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1.
Surg Oncol Clin N Am ; 32(1): 27-46, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36410920

RESUMO

Randomized controlled trials have informed the historical evolution of breast cancer management, distilling operative and nonoperative treatments to achieve disease control and improve survival while maximizing quality of life and minimizing complications. The authors describe landmark trials investigating and influencing the following aspects of breast cancer care: extent of breast surgery; axillary management; neoadjuvant and adjuvant therapies; and selection of chemotherapy versus endocrine therapy via application of genomic assays.


Assuntos
Neoplasias da Mama , Humanos , Feminino , Neoplasias da Mama/cirurgia , Qualidade de Vida , Terapia Neoadjuvante , Mastectomia , Axila
2.
Surg Clin North Am ; 103(1): 121-139, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36410345

RESUMO

Although surgery of the breast and axilla is generally well-tolerated by patients, the breast surgeon recognizes that complications can occur even when operating with experience on the lowest risk patients. The operative repertoire ranges from breast conserving surgery, mastectomy (including skin-sparing and nipple-sparing types), to modified radical mastectomy, with each procedure carrying a different expected surgical morbidity. Patients and families who are fully informed of potential complications before their operation describe greater trust in their surgeon and are better able to co-manage complications with the surgical team, when they occur.


Assuntos
Neoplasias da Mama , Humanos , Feminino , Axila , Neoplasias da Mama/cirurgia , Mastectomia/efeitos adversos , Complicações Pós-Operatórias/etiologia , Mastectomia Segmentar
3.
Surg Clin North Am ; 103(1): 141-153, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36410346

RESUMO

As breast oncologic surgical procedures and approaches have evolved in recent years, so have breast reconstruction techniques. Newer advances focus on expanding the options of reconstructive approaches and patient selection, optimizing quality of life, and helping improve postsurgical survivorship. These advances span from techniques to expand criteria for nipple-sparing mastectomies, optimizing and enhancing oncoplastic surgery, evolving autologous reconstruction options, and preserving and restoring sensation after mastectomy.


Assuntos
Neoplasias da Mama , Mamoplastia , Humanos , Feminino , Mastectomia/métodos , Mamilos/cirurgia , Qualidade de Vida , Neoplasias da Mama/cirurgia , Mamoplastia/métodos
4.
Surg Clin North Am ; 103(1): 107-119, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36410344

RESUMO

New innovations aid the breast surgeon with better ability to localize tumors using wireless techniques, reduce re-excision rates by intraoperative margin evaluation and perform aesthetically; pleasing, and safe surgeries. In addition to improving oncological outcomes, we can continue to improve the quality of life for our patients through evolving surgeries including nerve-sparing mastectomies, robotic mastectomies, and lymphovascular surgeries (LYMPHA). Our article reviews current and evolving techniques and technology that all breast surgeons should add to his or her armamentarium to provide optimal surgical care.


Assuntos
Mamoplastia , Cirurgiões , Humanos , Masculino , Feminino , Qualidade de Vida , Mastectomia/métodos , Mamoplastia/métodos , Margens de Excisão
5.
Surg Clin North Am ; 103(1): 187-199, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36410350

RESUMO

Radiation treatment is a well-established component of breast cancer treatment, in both breast conservation and also for many patients who have had mastectomy as well as those with metastatic disease. The basis for this was established in multiple large meta-analyses, and multiple modern studies have further defined the role of radiation. The radiation must be delivered to the area at risk, which can include the partial breast, whole breast, chest wall, and/or regional lymph nodes. There are a number of acceptable radiation treatment techniques and dose-fractionation schedules that can be individualized to each patient. Radiation can also play an important role in patients with metastatic cancer.


Assuntos
Neoplasias da Mama , Humanos , Feminino , Neoplasias da Mama/radioterapia , Neoplasias da Mama/cirurgia , Neoplasias da Mama/patologia , Mastectomia/métodos , Linfonodos/patologia
6.
JAMA Netw Open ; 5(12): e2244212, 2022 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-36454573

RESUMO

Importance: A discrepancy on current guidelines and clinical practice exists regarding routine imaging surveillance after mastectomy, mainly regarding the lack of adequate evidence for imaging in this setting. Objective: To investigate the usefulness of imaging surveillance in terms of cancer detection and interval cancer rates after mastectomy with or without reconstruction for patients with prior breast cancer. Data Sources: A comprehensive literature search was conducted in 3 electronic databases-PubMed, ISI Web of Science, and Scopus-without year restriction. References from relevant reviews and eligible studies were also manually searched. Study Selection: Eligible studies were defined as those conducting surveillance imaging (mammography, ultrasonography, or magnetic resonance imaging [MRI]) of patients with prior breast cancer after mastectomy with or without reconstruction that presented adequate data to calculate cancer detection rates for each surveillance method. Data Extraction and Synthesis: Independent data extraction by 2 investigators with consensus on discrepant results was performed. A quality assessment of studies was performed using the QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies-2) template. The generalized linear mixed model framework with both fixed-effects and random-effects models was used to meta-analyze the proportion of cases across studies including 3 variables: surveillance method, reconstruction after mastectomy, and surveillance measure. Main Outcomes and Measures: Three outcome measures were calculated for each eligible study and each surveillance imaging method within studies: overall cancer detection (defined as ipsilateral cancer, both palpable and nonpalpable) rate per 1000 examinations, clinically occult (nonpalpable) cancer detection rate per 1000 examinations, and interval cancer rate per 1000 examinations. Results: In total, 16 studies were eligible for the meta-analysis. The pooled overall cancer detection rates per 1000 examinations were 1.86 (95% CI, 1.05-3.30) for mammography, 2.66 (95% CI, 1.48-4.76) for ultrasonography, and 5.17 (95% CI, 1.49-17.75) for MRI. For mastectomy without reconstruction, the rate of clinically occult (nonpalpable) cancer per 1000 examinations (2.96; 95% CI, 1.38-6.32) and the interval cancer rate per 1000 examinations (3.73; 95% CI, 0.84-3.98) were lower than the overall cancer detection rate (including both palpable and nonpalpable lesions) per 1000 examinations (6.41; 95% CI, 3.09-13.25) across all imaging modalities. The interval cancer rate per 1000 examinations for mastectomy with reconstruction (3.73; 95% CI, 0.41-2.73) was comparable to the pooled cancer detection rate per 1000 examinations (4.73; 95% CI, 2.32-9.63) across all imaging modalities. In all clinical scenarios and imaging modalities, lower rates of clinically occult cancer compared with cancer detection rates were observed. Conclusions and Relevance: Lower detection rates of clinically occult-compared with overall-cancer across all 3 imaging modalities challenge the use of imaging surveillance after mastectomy, with or without reconstruction. Findings suggest that imaging surveillance in this context is unnecessary in clinical practice, at least until further studies demonstrate otherwise. Future studies should consider using the clinically occult cancer detection rate as a more clinically relevant measure in this setting.


Assuntos
Neoplasias da Mama , Mastectomia , Humanos , Feminino , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/cirurgia , Mamografia , Exame Físico , Consenso
7.
Anticancer Res ; 42(12): 5819-5823, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36456116

RESUMO

BACKGROUND/AIM: Invasive lobular carcinoma (ILC) of the breast has a low complete-response rate in the neoadjuvant-chemotherapy setting. The addiction to methionine is a fundamental and ubiquitous characteristic of cancer cells, termed the Hoffman effect. We have previously targeted methionine addiction of breast cancer with recombinant methioninase (rMETase) using patient-derived orthotopic xenograft (PDOX) models. The aim of the present study was to determine the efficacy of methionine restriction with rMETase and a low-methionine diet combined with first-line neo-adjuvant chemotherapy, in a patient with metastatic ILC of the breast. CASE REPORT: A 62-year-old female was diagnosed with metastatic ipsilateral axillary-lymph-node recurrence of breast ILC 3 years after mastectomy. The patient underwent [11C]-methionine positron-emission tomography (METPET) which showed extensive methionine accumulation in the ipsilateral axillary lymph nodes, indicating the presence of cancer cells. The patient received standard neo-adjuvant chemotherapy, which consisted of 3 months of doxorubicin and cyclophosphamide followed by 3 months of docetaxel from March 2022. The patient also went on a low-methionine diet and daily oral rMETase as a supplement every 6 hours concurrently with six months chemotherapy. The patient's blood carcinoembryonic antigen (CEA) level decreased gradually, and computed tomography findings showed loss of axillary lymph-node metastases in the first 3 months of neo-adjuvant chemotherapy with doxorubicin and cyclophosphamide combined with rMETase and a low-methionine diet. A complete response was demonstrated by METPET at 6 months, at conclusion of docetaxel chemotherapy. CONCLUSION: Combination therapy of doxorubicin and cyclophosphamide followed by docetaxel combined with methionine restriction led to a remarkable complete response that is expected in fewer than 10% of patients with ILC of the breast treated with neo-adjuvant chemotherapy alone. The present results suggest that methionine restriction in combination with doxorubicin and cyclophosphamide followed by docetaxel may be effective, after METPET has demonstrated the presence of methionine-addicted axillary-lymph-node metastases in ILC of the breast.


Assuntos
Neoplasias da Mama , Feminino , Humanos , Pessoa de Meia-Idade , Metástase Linfática , Neoplasias da Mama/tratamento farmacológico , Terapia Neoadjuvante , Metionina , Docetaxel , Mastectomia , Racemetionina , Linfonodos , Doxorrubicina/uso terapêutico , Ciclofosfamida
8.
Anaesthesiol Intensive Ther ; 54(4): 302-309, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36458667

RESUMO

INTRODUCTION: The benefits of type I/II pectoral nerve blocks (PECS I/II), which can be dose dependent, have been examined in different studies. Nonetheless, few randomised trials have been performed in South America. The present randomised trial examined the efficacy of PECS I/II with a higher dose of the local anaesthetic to manage perioperative pain after mastectomy in Brazil. MATERIAL AND METHODS: This was a randomised, parallel, single-centre, and single-blind trial. Eighty participants undergoing elective mastectomy were randomised (1 : 1) to receive PECS I/II plus ultrasound-guided ropivacaine (0.5%) or standard general anaesthesia. The primary outcome was pain intensity at rest 24 hours after surgery, assessed with a numerical rating scale. Haemodynamic outcomes, consumption of opioids, anaesthe-tics and antiemetics, and post-anaesthetic recovery times were also recorded. RESULTS: Sixty participants (75%) completed the study. The mean age was 54 years, with 57% of participants undergoing mastectomy and 43% undergoing quadrantectomy. Median pain intensity (interquartile range) at rest (24 h postoperatively) was lower in the PECS I/II group compared to the control group: 0 (0-1.75) vs. 1 (1-2), P = 0.021. A smaller number of patients in the PECS I/II group required intraoperative fentanyl (23.3% vs. 83.3%; P < 0.001) and postoperative tramadol (20.0 vs. 76.7%; P < 0.001). Mean doses of fentanyl and tramadol were about 4-5 times lower in the PECS I/II group (P < 0.001). PECS I/II significantly reduced sevoflurane consumption during surgery (P = 0.01). No difference was observed regarding adverse effects. CONCLUSIONS: PECS I/II blockade with high-dose local anaesthetic is efficacious and safe, resulting in lower levels of perioperative pain after mastectomy compared to standard general anaesthesia.


Assuntos
Neoplasias da Mama , Nervos Torácicos , Tramadol , Humanos , Pessoa de Meia-Idade , Feminino , Mastectomia , Anestésicos Locais , Neoplasias da Mama/cirurgia , Estudos Prospectivos , Método Simples-Cego , Fentanila , Dor
9.
Rev. esp. anestesiol. reanim ; 69(10): 617-624, dic. 2022. ilus, tab, graf
Artigo em Espanhol | IBECS | ID: ibc-VR-13

RESUMO

Objetivos: Lograr la analgesia perioperatoria adecuada puede ser difícil en los pacientes sometidos a cirugías de mama, debido a la compleja inervación de la mama y la axila. El objetivo del estudio es investigar la eficacia de bloqueo del plano del músculo erector de la columna (ESPB) en comparación con las técnicas anestésicas regionales convencionales (bloqueo paravertebral torácico [TPVB] y bloqueo del nervio pectoral [PECS] ecoguiado). Métodos: Se incluyó en el estudio a 80 mujeres programadas para mastectomía radical modificada (MRM) electiva, con puntuación ASAI-II, y edades comprendidas entre 18 y 60años. Se aleatorizó a las pacientes en cuatro grupos: TPVB, PECS, ESPB y grupo control. Todas las pacientes de los grupos de bloqueo recibieron 25ml de bupivacaína al 0,25% mediante guía ecográfica. El grupo control recibió únicamente opiáceos para el manejo del dolor perioperatorio. Se observó a las pacientes durante 48horas en el postoperatorio para medir la duración de la analgesia (resultado primario). Resultados: ESPB reflejó una menor duración de la analgesia en comparación con el bloqueo PECS, sin diferencia estadísticamente significativa en comparación con el grupo TPVB. El consumo de morfina se incrementó en ESPB en comparación con el grupo PECS, con una diferencia insignificante en comparación con el grupo TPVB. Se produjo una diferencia no significativa entre los grupos en términos de hemodinámica y complicaciones, reportándose un caso de neumotórax en el grupo TPVB. Conclusión: PECS y ESPB representan una buena alternativa a TPVB para analgesia post-mastectomía, reflejando el bloqueo PECS un efecto analgésico superior en cuanto a consumo de opiáceos, duración de la analgesia y puntuación EVA.(AU)


Objectives: Achieving adequate perioperative analgesia can be challenging in patients undergoing breast surgeries due to the complex nerve supply of the breast and axilla. The study aims to investigate the efficacy of ESPB in comparison to conventional regional anesthesia techniques (TPVB and PECS). Methods: Eighty female patients who were scheduled for elective MRM, with ASA scoreI-II, and aged between 18 and 60years, were included in the study. Patients were randomized into four groups: the TPVB, PECS, ESPB, and the control group. All patients in either block groups received 25ml bupivacaine 0.25% with ultrasound guidance. The control group received only opioids for perioperative pain management. The patients were observed for 48hours after surgery for the duration of analgesia (primary outcome) Results: ESPB has a shorter duration of analgesia than PECS block with no significant statistical difference compared with group TPVB. Morphine consumption is increased in ESPB compared to the PECS group, with an insignificant difference compared to group TPVB. There was an insignificant difference between the groups concerning hemodynamics and complications, with one pneumothorax case reported in the TPVB group. Conclusion: PECS and ESPB represent a good alternative to TPVB for post-mastectomy analgesia with a superior analgesic effect of PECS block regarding opioid consumption, duration of the analgesia, and VAS score.(AU)


Assuntos
Humanos , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Nervos Torácicos , Neoplasias da Mama/cirurgia , Analgesia , Dor Pós-Operatória , Bloqueio Nervoso , Mastectomia , Anestesiologia , Reanimação Cardiopulmonar , Ginecologia
10.
Front Immunol ; 13: 974487, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36439119

RESUMO

Breast cancer is one of the most common cancers in women. Triple-negative breast cancer (TNBC) has a significantly worse prognosis due to the lack of endocrine receptors including estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2). In this study, we investigated adjuvant cellular immunotherapy (CIT) in patients with post-mastectomy breast cancer. We enrolled 214 post-mastectomy breast cancer patients, including 107 patients in the control group (who received chemotherapy/radiotherapy/endocrine therapy) and the other 107 patients in the CIT group (who received chemotherapy/radiotherapy/endocrine therapy and subsequent immune cell infusion). Of these 214 patients, 54 had TNBC, including 26 patients in the control group and 28 patients in the CIT group. Survival analysis showed that the overall survival rate of patients treated with cellular immunotherapy was higher than that of patients who were not treated with CIT. Compared to those who received cytokine-induced killer (CIK) cells alone, the patients who received CIK combined with natural killer (NK) cell immunotherapy showed the best overall survival rate. In subgroup analyses, adjuvant CIT significantly improved the overall survival of patients in the TNBC subgroup and the patients who were aged over 50 years. Our study indicates that adjuvant CIK cell combined with NK cell treatment is an effective therapeutic strategy to prolong the survival of post-mastectomy patients, particularly for TNBC patients and those who are aged over 50 years.


Assuntos
Células Matadoras Induzidas por Citocinas , Neoplasias de Mama Triplo Negativas , Humanos , Feminino , Pessoa de Meia-Idade , Mastectomia , Neoplasias de Mama Triplo Negativas/metabolismo , Prognóstico , Imunoterapia , Células Matadoras Naturais/metabolismo , Adjuvantes Farmacêuticos/uso terapêutico , Fatores Imunológicos/uso terapêutico , Adjuvantes Imunológicos/uso terapêutico
11.
Breast Dis ; 41(1): 391-395, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36442188

RESUMO

Increased utilization of chemotherapy in breast cancer patients has led to improved survival outcomes but it has also resulted in rising incidence of adverse effects. Occurrence of new/unreported side effect poses challenge in front of clinicians. We report the case of a 53-year lady with locally advanced, hormone receptor-positive, and human epidermal growth factor-2 (HER-2) negative right breast carcinoma. She was started on neoadjuvant chemotherapy (NACT) (doxorubicin and cyclophosphamide), to facilitate breast-conserving surgery. She developed an inflammatory reaction involving the affected breast after each of three cycles of NACT (2 cycles of doxorubicin & cyclophosphamide, and 1 cycle of docetaxel). Infectious causes and disease progression were ruled out. She was then prescribed hormone therapy but the disease progressed after three months of therapy and the patient had to be subjected to modified radical mastectomy (MRM). She then received adjuvant radiotherapy and is currently doing well on second-line hormone therapy.


Assuntos
Neoplasias da Mama , Feminino , Humanos , Neoplasias da Mama/tratamento farmacológico , Mastectomia , Doxorrubicina/efeitos adversos , Ciclofosfamida/efeitos adversos , Hormônios
12.
World J Surg Oncol ; 20(1): 376, 2022 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-36451153

RESUMO

BACKGROUND: Colon cancer is one of the most common diagnosed malignancies. Despite the use of surgery, chemotherapy, radiotherapy, targeted therapy, immunotherapy, and other comprehensive treatments, distant metastasis is still one of the main causes for dying of colon cancer. The common metastatic site of colon cancer is the liver, lung, and bone. In this article, we report a rare case of breast metastasis of signet ring cell carcinoma from the colon. CASE PRESENTATION: A 44-year-old woman was diagnosed with colon cancer and received a radical surgery of colon cancer in 2019. Combined with postoperative pathological and computed tomography (CT) images, a diagnosis of cT3N2M0 mucinous adenocarcinoma of colon (according to AJCC cancer staging manual, Version 8) was established. Adjuvant chemotherapy (XELOX: oxaliplatin 130 mg/m2 on day 1 plus capecitabine 1000 mg/m2 twice daily on days 1 to 14 every 3 weeks for 18 weeks) was performed followed by surgical resection. Fourteen months later, the patient underwent mastectomy for breast mass, which was diagnosed pathologically as metastasis of signet ring cell carcinoma from the colon. XELOX chemotherapy regimen (oxaliplatin 130 mg/m2 on day 1 plus capecitabine 1000 mg/m2 twice daily on days 1 to 14 every 3 weeks for 24 weeks) combined with bevacizumab (7.5 mg/kg on day 1) was used after the mastectomy. The patient had stable disease according to her last examination (RECIST criteria). CONCLUSION: It is rare to find a report of a patient of colon cancer that metastasizes to breast. We hope to increase treatment experience for patients with this rare metastasis.


Assuntos
Neoplasias da Mama , Carcinoma de Células em Anel de Sinete , Neoplasias do Colo , Segunda Neoplasia Primária , Humanos , Feminino , Adulto , Capecitabina , Neoplasias da Mama/terapia , Oxaliplatina , Mastectomia , Carcinoma de Células em Anel de Sinete/terapia , Neoplasias do Colo/terapia
13.
Ann Plast Surg ; 89(6): 622-625, 2022 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-36416686

RESUMO

INTRODUCTION: Because of concerns related to the correlation of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) and textured implants, the use of smooth devices in breast reconstruction has been increasing. Currently, there is a paucity of literature evaluating the safety of smooth tissue expanders (STEs), which are now being used more frequently in first-stage breast reconstruction. This study sought to compare the safety and outcomes associated with STEs compared with textured tissue expanders in prosthesis-based breast reconstruction. METHODS: A single-institution retrospective review of 394 patients undergoing tissue expander-based breast reconstruction (147 smooth and 247 textured) between 2015 and 2019 was conducted. Patient demographics, comorbidities, treatment characteristics, complications, and surgical outcomes were evaluated. Data analysis was performed using Fisher exact and t tests. RESULTS: No significant difference in demographics or complication rates were identified, including rates of hematoma, seroma, wound dehiscence, delayed wound healing, infection, tissue expander malposition, nipple necrosis, mastectomy flap necrosis, reoperation, readmission, and explantation. Average follow-up was 19 and 22 months for the smooth and textured groups, respectively. No cases of BIA-ALCL were identified in either group. CONCLUSIONS: With equivocal safety profiles and no demonstrated risk in BIA-ALCL associated with STEs, this study supports the safety of using STEs compared with textured tissue expanders in prosthesis-based breast reconstruction with the advantage in preventing BIA-ALCL and concludes that there is no role for textured breast expanders.


Assuntos
Neoplasias da Mama , Linfoma Anaplásico de Células Grandes , Mamoplastia , Humanos , Feminino , Dispositivos para Expansão de Tecidos/efeitos adversos , Neoplasias da Mama/cirurgia , Neoplasias da Mama/complicações , Mastectomia/efeitos adversos , Linfoma Anaplásico de Células Grandes/epidemiologia , Linfoma Anaplásico de Células Grandes/etiologia , Linfoma Anaplásico de Células Grandes/cirurgia , Mamoplastia/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Necrose
14.
Ann Plast Surg ; 89(6): 615-621, 2022 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-36416685

RESUMO

BACKGROUND: A neuropsychiatric diagnosis (ND) has the potential to affect patient satisfaction after breast reconstruction. However, literature regarding the interplay between neuropsychiatric diagnoses and revision operations after reconstruction remains sparse. In this study, we aim to determine whether neuropsychiatric diagnoses result in increased revision operations and healthcare utilization of plastic surgery resources after alloplastic and autologous breast reconstruction. METHODS: We retrospectively reviewed 200 patients from 2010 to 2019 who underwent postmastectomy alloplastic or autologous breast reconstruction by a single surgeon at our institution. We evaluated for the presence of neuropsychiatric diagnoses, type of neuropsychiatric diagnoses, number of revisions, and number of postreconstruction plastic surgery appointments. Continuous variables were compared using independent samples t tests, and categorical variables were compared using χ 2 tests. RESULTS: Of the 196 patients who met inclusion criteria, the majority underwent at least one revision (65.3%). The presence of an ND did not predict a higher number of revision operations ( P = 0.512) nor was the timing of the diagnosis (preoperative vs postoperative) significantly associated with the number of revision procedures ( P = 0.156). The patients who had a ND at any point during the reconstructive process had a significantly higher number of plastic surgery appointments and a longer duration of follow-up compared with the patients without any neuropsychiatric diagnoses ( P = 0.009 and P = 0.040, respectively). Complications did not impact the number of revision operations ( P = 0.780). CONCLUSIONS: Neuropsychiatric diagnoses do not significantly influence the number of revision operations after breast reconstruction. However, neuropsychiatric diagnoses result in increased healthcare utilization of plastic surgery resources that may lead to increased healthcare costs.


Assuntos
Neoplasias da Mama , Mamoplastia , Humanos , Feminino , Reoperação , Mastectomia , Estudos Retrospectivos , Neoplasias da Mama/cirurgia , Mamoplastia/métodos
15.
Ann Plast Surg ; 89(6): e11-e17, 2022 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-36416687

RESUMO

INTRODUCTION: Partial breast reconstruction with oncoplastic reduction can provide breast cancer patients with improved aesthetic outcomes after breast conservation therapy. This study evaluates the implications of simultaneous oncoplastic reduction with lumpectomy on complication rates, time to adjuvant radiation therapy, and rates of margin reexcision compared with lumpectomy alone. METHODS: The Clinformatics Data Mart Database is a national deidentified commercial claims data warehouse. From 2003 to 2020, adult female patients were queried to identify patients with a breast cancer diagnosis with International Classification of Disease codes. Among those, current procedural terminology codes were used to identify those who underwent lumpectomy alone versus lumpectomy with oncoplastic reduction. Patient demographics, complications, adjuvant oncologic therapies, and need for reexcision were recorded. Patients not continuously enrolled for at least 6 months before and after the index procedure were excluded. Multivariable regression and χ 2 tests were used for statistical analysis. RESULTS: Of 53,165 patients meeting criteria (mean age, 61.4 ± 11.6 years), 1552 (2.9%) underwent oncoplastic reduction. Diagnoses of most nonsurgical complications (seroma, wound dehiscence, postoperative infection, fat necrosis, tissue necrosis, and nonspecified complications of surgical care) were significantly higher in the oncoplastic reduction group, as were rates of some surgical complications (hematoma, seroma, and tissue debridement). However, undergoing oncoplastic reduction did not impact time to adjuvant radiation ( P = 0.194) and protected against positive margins requiring repeat lumpectomy or completion mastectomy ( P < 0.001). CONCLUSIONS: In patients undergoing breast conservation therapy, simultaneous oncoplastic reduction decreased occurrence of positive margins and did not impact time to adjuvant radiation therapy despite increased rates of surgical and nonsurgical complications.


Assuntos
Neoplasias da Mama , Adulto , Humanos , Feminino , Pessoa de Meia-Idade , Idoso , Radioterapia Adjuvante/efeitos adversos , Neoplasias da Mama/radioterapia , Neoplasias da Mama/cirurgia , Neoplasias da Mama/complicações , Seroma , Mastectomia/efeitos adversos , Estudos Retrospectivos , Margens de Excisão , Complicações Pós-Operatórias/etiologia
16.
Ann Plast Surg ; 89(6): 656-659, 2022 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-36416694

RESUMO

ABSTRACT: The analgesic efficacy of bilateral low thoracic erector spinae blocks for combined major breast and abdominal surgery has not been reported. The aim of this case series was to assess the feasibility and efficacy of T8 thoracic preincisional erector spinae blocks in patients undergoing total radical mastectomies with axillary lymph node dissections in addition to reconstruction with abdominal deep inferior epigastric flaps. The aim was to supply dermatomal coverage to provide analgesia for T2-L1 that formed the basis for an opioid-sparing multimodal technique in the context of our early recovery after breast surgery with deep inferior epigastric flap program.


Assuntos
Neoplasias da Mama , Bloqueio Nervoso , Retalho Perfurante , Humanos , Feminino , Mastectomia Simples , Mastectomia , Neoplasias da Mama/cirurgia , Estudos de Viabilidade , Mastectomia Radical , Bloqueio Nervoso/métodos , Ultrassonografia de Intervenção
17.
Ann Plast Surg ; 89(6): 694-702, 2022 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-36416706

RESUMO

OBJECTIVE: The aim of the study is to determine rates of overall complications and failure of prepectoral breast reconstruction between various types of acellular dermal matrices (ADMs). BACKGROUND: Implant-based breast reconstruction is the most common reconstructive technique after mastectomy in the United States. Traditionally, the reconstruction has been performed in the subpectoral plane; however, there has been an emerging interest in prepectoral reconstruction using ADM. Human (hADM), porcine (pADM), and bovine (bADM) ADMs are available for use, but little is known about the benefits and complication profiles of each for prepectoral breast reconstruction. METHODS: Studies examining complications after the use of ADM for prepectoral breast reconstruction were identified using MEDLINE, Embase, the Cochrane Library, LILACS, and the Web of Science from January 2010 to August 2021. Titles and abstracts of 1838 studies were screened, followed by full-text screening of 355 articles. Thirty-three studies were found to meet inclusion criteria. RESULTS: From the 33 studies, 6046 prepectoral reconstructions were examined. Implant loss was comparable across the different types of ADM (pADM, 4.0%; hADM, 4.0%; bADM, 3.7%). Bovine ADM had the highest rate of capsular contracture (6.1%), infection (9.0%), skin flap necrosis (8.3%), dehiscence (5.4%), and hematoma (6.1%) when compared with both hADM and pADM. Human ADM had the highest rate of postoperative seroma (5.3%), followed by pADM (4.6%) and bADM (4.5%). CONCLUSIONS: Among the prepectoral breast reconstruction studies using hADM, pADM, or bADM included in our analysis, complication profiles were similar. Bovine ADM had the highest proportion of breast complications in the following categories: capsular contracture, infection rate, skin flap necrosis, dehiscence, and hematoma. Implant loss was comparable across the cohorts. Overall, prepectoral breast reconstruction using ADM leads to relatively low complication rates with the highest rates within the bADM cohort.


Assuntos
Derme Acelular , Implantes de Mama , Neoplasias da Mama , Contratura , Mamoplastia , Humanos , Bovinos , Animais , Suínos , Estados Unidos , Feminino , Mastectomia/métodos , Neoplasias da Mama/cirurgia , Mamoplastia/métodos , Complicações Pós-Operatórias/epidemiologia , Hematoma , Necrose
20.
Rev Assoc Med Bras (1992) ; 68(11): 1504-1508, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36449765

RESUMO

OBJECTIVE: Breast cancer is a leading cause of death not only in the young population but also in the elderly. There are no consensus treatment guidelines for elderly breast cancer patients. We purposed to discuss surgical treatment options for breast cancer cases over 80 years concerning morbidity and mortality. METHODS: This retrospective study includes 58 patients over 80 years of age at the time of surgery for breast cancer between 2006 and 2017. A sum of 58 cases (54 females and 4 males), over 80 years of age, with an average age of 84.5±4.07 (80-94) years were included in the study. The modified radical mastectomy was the most common surgical modality in 30 (51.7%) cases, and the axillary intervention was performed on 41 (70.7%). Axillary dissection and sentinel lymph node biopsy were performed for 30 (51.7%) and 11 (18.9%) cases, respectively. RESULTS: Minor and major complications were observed in 8 (13.8%) cases. The average follow-up period of the patients was 37.5 (1-120) months. During the follow-up period, breast cancer-related mortality was observed in 9 (15.52%) cases. No statistical differences were detected in mortality with/without axillary intervention and chosen surgical modality. CONCLUSIONS: Comorbidity, the American Society of Anesthesiologists score, and life expectancy should be considered in the management and surgical planning of patients over 80 years of age with breast cancer. Minimally invasive approaches should be preferred for the elderly whenever feasible and applicable in the light of oncologic surgery principles in order to reduce complications and mortality rates.


Assuntos
Neoplasias da Mama , Feminino , Masculino , Humanos , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/cirurgia , Estudos Retrospectivos , Mastectomia , Biópsia de Linfonodo Sentinela , Mama
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