Optimizing delivery of breast conservation therapy

A multidisciplinary approach to oncoplastic surgery

Michelle C. Roughton, Deana Shenaq, Nora Jaskowiak, Julie Park, David H. Song

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

BACKGROUND: For patients with small breasts relative to tumor size and for those with tumors in the central or inferior poles, lumpectomy can be aesthetically devastating. The field of oncoplastic surgery has developed to offset the aesthetic pitfalls of breast conservation. Questions remain regarding oncologic safety, potential complications, and patient selection. In this study, we report our institutional, multidisciplinary experience with oncoplastic surgery. METHODS: A retrospective review was performed including all patients at our institution undergoing oncoplastic breast surgery between 2003 and September 2009 at an academic medical center. Mean follow-up period was 38 months. All patients were referred by the institutional multidisciplinary breast team. RESULTS: Forty-five female patients underwent 46 oncoplastic breast reconstructions. Immediate reconstruction was performed in 21 patients, early (within 9 to 73 days of final tumor resection) in 18, and delayed (following completion of radiation) in 6. Three patients (14%) who underwent immediate oncoplastic reconstruction had positive margins on final pathology and proceeded to completion mastectomy. No local cancer recurrence was seen. Two patients developed distant metastatic disease. Twelve complications occurred in 11 patients; by group, 2 (10%) in immediate, 7 (39%) in delayed-immediate group, and 2 (33%) in delayed. Immediate oncoplastic reconstruction, performed as a single-stage procedure, inversely correlated with complication risk (P = 0.059). No other risk factor correlated with complications. CONCLUSIONS: Our review suggests this multidisciplinary approach to oncoplastic surgery is safe. Interestingly, women undergoing immediate oncoplastic reconstruction trended toward a lower rate of complications. The benefit of immediate reconstruction must be balanced by risk of positive tumor margin and subsequent necessity for completion mastectomy. This risk-benefit balance may be best delivered by a multidisciplinary team focused on all aspects of breast cancer care.

Original languageEnglish (US)
Pages (from-to)250-255
Number of pages6
JournalAnnals of Plastic Surgery
Volume69
Issue number3
DOIs
StatePublished - Sep 1 2012
Externally publishedYes

Fingerprint

Segmental Mastectomy
Breast
Mastectomy
Neoplasms
Mammaplasty
Esthetics
Patient Selection
Radiation
Pathology
Breast Neoplasms
Safety
Recurrence

Keywords

  • breast cancer
  • breast conservation therapy
  • multidisciplinary
  • oncoplastic surgery
  • radiation
  • reconstruction

ASJC Scopus subject areas

  • Surgery

Cite this

Optimizing delivery of breast conservation therapy : A multidisciplinary approach to oncoplastic surgery. / Roughton, Michelle C.; Shenaq, Deana; Jaskowiak, Nora; Park, Julie; Song, David H.

In: Annals of Plastic Surgery, Vol. 69, No. 3, 01.09.2012, p. 250-255.

Research output: Contribution to journalArticle

Roughton, Michelle C. ; Shenaq, Deana ; Jaskowiak, Nora ; Park, Julie ; Song, David H. / Optimizing delivery of breast conservation therapy : A multidisciplinary approach to oncoplastic surgery. In: Annals of Plastic Surgery. 2012 ; Vol. 69, No. 3. pp. 250-255.
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abstract = "BACKGROUND: For patients with small breasts relative to tumor size and for those with tumors in the central or inferior poles, lumpectomy can be aesthetically devastating. The field of oncoplastic surgery has developed to offset the aesthetic pitfalls of breast conservation. Questions remain regarding oncologic safety, potential complications, and patient selection. In this study, we report our institutional, multidisciplinary experience with oncoplastic surgery. METHODS: A retrospective review was performed including all patients at our institution undergoing oncoplastic breast surgery between 2003 and September 2009 at an academic medical center. Mean follow-up period was 38 months. All patients were referred by the institutional multidisciplinary breast team. RESULTS: Forty-five female patients underwent 46 oncoplastic breast reconstructions. Immediate reconstruction was performed in 21 patients, early (within 9 to 73 days of final tumor resection) in 18, and delayed (following completion of radiation) in 6. Three patients (14{\%}) who underwent immediate oncoplastic reconstruction had positive margins on final pathology and proceeded to completion mastectomy. No local cancer recurrence was seen. Two patients developed distant metastatic disease. Twelve complications occurred in 11 patients; by group, 2 (10{\%}) in immediate, 7 (39{\%}) in delayed-immediate group, and 2 (33{\%}) in delayed. Immediate oncoplastic reconstruction, performed as a single-stage procedure, inversely correlated with complication risk (P = 0.059). No other risk factor correlated with complications. CONCLUSIONS: Our review suggests this multidisciplinary approach to oncoplastic surgery is safe. Interestingly, women undergoing immediate oncoplastic reconstruction trended toward a lower rate of complications. The benefit of immediate reconstruction must be balanced by risk of positive tumor margin and subsequent necessity for completion mastectomy. This risk-benefit balance may be best delivered by a multidisciplinary team focused on all aspects of breast cancer care.",
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