Current practice and short-term outcomes of therapeutic mammaplasty in the international TeaM multicentre prospective cohort study
R. L. O'Connell
Department of Breast Surgery, Royal Marsden NHS Foundation Trust, Sutton, UK
Search for more papers by this authorE. Baker
Department of Breast Surgery, Airedale General Hospital, Keighley, UK
Search for more papers by this authorA. Trickey
Population Health Sciences, Bristol Medical School, Bristol, UK
Search for more papers by this authorT. Rattay
Leicester Cancer Research Centre, University of Leicester, Leicester, UK
Search for more papers by this authorL. Whisker
Nottingham Breast Institute, Nottingham University Hospitals NHS Trust, Nottingham, UK
Search for more papers by this authorR. D. Macmillan
Nottingham Breast Institute, Nottingham University Hospitals NHS Trust, Nottingham, UK
Search for more papers by this authorCorresponding Author
S. Potter
Population Health Sciences, Bristol Medical School, Bristol, UK
Bristol Breast Care Centre, North Bristol NHS Trust, Bristol, UK
Correspondence to: Miss S. Potter, Bristol Centre for Surgical Research, Population Health Sciences, Bristol Medical School, 2.14 Canynge Hall, Whatley Road, Bristol BS8 2PS, UK (e-mail: [email protected])Search for more papers by this authorthe TeaM Steering Group
Members of the TeaM Steering Group and Mammary Fold Academic and Research Collaborative are co-authors of this study and can be found under the heading CollaboratorsSearch for more papers by this authorthe Mammary Fold Academic and Research Collaborative
Members of the TeaM Steering Group and Mammary Fold Academic and Research Collaborative are co-authors of this study and can be found under the heading CollaboratorsSearch for more papers by this authorR. L. O'Connell
Department of Breast Surgery, Royal Marsden NHS Foundation Trust, Sutton, UK
Search for more papers by this authorE. Baker
Department of Breast Surgery, Airedale General Hospital, Keighley, UK
Search for more papers by this authorA. Trickey
Population Health Sciences, Bristol Medical School, Bristol, UK
Search for more papers by this authorT. Rattay
Leicester Cancer Research Centre, University of Leicester, Leicester, UK
Search for more papers by this authorL. Whisker
Nottingham Breast Institute, Nottingham University Hospitals NHS Trust, Nottingham, UK
Search for more papers by this authorR. D. Macmillan
Nottingham Breast Institute, Nottingham University Hospitals NHS Trust, Nottingham, UK
Search for more papers by this authorCorresponding Author
S. Potter
Population Health Sciences, Bristol Medical School, Bristol, UK
Bristol Breast Care Centre, North Bristol NHS Trust, Bristol, UK
Correspondence to: Miss S. Potter, Bristol Centre for Surgical Research, Population Health Sciences, Bristol Medical School, 2.14 Canynge Hall, Whatley Road, Bristol BS8 2PS, UK (e-mail: [email protected])Search for more papers by this authorthe TeaM Steering Group
Members of the TeaM Steering Group and Mammary Fold Academic and Research Collaborative are co-authors of this study and can be found under the heading CollaboratorsSearch for more papers by this authorthe Mammary Fold Academic and Research Collaborative
Members of the TeaM Steering Group and Mammary Fold Academic and Research Collaborative are co-authors of this study and can be found under the heading CollaboratorsSearch for more papers by this authorAbstract
Background
Therapeutic mammaplasty, which combines breast reduction and mastopexy techniques with tumour excision, may extend the boundaries of breast-conserving surgery and improve outcomes for patients, but current practice is unknown and high-quality outcome data are lacking. This prospective multicentre cohort study aimed to explore the practice and short-term outcomes of the technique.
Methods
Consecutive patients undergoing therapeutic mammaplasty at participating centres between 1 September 2016 and 30 June 2017 were recruited to the study. Demographic, preoperative, operative, oncological and complication data were collected. The primary outcome was unplanned reoperation for complications within 30 days of surgery. Secondary outcomes included re-excision rates and time to adjuvant therapy.
Results
Overall, 880 patients underwent 899 therapeutic mammaplasty procedures at 50 centres. The most common indications were avoidance of poor cosmetic outcomes associated with standard breast-conserving surgery (702 procedures, 78·1 per cent) or avoidance of mastectomy (379, 42·2 per cent). Wise-pattern skin incisions were the most common (429 of 899, 47·7 per cent), but a range of incisions and nipple–areola pedicles were used. Immediate contralateral symmetrization was performed in one-third of cases (284 of 880, 32·3 per cent). In total, 205 patients (23·3 per cent) developed a complication, but only 25 (2·8 per cent) required reoperation. Median postoperative lesion size was 24·5 (i.q.r. 16–38) mm. Incomplete excision was seen in 132 procedures (14·7 per cent), but completion mastectomy was required for only 51 lesions (5·7 per cent). Median time to adjuvant therapy was 54 (i.q.r. 42–66) days.
Conclusion
Therapeutic mammaplasty is a safe and effective alternative to mastectomy or standard breast-conserving surgery. Further work is required to explore the impact of the technique on quality of life, and to establish cost-effectiveness.
Supporting Information
| Filename | Description |
|---|---|
| bjs10959-sup-0001-AppendixS1.docxWord 2007 document , 16.3 KB |
Table S1 Complications at 30 days per breast and per patient Table S2 Multidisciplinary team decision-making and time to adjuvant therapy |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
References
- 1Fisher B, Anderson S, Bryant J, Margolese RG, Deutsch M, Fisher ER et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med 2002; 347: 1233–1241.
- 2Veronesi U, Cascinelli N, Mariani L, Greco M, Saccozzi R, Luini A et al. Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med 2002; 347: 1227–1232.
- 3Clough KB, Cuminet J, Fitoussi A, Nos C, Mosseri V. Cosmetic sequelae after conservative treatment for breast cancer: classification and results of surgical correction. Ann Plast Surg 1998; 41: 471–481.
- 4D'Aniello C, Grimaldi L, Barbato A, Bosi B, Carli A. Cosmetic results in 242 patients treated by conservative surgery for breast cancer. Scand J Plast Reconstr Surg Hand Surg 1999; 33: 419–422.
- 5Cochrane RA, Valasiadou P, Wilson AR, Al-Ghazal SK, Macmillan RD. Cosmesis and satisfaction after breast-conserving surgery correlates with the percentage of breast volume excised. Br J Surg 2003; 90: 1505–1509.
- 6Heil J, Holl S, Golatta M, Rauch G, Rom J, Marmé F et al. Aesthetic and functional results after breast conserving surgery as correlates of quality of life measured by a German version of the Breast Cancer Treatment Outcome Scale (BCTOS). Breast 2010; 19: 470–474.
- 7Waljee JF, Hu ES, Ubel PA, Smith DM, Newman LA, Alderman AK. Effect of esthetic outcome after breast-conserving surgery on psychosocial functioning and quality of life. J Clin Oncol 2008; 26: 3331–3337.
- 8Al-Ghazal SK, Fallowfield L, Blamey RW. Does cosmetic outcome from treatment of primary breast cancer influence psychosocial morbidity? Eur J Surg Oncol 1999; 25: 571–573.
- 9McCulley SJ, Macmillan RD. Planning and use of therapeutic mammoplasty – Nottingham approach. Br J Plast Surg 2005; 58: 889–901.
- 10Macmillan RD, James R, Gale KL, McCulley SJ. Therapeutic mammaplasty. J Surg Oncol 2014; 110: 90–95.
- 11Mansfield L, Agrawal A, Cutress RI. Oncoplastic breast conserving surgery. Gland Surg 2013; 2: 158–162.
- 12Piper M, Peled AW, Sbitany H. Oncoplastic breast surgery: current strategies. Gland Surg 2015; 4: 154–163.
- 13Bamford R, Sutton R, McIntosh J. Therapeutic mammoplasty allows for clear surgical margins in large and multifocal tumours without delaying adjuvant therapy. Breast 2015; 24: 171–174.
- 14Schaverien MV, Raine C, Majdak-Paredes E, Dixon JM. Therapeutic mammaplasty--extending indications and achieving low incomplete excision rates. Eur J Surg Oncol 2013; 39: 329–333.
- 15Crown A, Wechter DG, Grumley JW. Oncoplastic breast-conserving surgery reduces mastectomy and postoperative re-excision rates. Ann Surg Oncol 2015; 22: 3363–3368.
- 16Di Micco R, O'Connell RL, Barry PA, Roche N, MacNeill FA, Rusby JE. Standard wide local excision or bilateral reduction mammoplasty in large-breasted women with small tumours: surgical and patient-reported outcomes. Eur J Surg Oncol 2017; 43: 636–641.
- 17Harvey J, Henderson J, Patel L, Murphy J, Johnson R. Therapeutic mammaplasty – impact on the delivery of chemotherapy. Int J Surg 2014; 12: 51–55.
- 18Clough KB, van la Parra RFD, Thygesen HH, Levy E, Russ E, Halabi NM et al. Long-term results after oncoplastic surgery for breast cancer: a 10-year follow-up. Ann Surg 2018; 268: 165–171.
- 19De Lorenzi F, Hubner G, Rotmensz N, Bagnardi V, Loschi P, Maisonneuve P et al. Oncological results of oncoplastic breast-conserving surgery: long term follow-up of a large series at a single institution: a matched-cohort analysis. Eur J Surg Oncol 2016; 42: 71–77.
- 20Khan J, Barrett S, Forte C, Stallard S, Weiler-Mithoff E, Doughty JC et al. Oncoplastic breast conservation does not lead to a delay in the commencement of adjuvant chemotherapy in breast cancer patients. Eur J Surg Oncol 2013; 39: 887–891.
- 21Mansell J, Weiler-Mithoff E, Stallard S, Doughty JC, Mallon E, Romics L. Oncoplastic breast conservation surgery is oncologically safe when compared to wide local excision and mastectomy. Breast 2017; 32: 179–185.
- 22Acea-Nebril B, Cereijo-Garea C, García-Novoa A, Varela-Lamas C, Builes-Ramírez S, Bouzón-Alejandro A et al. The role of oncoplastic breast reduction in the conservative management of breast cancer: complications, survival, and quality of life. J Surg Oncol 2017; 115: 679–686.
- 23Carter SA, Lyons GR, Kuerer HM, Bassett RL Jr, Oates S, Thompson A et al. Operative and oncologic outcomes in 9861 patients with operable breast cancer: single-institution analysis of breast conservation with oncoplastic reconstruction. Ann Surg Oncol 2016; 23: 3190–3198.
- 24Wijgman DJ, Ten Wolde B, van Groesen NR, Keemers-Gels ME, van den Wildenberg FJ, Strobbe LJ. Short term safety of oncoplastic breast conserving surgery for larger tumors. Eur J Surg Oncol 2017; 43: 665–671.
- 25Schaverien MV, Doughty JC, Stallard S. Quality of information reporting in studies of standard and oncoplastic breast-conserving surgery. Breast 2014; 23: 104–111.
- 26McIntosh J, O'Donoghue JM. Therapeutic mammaplasty – a systematic review of the evidence. Eur J Surg Oncol 2012; 38: 196–202.
- 27Haloua MH, Krekel NM, Winters HA, Rietveld DH, Meijer S, Bloemers FW et al. A systematic review of oncoplastic breast-conserving surgery: current weaknesses and future prospects. Ann Surg 2013; 257: 609–620.
- 28Iwuchukwu OC, Harvey JR, Dordea M, Critchley AC, Drew PJ. The role of oncoplastic therapeutic mammoplasty in breast cancer surgery – a review. Surg Oncol 2012; 21: 133–141.
- 29Yiannakopoulou EC, Mathelin C. Oncoplastic breast conserving surgery and oncological outcome: systematic review. Eur J Surg Oncol 2016; 42: 625–630.
- 30Piper ML, Esserman LJ, Sbitany H, Peled AW. Outcomes following oncoplastic reduction mammoplasty: a systematic review. Ann Plast Surg 2016; 76(Suppl 3): S222–S226.
- 31De La Cruz L, Blankenship SA, Chatterjee A, Geha R, Nocera N, Czerniecki BJ et al. Outcomes after oncoplastic breast-conserving surgery in breast cancer patients: a systematic literature review. Ann Surg Oncol 2016; 23: 3247–3258.
- 32Yoon JJ, Green WR, Kim S, Kearney T, Haffty BG, Eladoumikdachi F et al. Oncoplastic breast surgery in the setting of breast-conserving therapy: a systematic review. Adv Radiat Oncol 2016; 1: 205–215.
- 33Campbell EJ, Romics L. Oncological safety and cosmetic outcomes in oncoplastic breast conservation surgery, a review of the best level of evidence literature. Breast Cancer (Dove Med Press) 2017; 9: 521–530.
- 34Losken A, Dugal CS, Styblo TM, Carlson GW. A meta-analysis comparing breast conservation therapy alone to the oncoplastic technique. Ann Plast Surg 2014; 72: 145–149.
- 35Baker E, Kim B, Rattay T, Williams K, Ives C, Remoundos D et al. The TeaM (Therapeutic Mammaplasty) study: protocol for a prospective multi-centre cohort study to evaluate the practice and outcomes of therapeutic mammaplasty. Int J Surg Protoc 2016; 1: 3–10.
- 36Obeid JS, McGraw CA, Minor BL, Conde JG, Pawluk R, Lin M et al. Procurement of shared data instruments for Research Electronic Data Capture (REDCap). J Biomed Inform 2013; 46: 259–265.
- 37Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap) – a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009; 42: 377–381.
- 38 Association of Breast Surgery and British Association of Plastic Reconstructive and Aesthetic Surgeons. Oncoplastic Breast Reconstruction: Guidelines for Best Practice, R Rainsbury, A Willett (eds); 2012. http://www.bapras.org.uk/docs/default-source/commissioning-and-policy/final-oncoplastic-guidelines---healthcare-professionals.pdf?sfvrsn=0 [accessed 9 July 2018].
- 39 National Institute for Health and Care Excellence (NICE). Breast Cancer (Early and Locally Advanced): Diagnosis and Treatment. NICE: London, 2009.
- 40Vohra RS, Spreadborough P, Johnstone M, Marriott P, Bhangu A, Alderson D et al.; West Midlands Research Collaborative. Protocol for a multicentre, prospective, population-based cohort study of variation in practice of cholecystectomy and surgical outcomes (The CholeS study). BMJ Open 2015; 5: e006399.
- 41Hartmann-Johnsen OJ, Kåresen R, Schlichting E, Nygård JF. Better survival after breast-conserving therapy compared to mastectomy when axillary node status is positive in early-stage breast cancer: a registry-based follow-up study of 6387 Norwegian women participating in screening, primarily operated between 1998 and 2009. World J Surg Oncol 2017; 15: 118.
- 42Lagendijk M, van Maaren MC, Saadatmand S, Strobbe LJA, Poortmans PMP, Koppert LB et al. Breast conserving therapy and mastectomy revisited: breast cancer-specific survival and the influence of prognostic factors in 129 692 patients. Int J Cancer 2018; 142: 165–175.
- 43Christiansen P, Carstensen SL, Ejlertsen B, Kroman N, Offersen B, Bodilsen A et al. Breast conserving surgery versus mastectomy: overall and relative survival–a population based study by the Danish Breast Cancer Cooperative Group (DBCG). Acta Oncol 2018; 57: 19–25.
- 44Tong WM, Baumann DP, Villa MT, Mittendorf EA, Liu J, Robb GL et al. Obese women experience fewer complications after oncoplastic breast repair following partial mastectomy than after immediate total breast reconstruction. Plast Reconstr Surg 2016; 137: 777–791.
- 45Kelsall JE, McCulley SJ, Brock L, Akerlund MTE, Macmillan RD. Comparing oncoplastic breast conserving surgery with mastectomy and immediate breast reconstruction: case-matched patient reported outcomes. J Plast Reconstr Aesthet Surg 2017; 70: 1377–1385.
- 46 The Breast Reconstruction Research Collaborative. Does immediate breast reconstruction delay delivery of adjuvant treatment? First results of the iBRA-2 prospective multicentre cohort study. Eur J Surg Oncol 2017; 43: 2204.
10.1016/j.ejso.2017.10.077 Google Scholar
- 47Jeevan R, Cromwell DA, Trivella M, Lawrence G, Kearins O, Pereira J et al. Reoperation rates after breast conserving surgery for breast cancer among women in England: retrospective study of hospital episode statistics. BMJ 2012; 345: e4505.
- 48Wilke LG, Czechura T, Wang C, Lapin B, Liederbach E, Winchester DP et al. Repeat surgery after breast conservation for the treatment of stage 0 to II breast carcinoma: a report from the National Cancer Data Base, 2004-2010. JAMA Surg 2014; 149: 1296–1305.
- 49Losken A, Hart AM, Chatterjee A. Updated evidence on the oncoplastic approach to breast conservation therapy. Plast Reconstr Surg 2017; 140(Suppl 5S): 14S–22S.
- 50Clough KB, Kaufman GJ, Nos C, Buccimazza I, Sarfati IM. Improving breast cancer surgery: a classification and quadrant per quadrant atlas for oncoplastic surgery. Ann Surg Oncol 2010; 17: 1375–1391.
- 51Weber WP, Soysal SD, Zeindler J, Kappos EA, Babst D, Schwab F et al. Current standards in oncoplastic breast conserving surgery. Breast 2017; 34(Suppl 1): S78–S81.
- 52Weber WP, Soysal SD, El-Tamer M, Sacchini V, Knauer M, Tausch C et al. First international consensus conference on standardization of oncoplastic breast conserving surgery. Breast Cancer Res Treat 2017; 165: 139–149.
- 53Weber WP, Soysal SD, Fulco I, Barandun M, Babst D, Kalbermatten D et al. Standardization of oncoplastic breast conserving surgery. Eur J Surg Oncol 2017; 43: 1236–1243.
- 54Potter S, Holcombe C, Ward JA, Blazeby JM; BRAVO Steering Group. Development of a core outcome set for research and audit studies in reconstructive breast surgery. Br J Surg 2015; 102: 1360–1371.
- 55Pusic AL, Klassen AF, Scott AM, Klok JA, Cordeiro PG, Cano SJ. Development of a new patient-reported outcome measure for breast surgery: the BREAST-Q. Plast Reconstr Surg 2009; 124: 345–353.
- 56Duxbury PJ, Gandhi A, Kirwan CC, Jain Y, Harvey JR. Current attitudes to breast reconstruction surgery for women at risk of post-mastectomy radiotherapy: a survey of UK breast surgeons. Breast 2015; 24: 502–512.
