Breast Cancer Clinical Trial
Official title:
Role of Oncoplastic Breast Surgery In Breast Cancer Treatement
Role of Oncoplastic Breast Surgery In Breast Cancer Treatement
Breast cancer is the most common cancer in women throughout the world (FerlayJ.,2010) .
The overarching principle guiding surgical management of women with breast cancer remains the
oncological safety. The mainstay of satisfactory local control continues to be adequate
clearance of the primary tumour and involved axillary lymph nodes. Improvements in
understanding of tumour biology have enabled the risk of loco-regional recurrence and distant
events to be further reduced by adjuvant, or neo-adjuvant, radiotherapy and systemic
treatments. In keeping with this, breast conserving therapy has become well established as
the treatment of choice for most women with early breast cancer . However, approximately
one-third of women still undergo mastectomy, either due to patient preference or in cases
where breast conservation is not oncologically or aesthetically compatible with the size or
distribution of disease. (Reefy et al; 2010)
The primary aim of BCS is preservation of the breast while adhering to oncologic principles,
with the secondary objective to provide breast aesthetics. In recent years, with advances in
early detection and adjuvant therapy life expectancy has prolonged in breast cancer prolonged
and quality of life issues have gained importance (Veiga DF.,2010)
Skin sparing mastectomy involves the en-bloc removal of all glandular tissue including the
nipple-areola complex and in some cases adjacent biopsy scars and skin overlying superficial
tumours. In contrast to conventional mastectomy, there is maximal preservation of the
remaining breast skin envelope and infra-mammary fold that facilitate immediate breast
reconstruction with autologous tissue and/or prosthetic implants by utilising the native skin
envelope to optimise the contour, texture, colour and scarring of the reconstructed breast.
(Cunnick and Mokbel; 2004).
Due to the positive results obtained in the surgical treatment of breast cancer, the
prevalence of this technique is increasing throughout the world and our country. There was an
approximately 2.3-fold increase in OBS publications over the last five years (Losken A et
al.,2014)
Surgical planning and timing of reconstruction should include breast volume, tumor location,
the extent of glandular tissue resected, enabling each patient to receive an individual
"custom-made" reconstruction. With immediate oncoplastic approach, the surgical process is
smooth since oncological and reconstructive surgery can be associated in one operative
setting. Additionally, because there is no scar and fibrosis tissue, breast reshaping is
easier, and the aesthetic is improved (Munhoz AM et al .,2011) When considering a patient for
an oncoplastic breast conserving procedure, the following points must be considered:
1. volume of tissue to be excised;
2. tumour location;
3. breast size and glandular density;
4. patient related risk factors, particularly smoking, obesity, diabetes, previous surgery;
5. adjuvant therapies. Excision volume is the single, most predictive factor for breast
deformity (Clough KB et al .,2010).
Recently, several studies have contributed to the evidence base supporting the oncological
adequacy of skin sparing mastectomy in selected early-stage breast cancer , excluding
inflammatory breast cancer and tumours with extensive involvement of the skin. In this study
the oncological safety, post-operative morbidity and patients' satisfaction with skin sparing
mastectomy and immediate breast reconstruction will be evaluated in a prospective cohort of
women with early-stage breast cancer. (Cunnick and Mokbel; 2004) Skin sparing mastectomy and
immediate breast reconstruction is particularly attractive for women with ductal Carcinoma
In-Situ in view of the fact that post-mastectomy radiotherapy is not given to the
reconstructed breast and the risk of loco-regional recurrence is very low. (Spiegel and
Butler; 2003)
Most women who will undergo skin sparing mastectomy and immediate breast reconstruction for
early-stage breast cancer will not require post-mastectomy radiotherapy. However,
post-mastectomy radiotherapy has been shown to reduce loco-regional recurrence and improve
survival for patients with three or more involved regional lymph nodes or tumors >5 cm.
(Recht and Edge; 2003) Mastectomy can also be indicated in several non-invasive conditions.
Ductal Carcinoma In-Situ may necessitate mastectomy when the lesions are extensive,
multi-centric or recurrent, however, patients request to be managed in this way. Mastectomy
for ductal Carcinoma In-Situ is associated with cure rates in excess of 98%. (Mokbel; 2003)
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