Oncologic safety of immediate autologous fat grafting for reconstruction in breast-conserving surgery.

IMPORTANCE: Autologous fat grafting (AFG), or lipofilling, has been used for immediate reconstruction at the time of breast-conserving surgery in order to achieve a satisfactory cosmetic outcome in patients with breast cancer and an unfavorable tumor-to-breast volume ratio or unfavorable tumor location. However, the oncologic safety of this technique is still unclear. OBJECTIVE: To determine whether AFG performed simultaneously with breast-conserving surgery is associated with differences in local relapse rates and disease-free survival. DESIGN: Matched retrospective cohort study. SETTING: Tertiary referral center. PARTICIPANTS: Patients undergoing breast-conserving surgery with or without AFG between 2004 and 2016 were retrospectively enrolled and matched for age, staging, grade, tumor histology, and tumor immunohistochemical profile. MAIN OUTCOME(S) AND MEASURE(S): The cumulative incidence of locoregional recurrence (LRR) and disease-free survival were the primary end points, while distant recurrence and overall survival were the secondary end points. RESULTS: A total of 320 patients were followed. Cases were matched with controls at a 1:4 ratio. There was no difference in LRR or distant recurrence of breast cancer between the two groups. The annual LRR rate was 0.86% in patients who received immediate AFG vs. 0.7% in patients undergoing breast-conserving surgery alone (p ≥ 0.05). Number of lymph nodes was the sole independent risk factor for local recurrence (p = 0.045). No significant differences in disease-free survival rates were found between the groups. CONCLUSIONS AND RELEVANCE: At a mean follow-up of 5 years, no significant differences in locoregional recurrence rates were found between patients who received immediate AFG and those who underwent breast-conserving surgery alone. These findings corroborate previous research demonstrating the oncological safety of immediate AFG reconstruction, further suggesting that this technique as a safe, effective way to achieve optimal cosmetic outcomes in primary breast cancer surgery without jeopardizing oncologic outcomes.

Reconstrucción mamaria inmediata con expansores tisulares / Immediate breast reconstruction with tissue expanders

RESUMEN Introducción: La reconstrucción mamaria postmastectomía es la forma habitual en nuestro país. En el Instituto de Oncología se realizan en la actualidad con sistematicidad de manera inmediata para disminuir el impacto psicológico de la mastectomía. Objetivo: Evaluar el comportamiento de la reconstrucción mamaria inmediata con el uso de expansores tisulares. Métodos: Se realizó un estudio observacional, descriptivo, retrospectivo y longitudinal, en pacientes ingresadas en el Instituto Nacional de Oncología y Radiología con criterios de reconstrucción mamaria inmediata con expansores tisulares, en el periodo comprendido entre octubre de 2015 a diciembre de 2018. El universo estuvo conformado por 51 paciente siendo la muestra 43. Resultados: Predominó la reconstrucción en mujeres entre 40 y 49 de color de la piel blanca. La mayoría con hábitos tóxicos de fumadoras. Se realizó como técnica quirúrgica la reconstrucción inmediata con expansión tisular, fue el más utilizado el anatómico. Las principales complicaciones estuvieron relacionadas con la radioterapia y hábitos tóxicos. Conclusiones: Todas las mujeres se reconstruyeron con expansor tisular, de forma inmediata, con bajo índice de complicaciones(AU)

ABSTRACT Introduction: Postmastectomy breast reconstruction is the usual way in our country. At the Oncology Institute they are currently performed systematically immediately to lessen the psychological impact of mastectomy. Objective: To evaluate the behavior of immediate breast reconstruction with the use of tissue expanders. Methods: An observational, descriptive, retrospective and longitudinal study was carried out in patients admitted to the National Institute of Oncology and Radiology with criteria for immediate breast reconstruction with tissue expanders, in the period from October 2015 to December 2018. The universe it was made up of 51 patients, sample 43. Results: Reconstruction predominated in women between 40 and 49 of white skin color. Most with toxic smoking habits. Immediate reconstruction with tissue expansion was performed as a surgical technique, anatomical was the most used. The main complications were related to radiation therapy and toxic habits. Conclusions: All the women were reconstructed with a tissue expander, immediately, with a low rate of complications(AU)

Importancia de la clasificación ANDI para la reconstrucción inmediata de mama en tumor phyllodes recurrente / Importance of classification ANDI for the inmediate breast reconstruction in recurrent phyllodes tumor

La cirugía reconstructiva de mama ofrece a las pacientes alivio en síntomas secundarios a deformidades ocasionadas por tumores que, a pesar de ser benignos como en el caso de algunos tumores phyllodes, alteran la calidad de vida por ocasionar dolor, deformidad y dificultades con la ropa. Estos síntomas son proporcionales al tama±o de la lesión y a la duración de la enfermedad. El manejo integral por un mismo equipo quirúrgico de expertos permite resecar por completo una lesión gigante benigna y la reconstrucción inmediata. Esto se hizo en una paciente de 39 años con un colgajo extendido del músculo dorsal ancho homolateral que reemplazó el volumen mamario resecado, la cobertura de la piel se realizó con tejido autólogo que se conservó durante el procedimiento quirúrgico de ablación del tumor. El resultado en cuanto al manejo de la enfermedad fue bueno; el tumor de 17x15x9 cm y 1000 g de peso que ocupaba 90% del seno se resecó en toda su extensión. El efecto estético de la reconstrucción inmediata tanto para la paciente como para el equipo quirúrgico, fue satisfactorio. Después de 30 meses de la cirugía; la paciente estß libre de síntomas y no ha habido recurrencia del tumor. Este manejo plantea la importancia de tener en cuenta los conceptos que se enuncian en la clasificación de la enfermedad benigna de la mama (ANDI) para los procedimientos quirúrgicos reconstructivos de tumores benignos en mujeres mayores de 35 a±os cuyo tejido mamario ya inició su involución.

Immediate breast reconstructive surgery offers to a patient relief in secondary symptoms due to deformities caused by tumours that in spite of the fact of being harmless, for instance in some phyllodes tumours, alter life quality since they produce pain, malformations and inconveniences to clothesÆ employment. These symptoms are in proportion to lesion size and disease duration. Integral management by the same expertsÆ surgical team allows a complete resection of a benign giant lesion as well as an immediate reconstruction. The immediate breast reconstruction was performed in a 39 year old patient with a homolateral extended latissimus dorsi flap that replaced the breast volume removed; for skin covering an autologous tissue kept during surgical procedure for tumour ablation was used. Results related to disease management were adequate. The tumour, which measured 17x15x9 cm, weight 1000 g and occupied almost 90 per cent of the breast, was completely extirpated. Aesthetic result for patient (and for the surgical team) was acceptable and satisfactory. End outcome has persisted 30 months post-surgery; presently there are no symptoms and no tumour recurrences have been detected. This type of management establishes the importance of having in mind those concepts clearly given on breast benign pathology classification (ANDI) in order to follow reconstructive surgical techniques in women older tan 35 years, with benign tumours in whom breast tissuesÆ involution have already begun.