Local Flaps to Cover Skin Necrosis after Skin-sparing Mastectomy and Prepectoral Reconstruction from PreQ-20 Trial.

Background: In recent years, mastectomy has increasingly been indicated for women at high risk and those with breast cancer. Prepectoral reconstruction with polyurethane implant is an option for these patients. Nevertheless, this procedure can become complicated with exposure of the implant. The aim of this article is to describe the feasibility of local flaps to treat skin necrosis and dehiscence after prepectoral reconstruction and its impact on implant loss. Methods: This study includes the women who met the inclusion/exclusion criteria of the PreQ-20 protocol (12), which assessed patients with exposed implant who required a local flap for its coverage. Three types of flaps were used: thoracoepigastric, lateral thoracic, and batwing. Results: The study included 226 skin-sparing mastectomies and immediate reconstruction using prepectoral implants (52.7% bilateral mastectomies). Some 20.9% of the patients showed complications, with wound dehiscence the most frequent. Thirteen local flaps to cover the implant were performed. All flaps presented appropriate perfusion; however, the implant cover failed in six patients (46.2%). Conclusions: The use of local flaps can be a low-morbidity option for preventing implant loss when skin dehiscence or necrosis occurs and delays in oncology treatments.

Safety and Quality of Life in Women with Immediate Reconstruction with Polyurethane Implants after Neoadjuvant Chemotherapy: Outcomes from The Preq-20 Trial.

INTRODUCTION: Various studies have evaluated the impact of neoadjuvant chemotherapy (NAC) on the complications of breast cancer surgery, most of which were retrospective and did not assess the variables related to postoperative risk factors. The aim of this study is to analyse the safety and satisfaction of women included in the PreQ-20 trial who underwent NAC and who underwent mastectomy and immediate reconstruction with prepectoral polyurethane implants. MATERIAL AND METHODS: The patients included in the study belong to the prospective study PreQ-20. The study group consisted of patients who underwent immediate reconstruction after primary systemic therapy. The control groups consisted of patients with immediate reconstruction and adjuvant chemotherapy (control group 1) and patients with an infiltrating carcinoma or in situ ductal carcinoma who did not require chemotherapy (control group 2). RESULTS: The study included 157 women, 58 (36.9%) of whom underwent primary systemic therapy. The indication for genetic study was significantly greater for the study group (87.9%) than for control groups 1 (49.1%) or 2 (30.4%). Seventy-two (45.9%) of the patients underwent bilateral mastectomy (BM), a procedure that was performed significantly more frequently in the study group (69%) than in control groups 1 (30.2%) or 2 (34.8%). The incidence rate for BM after complete pathologic response was 78%. There were no statistically significant differences in the number of complications between the groups. Implant loss was significantly more frequent in control group 1 (13.2%) than in the study group (3.4%) and control group 2 (2.2%). CONCLUSIONS: Mastectomy with prepectoral polyurethane implant reconstruction in patients with neoadjuvant chemotherapy presented a similar incidence of complications compared with patients who underwent primary surgery. There is a high rate of BM in women with NAC.

Combining Wire Localization of Clipped Nodes with Sentinel Lymph Node Biopsy After Neoadjuvant Chemotherapy in Node-Positive Breast Cancer: Preliminary Results from a Prospective Study.

BACKGROUND: The ideal technique for lymph node staging for patients with pathologically confirmed node-positive breast cancer at diagnosis and neoadjuvant chemotherapy (NAC) is unclear. OBJECTIVE: The aim of this study was to analyze the feasibility of wire/clip localization and sentinel lymph node biopsy (SLNB) for the axillary staging of these patients. METHODS: We conducted a prospective study in which lymph node staging was performed using wire localization of positive lymph nodes and an SLNB with dual tracer. All patients who presented no metastatic involvement of the sentinel lymph node (SLN) or clip/wire-marked lymph node were spared an axillary lymph node dissection (ALND). The multidisciplinary committee agreed on axillary treatment for patients with lymph node involvement. RESULTS: Forty-two patients met the inclusion criteria. We identified and extirpated the clip/wire-marked node in all patients (100%), with SLNB performed successfully in 95.3% of patients. The SLN and wire-marked node matched in 80% of patients; 73.8% of patients did not undergo ALND. DISCUSSION AND CONCLUSIONS: Several studies have evaluated the efficacy of various procedures for lymph node marking for women with prechemotherapy lymph node involvement. Most of the studies reported high identification rates (> 94.8%), with false negative rates of < 7%. Similarly, our study allows us to conclude that combined axillary marking (clip and SLNB) in patients with metastatic lymph node at diagnosis and NAC offers a high identification rate (100%) and a high correlation between the wire-marked lymph node and the SLN (80%). This procedure has enabled the suppression of ALND for a significant number of patients (73%).

Cosmetic sequelae after oncoplastic breast surgery: long-term results of a prospective study.

BACKGROUND: To analyze risk factors for the cosmetic sequelae of patients treated with oncoplastic procedures and their impact on patient-reported satisfaction. METHODS: Prospective nonrandomized study between 2003 and 2020. Complications and cosmetic sequelae were reported by the surgeon. We employed the Clough classification for oncoplastic procedures (Level 1 and Level 2) and to define the cosmetic sequelae (Type I, Type II and Type III). The assessment of satisfaction and quality of life was performed with the BreastQ™ questionnaire. RESULTS: 429 level 1 and 326 level 2 oncoplastic operations were included. We recorded 89 cosmetic sequelae: 55 deformities (type II), 29 asymmetries (type I), and 5 type III defects. The incidence of cosmetic sequelae at 10 years for levels 1 and 2 oncoplastic procedures was 11.5% and 20.0%, respectively. The level 2 techniques and the postoperative complications increased the risk of cosmetic sequelae. Patients with cosmetic sequelae did not achieve significant improvements in breast satisfaction. CONCLUSIONS: Cosmetic sequelae affect up to 17% of oncoplastic procedures. Most of them appear during the first 5 years. Cosmetic sequelae and their predisposing factors should be part of the shared decision-making process with patients, as well as part of the training programs for breast surgeons.

Single-Incision Approach for Breast-Conserving Surgery: Effectiveness, Complications and Quality of Life.

OBJECTIVE: The aim of this study was to assess the success of tumor resection and its postoperative complications, satisfaction, and quality of life using a single-incision approach for breast-conserving surgery. MATERIALS AND METHODS: This was an observational, prospective study conducted between 2015 and 2018. The study group consisted of patients in whom tumor extirpation and lymph node (LN) staging was performed using a single incision, while the control group consisted of patients who underwent a breast-conserving procedure with independent incisions. All patients were given the preoperative and postoperative module of the Breast-Q™ questionnaire. RESULTS: Overall, 226 patients met the study's inclusion criteria, 152 of whom successfully underwent breast and LN removal using a single-incision approach (98.7% overall success). There were no significant differences in postoperative complications, although there was a greater tendency towards breast seroma in the study group and axillary neuralgia in the control group. Both groups presented a similar rate of breast and axillary salvage surgery. The postoperative Breast-Q™ questionnaire showed that the study group had greater satisfaction with both the breast and the information provided by the surgeon. CONCLUSION: The single-incision approach is as effective as standard surgery, with custom incisions in terms of breast resection, LN staging, and complications. There was greater satisfaction with both the breast and the information provided.

El declive de la linfadenectomía axilar en el cáncer de mama. Evolución de su indicación durante los últimos 20 años / The decline of axillary lymph node dissection in breast cancer. Evolution of its indication over the last 20 years

Introducción: En los últimos 20 años los procedimientos de estadificación ganglionar en el cáncer de mama se han modificado. El objetivo de este estudio es describir la evolución de estos procedimientos en nuestro centro. Métodos: Estudio prospectivo observacional que incluye a las mujeres con cáncer de mama intervenidas entre el 2001 y el 2017. Se identificaron 4 grupos según el esquema terapéutico utilizado y 3 periodos a estudio definidos por las indicaciones de la linfadenectomía. Resultados: Mil trescientos diecinueve pacientes cumplieron los criterios de inclusión. La cirugía conservadora primaria fue el esquema terapéutico más frecuente (54,13%) y se realizaron 615 linfadenectomías axilares (46,62%) durante los 20 años estudiados. El porcentaje de linfadenectomías axilares disminuyó progresivamente en el tiempo, pasando del 91% en el primer periodo al 34% en el último periodo. Las linfadenectomías axilares fútiles descendieron al 6,6% en el último año. En la cirugía conservadora primaria no se realizó ninguna linfadenectomía axilar fútil los 2 últimos años. Conclusión: La introducción de la biopsia de ganglio centinela en 2001 y de los criterios ACOSOG Z0011 han modificado la indicación de la linfadenectomía axilar. Así, se han disminuido las linfadenectomías axilares sin afectación, evitando la morbilidad que asocia este procedimiento, especialmente linfedema. El estudio refleja el descenso progresivo de la indicación de la linfadenectomía en los diferentes grupos a estudio, similar a lo expuesto por otros autores. En diversos ensayos clínicos se ha descrito que estos cambios no han impactado negativamente en supervivencia

Introduction: In last 20 years, lymph node staging procedures in breast cancer have been modified. The objective of this study is to describe the evolution of these procedures at our hospital. Methods: A prospective observational study that included women with breast cancer who were treated surgically between 2001 and 2017. Four groups were identified according to the therapeutic regimen and 3 study periods defined by the lymph node dissection. Results: 1319 patients met the inclusion criteria. Primary conservative surgery was the most frequent therapy (54.13%), and 615 (46.62%) axillary lymph node dissections (ALND) were performed in the 20-year study period. The percentage of ALND decreased progressively over time, going from 91% in the first period to 34% in the last period. The futile ALND fell to 6.6% in the last year. In the primary conservative surgery, no futile ALND was performed in the last two years. Conclusion: The introduction of sentinel lymph node biopsy and the ACOSOG Z0011 criteria have modified the indication for ALND. Thus, ALND without involvement have been reduced, thereby avoiding the associated morbidity. The study demonstrates the progressive decrease in the indication of lymphadenectomy in the different study groups, similar to reports by other authors. Several clinical trials have described that these changes have not negatively impacted survival

The decline of axillary lymph node dissection in breast cancer. Evolution of its indication over the last 20 years. / El declive de la linfadenectomía axilar en el cáncer de mama. Evolución de su indicación durante los últimos 20 años.

INTRODUCTION: In last 20 years, lymph node staging procedures in breast cancer have been modified. The objective of this study is to describe the evolution of these procedures at our hospital. METHODS: A prospective observational study that included women with breast cancer who were treated surgically between 2001 and 2017. Four groups were identified according to the therapeutic regimen and 3 study periods defined by the lymph node dissection. RESULTS: 1319 patients met the inclusion criteria. Primary conservative surgery was the most frequent therapy (54.13%), and 615 (46.62%) axillary lymph node dissections (ALND) were performed in the 20-year study period. The percentage of ALND decreased progressively over time, going from 91% in the first period to 34% in the last period. The futile ALND fell to 6.6% in the last year. In the primary conservative surgery, no futile ALND was performed in the last two years. CONCLUSION: The introduction of sentinel lymph node biopsy and the ACOSOG Z0011 criteria have modified the indication for ALND. Thus, ALND without involvement have been reduced, thereby avoiding the associated morbidity. The study demonstrates the progressive decrease in the indication of lymphadenectomy in the different study groups, similar to reports by other authors. Several clinical trials have described that these changes have not negatively impacted survival.

Angiosarcoma radioinducido de mama en paciente con síndrome de Li-Fraumeni / Radiation-induced angiosarcoma of the breast in a Li-Fraumeni patient

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Predictive factors of satisfaction and quality of life after immediate breast reconstruction using the BREAST-Q©.

AIMS AND OBJECTIVES: To analyse quality of life and satisfaction after immediate breast reconstruction due to cancer and its determining factors. BACKGROUND: Studying breast reconstruction is important because of its frequency and variability. In addition to the surgical results, it is necessary to analyse the quality of life and patient satisfaction using a specific tool. DESIGN METHODS: An ambispective design was used (n = 101; α = 0.05; precision = 10%), studying anthropometric, sociocultural data, Fagerström test and the BREAST-Q© questionnaire. A logistic regression analysis was performed to identify variables associated with quality of life and satisfaction. RESULTS: Mean age of the patients on diagnosis was 44.87 ± 8.5 years. Forty-one of the patients were carried out a skin-sparing mastectomy (42.7%). Immediate reconstruction was performed with implant in 73 (74.5%). The domains on the BREAST-Q© for quality of life with the lowest scores were physical well-being chest (74) and sexual well-being (61.5). The satisfaction domain with the lowest score was with the breast (59). The variables associated with the worst quality of life in the physical well-being chest domain were the skin-sparing mastectomy (OR, 4.2; 95% confidence interval (CI), 1.2-14.1) and lymphedema (OR, 12.9; 95% CI, 1.0-159.9). Antibody treatment was associated with a worse score on the psychosocial well-being domain (OR, 4.25; 95% CI, 1.0-18.0) and sexual well-being domain (OR, 7.34; 95% CI, 0.9-54.6). Satisfaction was associated with nicotine dependence on the breast and outcome scale. The higher the dependence on nicotine, the greater the dissatisfaction with the breasts (OR, 2.41; 95% CI, 1.1-5.3) and with the result (OR, 2.45; 95% CI, 1.0-5.9). CONCLUSIONS: The type of treatment and lymphedema modify the patients' quality of life. Nicotine dependence is associated with lower satisfaction with the breast and with the outcome. RELEVANCE TO CLINICAL PRACTICE: This study suggests the need for multidisciplinary attention during the first year of adjuvant treatment despite the benefits of immediate reconstruction. It shows the need for preoperative assessment of the level of nicotine dependence, anxiety and depression of smoking patients before preoperative counselling.

The role of oncoplastic breast reduction in the conservative management of breast cancer: Complications, survival, and quality of life.

BACKGROUND AND OBJECTIVES: Reduction Mammaplasty (RM) in breast cancer allows mammary remodeling after wide excisions. We aimed to analyze the complications, survival, and quality of life after RM. METHODS: Retrospective study of women who underwent a surgical intervention for breast cancer between 2000 and 2016. Patients were divided into two groups: RM and tumorectomy. Postoperative complications, survival and quality of life were assessed using the Breast-Q questionnaire. RESULTS: A total of 801 patients were evaluated, with a mean follow up of 84 months. RM patients experienced a longer operating time and hospital stay, and a higher proportion of tissue necrosis compared to tumorectomy patients (P < 0.001). No significant differences were observed regarding rate of re-excision or rate of mastectomy, but the recurrence rate at 10 years was higher for RM patients (P < 0.03). Patients who underwent RM reported optimal satisfaction with the breast and a good quality of life. CONCLUSIONS: RM is a useful approach in breast cancer surgery, with a low rate of re-excision and mastectomy. Overall survival at 10 years is similar to that associated with tumorectomy, though with a higher rate of local recurrence. Patient satisfaction and quality of life appears to be good one year after radiotherapy.

Repercusión de los criterios ACOSOG Z0011 sobre la indicación de la linfadenectomía axilar y el control locorregional en mujeres con ganglio centinela metastásico. Resultados preliminares tras cuatro años de aplicación clínica / Repercussion of the ACOSOG-Z0011 criteria for the indication of axillary lymph node dissection and locoregional control in women with metastatic sentinel lymph node. Preliminary results after four years of clinical application

Objetivo. Evaluar los cambios en la indicación de la linfadenectomía axilar (LA), su eficacia para eliminar enfermedad residual y control locorregional, tras la adopción de los criterios del estudio ACOSOG Z0011. Pacientes y método. Estudio observacional retrospectivo en mujeres con carcinoma infiltrante de mama tratadas quirúrgicamente, entre febrero 2010 y mayo de 2014. Todas las pacientes fueron valoradas según los criterios del ensayo clínico ACOSOG Z0011 para el manejo del ganglio centinela (GC) metastatizado. Resultados. Un total de 118 enfermas presentaron afectación del GC, y de ellas 53 (44,92% de las pacientes con GC metastásico) evitaron la LA por la aplicación de los criterios ACOSOG Z0011. La mayoría de estas mujeres (73,58%) presentaron afectación micrometastásica del GC. El grupo de enfermas con mayor beneficio fueron las pacientes con conservación mamaria, ya que el 58,23% de estas enfermas evitaron la LA. Se realizaron un total de 65 LA por afectación metastásica del GC sin que se evidenciase metástasis en la grasa axilar en 37 (55,2%) pacientes. Conclusiones. La adopción de los criterios ACOSOG Z0011 permite disminuir la indicación de la LA, especialmente en aquellas mujeres sometidas a un procedimiento conservador. A pesar de la introducción de estos criterios, existe un grupo significativo de mujeres (55%) en quienes la LA no demuestra afectación ganglionar de la grasa axilar y no obtienen ningún beneficio con la misma (AU)

Objective. To evaluate changes in the indication of axillary lymph node dissection (ALND), its effectiveness in eliminating residual disease, and locoregional control after the adoption of the ACOSOG Z0011 study criteria. Patients and methods. Retrospective study in women with invasive breast cancer treated surgically from February 2010 to May 2014. All women were evaluated according to the ACOSOG-Z0011 trial criteria for the management of metastasized sentinel lymph node (SLN). Results. A total of 118 women had SLN involvement. Application of the ACOSOG Z0011 criteria avoided ALND in 53 of the 118 patients (44.92% of the patients with metastatic SLN), most of them (73.58%) with micrometastases. The benefit was greater in women undergoing conservative surgery, because 58.23% of these women avoided ALND. A total of 65 ALND were performed for metastatic SLN, of which 37 (55.2%) showed no involvement of axillary fat. Conclusions. Adoption of the ACOSOG Z0011 criteria decreases the indication of ALND, especially in women undergoing conservative surgery. Despite the introduction of these criteria, there is a significant percentage of women (55%) in whom ALND shows no lymph node involvement in axillary fat and produces no benefit (AU)

Secuelas estéticas de la cirugía oncoplástica de la mama. Clasificación y principios para su prevención / Cosmetic sequelae after oncoplastic surgery of the breast. Classification and factors for prevention

La cirugía oncoplástica es una herramienta fundamental en el tratamiento quirúrgico de la mujer con cáncer de mama. Sin embargo, la realización de una técnica oncoplástica no es garantía absoluta de un buen resultado estético y, por ello, algunas pacientes pueden presentar secuelas estéticas tras su realización ya sea por una deficiente planificación quirúrgica, por los efectos de los tratamientos adyuvantes o por la necesidad de una resección mayor de la inicialmente prevista. La relativa frecuencia de estas secuelas estéticas en la práctica oncológica hace necesario clasificarlas para optimizar la planificación quirúrgica. El objetivo de este artículo es describir y clasificar las secuelas estéticas que pueden aparecer tras un procedimiento oncoplástico con el fin de identificar aquellos factores que son determinantes en su aparición y prevención. Esta clasificación incluye 4 grupos de secuelas que se corresponden con las deformidades del contorno mamario, las asimetrías, las alteraciones del complejo aréola-pezón (CAP) y los defectos en la estructura tridimensional de la mama. Un grupo significativo de estas secuelas (asimetrías y deformidades) se relacionan con la irradiación mamaria y hace necesario un proceso informativo veraz con las pacientes para fijar unas expectativas reales en el resultado estético. Finalmente, existe otro grupo de secuelas (alteraciones del CAP y estructura tridimensional) que se relacionan con una planificación y ejecución deficiente del procedimiento oncoplástico, lo que hace imprescindible una formación específica para el aprendizaje de estas técnicas quirúrgicas

Oncoplastic surgery is an essential tool in the surgical approach to women with breast cancer. These techniques are not absolute guarantee for a good cosmetic result and therefore some patients will have cosmetic sequelae secondary to poor surgical planning, the effects of adjuvant treatments or the need for resection greater than originally planned. The high frequency of these cosmetic sequelae in oncology practice makes it necessary to classify them for optimal surgical planning. The aim of this paper is to present a classification of cosmetic sequelae after oncoplastic procedures to identify those factors that are crucial to its prevention. This classification contains 4 groups: breast contour deformities, asymmetries, alterations in nipple-aréola complex (NAC) and defects in the three dimensional structure of the breast. A significant group of these sequelae (asymmetries and deformities) are associated with breast irradiation and need an accurate information process with patients to set realistic expectations about cosmetic results. Finally, there is another group of sequelae (NAC disorders and three-dimensional structure) that are related to poor planning and deficiencies in surgical approach, therfore specific training is essential for learning these surgical techniques

Cosmetic sequelae after oncoplastic surgery of the breast. Classification and factors for prevention.

Oncoplastic surgery is an essential tool in the surgical approach to women with breast cancer. These techniques are not absolute guarantee for a good cosmetic result and therefore some patients will have cosmetic sequelae secondary to poor surgical planning, the effects of adjuvant treatments or the need for resection greater than originally planned. The high frequency of these cosmetic sequelae in oncology practice makes it necessary to classify them for optimal surgical planning. The aim of this paper is to present a classification of cosmetic sequelae after oncoplastic procedures to identify those factors that are crucial to its prevention. This classification contains 4 groups: breast contour deformities, asymmetries, alterations in nipple-aréola complex (NAC) and defects in the three dimensional structure of the breast. A significant group of these sequelae (asymmetries and deformities) are associated with breast irradiation and need an accurate information process with patients to set realistic expectations about cosmetic results. Finally, there is another group of sequelae (NAC disorders and three-dimensional structure) that are related to poor planning and deficiencies in surgical approach, therfore specific training is essential for learning these surgical techniques.

Evaluación de un programa de reconstrucción mamaria inmediata mediante expansión-prótesis en mujeres con cáncer de mama / Evaluation of an immediate tissue expander-implant breast reconstruction program in women with breast cancer

Introducción. La reconstrucción mamaria inmediata mediante expansor-prótesis constituye una alternativa en la cirugía del cáncer de mama que precisa mastectomía. El objetivo de este estudio es analizar el impacto asistencial de este procedimiento y su eficacia para la reconstrucción mamaria. Pacientes y método. El grupo a estudio fueron pacientes intervenidas quirúrgicamente de cáncer de mama, por un mismo cirujano, entre enero de 2009 y diciembre de 2012, y a quienes se realizó mastectomía y reconstrucción inmediata con expansor-prótesis. Se excluyeron todas aquellas pacientes con reconstrucción diferida o autóloga, así como a las que se realizó mastectomía profiláctica. Las variables analizadas fueron: edad, tiempo quirúrgico, estancia hospitalaria, retraso en el inicio de quimioterapia, complicaciones, reintervenciones, características histopatológicas del tumor y afectación ganglionar, comparándose, mediante un estudio prospectivo no aleatorizado, con un grupo control, constituido por pacientes intervenidas mediante una cirugía conservadora o mastectomía sin reconstrucción. Resultados. Se incluyeron 69 pacientes en el grupo a estudio y 312 pacientes en el grupo control. El análisis comparativo entre el grupo a estudio y control no mostró diferencias significativas en las demoras asistenciales, el inicio del tratamiento adyuvante y las complicaciones postoperatorias, aunque sí en el tiempo quirúrgico y la estancia hospitalaria. Un total de 61 pacientes (88,4%) finalizaron la expansión y 53 (76,8%) acabaron con éxito su reconstrucción mamaria. El análisis por grupos de tratamiento demostró que el mayor éxito del procedimiento se consiguió en las pacientes sin tratamientos adyuvantes (100%), mientras que las pacientes con tratamiento quimioterápico y radioterápico presentaron la menor tasa de éxito (80%). Conclusión. La reconstrucción mamaria inmediata mediante expansor-prótesis es un procedimiento que precisa mayor tiempo quirúrgico y estancia hospitalaria respecto a otras técnicas oncológicas de la mama. La mayoría de las pacientes culminarán con éxito el proceso reconstructivo, aunque existirá una mayor tasa de fracaso en las pacientes irradiadas

Introduction. Immediate breast reconstruction with an expander-implant is an alternative in breast cancer surgery in patients requiring mastectomy. The objective of this study was to analyze the welfare impact of this procedure and its effectiveness in breast reconstruction. Patients and method. The study group consisted of patients treated for breast cancer who underwent mastectomy and immediate reconstruction with an expander-implant. All patients were treated by a single surgeon between January 2009 and December 2012. We excluded all patients with delayed or autologous reconstruction and prophylactic mastectomy. The variables analyzed were age, operating time, length of hospital stay, delayed initiation of chemotherapy, complications, reoperations, histopathologic features of the tumor, and lymph node involvement. These variables were compared in a prospective non-randomized study with those in a control group consisting of patients who underwent conservative surgery or mastectomy without reconstruction. Results. There were 69 patients in the study group and 312 patients in the control group. Comparison between the study and the control group showed no significant differences in healthcare delays, the start of adjuvant therapy, or postoperative complications, but differences were found in operating time and length of hospital stay. Expansion was completed in 61 patients (88.4%) and breast reconstruction in 53 (76.8%). Analysis by treatment groups showed that greater procedural success was achieved in patients without adjuvant treatments (100%), while patients with chemotherapy and radiotherapy had the lowest success rate (80%). Conclusion. Immediate breast reconstruction with an expander-implant requires longer operating time and hospital stay than other techniques in breast oncology. Most patients will successfully complete the reconstructive process, but the failure rate will be higher in irradiated patients

Propuesta de una nueva estrategia terapéutica multidisciplinar en la mujer con cáncer de mama y afectación del ganglio centinela / Proposal for a new multidisciplinary therapeutic strategy in the breast cancer patient with sentinel lymph node metastasis

La biopsia de ganglio centinela (GC) es la técnica de elección para el estudio de extensión de la axila en la mujer con cáncer de mama sin afectación ganglionar. Por el contrario, la linfadenectomía axilar (LA) constituye el procedimiento idóneo para las pacientes con afectación metastásica del GC. Durante los últimos años diferentes estudios han sugerido que algunas pacientes con afectación del GC pueden ser tratadas sin LA. Este artículo expone la revisión bibliográfica realizada por nuestro grupo multidisciplinar y su estrategia para la supresión de la LA en mujeres con afectación metastásica del GC. En esta nueva estrategia la LA no se llevaría a cabo en mujeres con tumores T1, con afectación de 1-2 GC e intervenidas mediante una técnica quirúrgica conservadora. Por el contrario, se indicaría la LA en aquellas pacientes con tres o más GC afectados, invasión extracapsular del GC, mujeres mastectomizadas y tumores del subtipo triple negativo o HER2+ que no reciban tratamiento biológico con anticuerpos (AU)

Sentinel lymph node (SLN) biopsy is the standard of practice for assessing axillary spread inclinically node-negative breast cancer patients. On the other hand, axillary lymph no dedissection (ALND) is the ideal procedure for patients with SLN metastasis. Different studies over the last few years have suggested that some patients with positive SLN can be treated without ALND. This article presents a literature review carried out by our multidisciplinary group and its strategy for avoiding routine ALND in women with SLN metastases. In this new strategy ALND should not be performed on women with T1 tumours, with 1-2 positive SLN and undergoing breast conservative surgery. On the other hand, ALND would be indicated in those patients with three or more positive SLN, presence of extracapsular invasion, mastectomised women and triple negative subtype or HER2+ tumours that have not received biological treatment with antibodies (AU)

[Proposal for a new multidisciplinary therapeutic strategy in the breast cancer patient with sentinel lymph node metastasis]. / Propuesta de una nueva estrategia terapéutica multidisciplinar en la mujer con cáncer de mama y afectación del ganglio centinela.

Sentinel lymph node (SLN) biopsy is the standard of practice for assessing axillary spread in clinically node-negative breast cancer patients. On the other hand, axillary lymph node dissection (ALND) is the ideal procedure for patients with SLN metastasis. Different studies over the last few years have suggested that some patients with positive SLN can be treated without ALND. This article presents a literature review carried out by our multidisciplinary group and its strategy for avoiding routine ALND in women with SLN metastases. In this new strategy ALND should not be performed on women with T1 tumours, with 1-2 positive SLN and undergoing breast conservative surgery. On the other hand, ALND would be indicated in those patients with three or more positive SLN, presence of extracapsular invasion, mastectomised women and triple negative subtype or HER2+ tumours that have not received biological treatment with antibodies.