Practical oncoplastic surgery techniques needed for practice.

Oncoplastic breast surgery (OPS) is a form of breast conservation surgery that includes immediate breast reconstruction. OPS has previously been shown to be a safe and effective treatment for breast cancer. In a special series on Breast Reconstruction, we aimed to describe oncoplastic breast reconstruction options and the corresponding technical details. Sections were divided by descriptions of OPS specific preoperative workup, volume displacement techniques, volume replacement techniques, and postoperative considerations. In addition, to sharing expert surgical pearls gained through performing OPS procedures over the years. Innovations in breast reconstruction offer women treatment options that are both oncologically safe and aesthetically preferred. The rise in reconstructive procedures is changing how patients make decisions based on their diagnosis. The ultimate surgical decision should be determined by the patient's anatomy, patient's personal preferences, tumor characteristics, and clinical presentation in a shared decision-making fashion with a multidisciplinary team. However, with both volume displacement and volume replacement techniques, women of all breast sizes can achieve an aesthetic outcome without sacrificing oncologic resection.

Oncoplastic Surgery in the Large-Breasted Breast Cancer gene Patient: A Staged Step to Enable Nipple Sparing Mastectomy.

Patients with macromastia and/or moderate-severe ptosis who desire mastectomy are typically offered skin sparing mastectomies. Recent technical advances have broadened the inclusion criteria to allow for nipple sparing mastectomy (NSM) in this population; however, they have been limited to patients with unifocal disease. We report on the multidisciplinary approach used to offer a NSM to a patient with multicentric triple-negative breast cancer and symptomatic macromastia with severe ptosis in the setting of positive genetic testing. We discuss the combination of a staged oncoplastic approach with neoadjuvant and adjuvant chemotherapy, as well as the foundations of these approaches. We encourage further research and inclusion of patients such as ours in the criteria for NSM.

Immediate breast reconstruction for women having inflammatory breast cancer in the United States.

Inflammatory breast cancer (IBC) is an aggressive malignancy having a poor prognosis. Traditionally, reconstruction is not offered due to concerns about treatment delay, margin positivity, recurrence, and poor long-term survival. There is a paucity of literature, however, evaluating whether immediate breast reconstruction (IBR) is associated with greater mortality in patients with IBC. A population-based study was conducted via the SEER-Medicare-linked database (1991-2009). Female patients greater than 65 years were reviewed who had mastectomy and reconstruction claims for nonmetastatic IBC. Competing risk and Cox regression were used to assess whether IBR was associated with higher breast cancer-specific mortality (BCSM) or overall mortality (OM). Among 552 936 patients, 1472 (median age 74 years) were diagnosed with IBC and had a mastectomy. Forty-four patients (3%) underwent IBR. Younger age, a lower Charlson comorbidity score, and a greater median income were predictors of IBR use. Tumor grade, hormone receptor status, and lymph node status were independent predictors of adjusted OM and BCSM. There was no difference by IBR status in BCSM or covariate-adjusted BCSM (sHR 1.04; CI 0.71-1.54; P = .83 and sHR 1.13; CI 0.84-1.93; P = .58, respectively). Cumulative incidence of OM was lower among IR patients (P = .013), and IR did not influence the cumulative incidence of BCSM (P = .91). IBR was not associated with increased overall and BCSM mortality. Although further study of IBR in the IBC setting may be of value, these data suggest that IBC should not be considered an absolute contraindication to IBR.

Invasive mucinous carcinoma arising in ectopic axillary breast tissue: a case report and literature review.

BACKGROUND: Invasive mucinous carcinoma arising in ectopic axillary breast tissue is an uncommon diagnosis. While some published medical literature makes recommendations regarding the management of ectopic primaries, many of these recommendations are outdated. We therefore hope to provide general guidance with the management of this rare entity. CASE REPORT: We report a case of a 70-year-old woman with primary invasive mucinous carcinoma of ectopic breast tissue. A literature study was performed on primary ectopic breast carcinoma. This case report with review of the literature was performed to provide rationales for a more conservative treatment based upon current data and treatment paradigms. Although the diagnosis of primary ectopic breast carcinoma is uncommon, the presence of a suspicious nodule along the mammary ridge should alert the clinician to consider the possibility of this diagnosis. A mammogram and ultrasound of the nodule were performed and the suspicious nodule was biopsied, confirming the diagnosis. Breast conservation was performed with standard nodal evaluation. CONCLUSIONS: The management of primary ectopic breast carcinoma should be based upon current breast conservation techniques of orthotopic breast cancer. Current data suggest that standard treatment paradigms remain applicable to this rare clinical entity.