient developed recurrent disease during the follow-up interval. No major surgical complications were observed. CONCLUSION: Oncoplastic reduction mammaplasty is associated with low rates of re-excision and complications and can be safely and effectively performed by appropriately trained surgical breast oncologists.