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Anees B Chagpar - One of the best experts on this subject based on the ideXlab platform.

  • abstract pd8 07 does resection of cavity shave margins result in lower positive margin and re excision rates in patients with stage 0 iii breast cancer results from a prospective multicenter randomized controlled trial
    Cancer Research, 2019
    Co-Authors: Anees B Chagpar, Theodore N Tsangaris, Carlos Garciacantu, Marissa Howardmcnatt, Akiko Chiba, A C Berger, E Levine, J S Gass, K Gallagher, Sharon S Lum
    Abstract:

    INTRODUCTION: Routine resection of cavity shave margins has been shown in single center studies to result in a significant reduction in positive margin and re-excision rates. In this prospective multicenter randomized controlled trial, we sought to validate these findings across practice settings. METHODS: Nine centers across the United States, varying in practice setting and patient population, participated in this clinical trial of 398 stage 0-III breast cancer patients undergoing Partial Mastectomy (with or without resection of selective cavity margins). Participants were stratified by clinical stage and randomized 1:1 to either have routine cavity shave margins resected (“shave”) or not (“no shave”). Randomization group was revealed to the surgeon intraoperatively, after they had completed their standard Partial Mastectomy and were ready to close. Positive margins were defined as “tumor at ink” for invasive cancer or within 2 mm for ductal carcinoma in situ (DCIS). Adverse events were defined as seromas requiring percutaneous drainage, and/or hematomas or abscesses requiring operative intervention. RESULTS: Median patient age was 65 (range; 29-94). 116 patients had invasive disease, 74 had DCIS, 179 had both, and 29 had no residual cancer at the time of Partial Mastectomy. The median invasive cancer size was 1.2 cm (range; 0.05-8.00 cm); the median extent of DCIS was 0.9 cm (range; 0.05-6.40 cm). The “shave” and “no shave” groups were well matched at baseline for clinicopathologic and demographic factors. Prior to randomization, positive margin rates were similar in the “shave” and “no shave” groups (38.1% vs. 37.3%, respectively, p=0.918). After randomization, however, those in the “shave” group were significantly less likely than those in the “no shave” group to have positive margins (8.6% vs. 37.3%, respectively, p CONCLUSION: Resection of cavity shave margins significantly reduces positive margin and re-excision rates in patients with stage 0-III breast cancer undergoing Partial Mastectomy. Citation Format: Chagpar AB, Tsangaris T, Garcia-Cantu C, Howard-McNatt M, Chiba A, Berger AC, Levine E, Gass JS, Gallagher K, Lum SS, Martinez RD, Willis AI, Pandya SV, Brown EA, Fenton A, Mendiola A, Murray M, Haddad V, Solomon NL, Senthil M, Bansil H, Ollila D, Snyder SK, Edmonson D, Lazar M, Namm JP, Li F, Butler M, McGowan NE, Herrera ME, Avitan YP, Yoder B, Dupont E. Does resection of cavity shave margins result in lower positive margin and re-excision rates in patients with stage 0-III breast cancer? Results from a prospective multicenter randomized controlled trial [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr PD8-07.

  • do all positive margins in breast cancer patients undergoing a Partial Mastectomy need to be resected
    Journal of The American College of Surgeons, 2018
    Co-Authors: Anees B Chagpar, Theodore N Tsangaris, Donald R Lannin
    Abstract:

    Background Positive margins have been reported in 20% to 40% of patients undergoing a Partial Mastectomy, often resulting in re-excision. How often the re-excision yields additional cancer and whether there are predictors of residual disease remain unknown. Study Design Patients who had a positive margin (defined as tumor at ink for patients with invasive disease or within 1 mm for patients with ductal carcinoma in situ) in the SHAVE (A Randomized Controlled Trial of Routine Shave Margins Versus Standard Partial Mastectomy in Breast Cancer Patients) trial before randomization were evaluated to determine the rate of additional disease either in cavity shave margins or at re-excision. Details of the SHAVE trial can be found elsewhere. Results Of the 235 patients in the trial, 82 (34.9%) had a positive margin before randomization; 58 of these patients underwent either cavity shave margins excision or a re-excision of the positive margin(s). Twenty-one (36.2%) patients had residual disease. On bivariate analysis, residual disease was associated with younger patient age (median 51 vs 62 years; p = 0.007), and the presence of high-grade ductal carcinoma in situ (57.1% vs 31.3% for grade 2 and 0% for grade 1; p = 0.025). The following factors were not associated with further disease: patient race; ethnicity; BMI; volume of resection; number of positive margins; extent of ductal carcinoma in situ; and extent, grade, and histologic subtype of invasive cancer. On multivariate analysis, only patient age younger than 60 years remained a significant predictor of residual disease (odds ratio 3.920; 95% CI 1.081 to 14.220; p = 0.038). Conclusions Positive margins are associated with further disease in more than one-third of patients and, aside from young age, there are no predictors of this. These findings support continued re-excision of positive margins, particularly in patients younger than 60 years of age.

  • economic impact of routine cavity margins versus standard Partial Mastectomy in breast cancer patients results of a randomized controlled trial
    Annals of Surgery, 2017
    Co-Authors: Anees B Chagpar, Karen Stavris, Brigid K Killelea, Theodore N Tsangaris, Nina R Horowitz, Peter Longley, Sonia Grizzle, Michael Loftus, Meghan Butler, Xiaopan Yao
    Abstract:

    Objective:The aim of the study was to compare costs associated with excision of routine cavity shave margins (CSM) versus standard Partial Mastectomy (PM) in patients with breast cancer.Background:Excision of CSM reduces re-excision rates by more than 50%. The economic implications of this is, howev

  • can routine cavity shave margins csm improve local control in breast cancer initial results of the shave trial a prospective randomized controlled trial of routine csm vs standard Partial Mastectomy spm
    Journal of Clinical Oncology, 2015
    Co-Authors: Anees B Chagpar, Karen Stavris, Brigid K Killelea, Theodore N Tsangaris, Meghan Butler, Xiaopan Yao, Veerle Bossuyt, Lajos Pusztai, Nina R Horowitz
    Abstract:

    1012 Background: Considerable controversy exists regarding the utility of routine CSM in patients undergoing Partial Mastectomy for breast cancer. We performed a prospective RCT to determine whethe...

  • shave a randomized controlled trial of routine shave margins versus standard Partial Mastectomy
    Journal of Clinical Oncology, 2013
    Co-Authors: Anees B Chagpar, Karen Stavris, Brigid K Killelea, Theodore N Tsangaris, Nina R Horowitz
    Abstract:

    TPS1145 Background: It is well known that Partial Mastectomy for breast cancer is associated with a positive margin rate of 20-40% in most series. This has led some surgeons to advocate for routine...

Theodore N Tsangaris - One of the best experts on this subject based on the ideXlab platform.

  • abstract ps1 15 does breast cancer subtype impact margin status in patients undergoing Partial Mastectomy
    Cancer Research, 2021
    Co-Authors: Andrew Fenton, Theodore N Tsangaris, Elisabeth Dupont, Carlos Garciacantu, Marissa Howardmcnatt, Akiko Chiba, Adam C Berger, Edward A Levine, Jennifer Gass, Kristalyn K Gallagher
    Abstract:

    BACKGROUND: It is known that breast cancer subtype (e.g., luminal vs. triple negative (TN)) can affect response to systemic therapy and prognosis; however, it is less well-understood whether these subtypes affect margin status and should therefore alter surgical management. METHODS: Data from two randomized trials evaluating cavity shave margins (CSM) on margin status in patients undergoing Partial Mastectomy (PM) were used for this analysis. The data were restricted to patients who had invasive carcinoma present in the PM specimen, and in whom data for all three receptors (ER, PR and HER-2) were known. Patients were classified as luminal if they were ER and/or PR+, HER-2 enriched if they were ER and PR negative but HER-2 positive, and TN if they were negative for all three receptors. We evaluated the impact of subtype on the margin status at the time the surgeon had completed their standard PM, prior to randomization to CSM vs. no CSM. Non-parametric statistical analyses were performed using SPSS Version 26. RESULTS: 350 patients were included in this cohort for analysis. The median patient age was 64 (range; 32-94 years) and the median invasive tumor size was 1.2 cm (range; 0.6-8.0 cm). 326 (93.1%) were luminal type, 22 (6.3%) were triple negative, and 2 (0.6%) were HER-2 enriched. Subtype was significantly correlated with race (black patients were more likely to have TN disease than white patients, 22.2% vs. 3.8%, p=0.001), palpability (TN tumors were more likely to be palpable than luminal cancers 54.5% vs. 29.8%, p=0.007) and grade (78.9% of TN cancers were high grade vs. 13.5% of luminal cancers p 0.05 for all). While patients with TN and HER-2 enriched tumors were more likely to receive neoadjuvant therapy, this did not reach statistical significance (p=0.117). Surgeons were no more likely to take selective margins on the basis of molecular subtype (p=0.413). In this cohort, the overall positive margin rate was 33.7%. This did not vary based on molecular subtype (positive margin rate: 33.7% for patients with luminal tumors vs. 36.4% for those with TN tumors, p=0.425). On multivariate regression controlling for molecular subtype, race, grade and palpability, the only factor which predicted positive margin status was grade (p=0.005), with high grade tumors being significantly more likely to have a positive margin than low grade tumors, independent of other factors (OR=3.503, 95% CI: 1.638-7.494, p=0.001). CONCLUSION: While molecular subtype correlates with race, tumor grade and palpability, it does not predict margin status. Therefore, molecular subtype should not, independent of other factors, influence surgical decision-making. Citation Format: Andrew Fenton, Elisabeth Dupont, Theodore Tsangaris, Carlos Garcia-Cantu, Marissa Howard-McNatt, Akiko Chiba, Adam Berger, Edward Levine, Jennifer Gass, Kristalyn Gallagher, Sharon Lum, Ricardo Martinez, Alliric Willis, Sonali Pandya, Eric Brown, Amanda Mendiola, Mary Murray, Naveenraj Solomon, Maheswari Senthil, David Ollila, David Edmonson, Melissa Lazar, Jukes Namm, Fangyong Li, Meghan Butler, Noreen McGowan, Maria Herrera, Yoana Avitan, Brian Yoder, Laura Walters, Tara McPartland, Victor Haddad, Hongwei Ma, Ming Xie, Anees Chagpar. Does breast cancer subtype impact margin status in patients undergoing Partial Mastectomy? [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS1-15.

  • abstract pd8 07 does resection of cavity shave margins result in lower positive margin and re excision rates in patients with stage 0 iii breast cancer results from a prospective multicenter randomized controlled trial
    Cancer Research, 2019
    Co-Authors: Anees B Chagpar, Theodore N Tsangaris, Carlos Garciacantu, Marissa Howardmcnatt, Akiko Chiba, A C Berger, E Levine, J S Gass, K Gallagher, Sharon S Lum
    Abstract:

    INTRODUCTION: Routine resection of cavity shave margins has been shown in single center studies to result in a significant reduction in positive margin and re-excision rates. In this prospective multicenter randomized controlled trial, we sought to validate these findings across practice settings. METHODS: Nine centers across the United States, varying in practice setting and patient population, participated in this clinical trial of 398 stage 0-III breast cancer patients undergoing Partial Mastectomy (with or without resection of selective cavity margins). Participants were stratified by clinical stage and randomized 1:1 to either have routine cavity shave margins resected (“shave”) or not (“no shave”). Randomization group was revealed to the surgeon intraoperatively, after they had completed their standard Partial Mastectomy and were ready to close. Positive margins were defined as “tumor at ink” for invasive cancer or within 2 mm for ductal carcinoma in situ (DCIS). Adverse events were defined as seromas requiring percutaneous drainage, and/or hematomas or abscesses requiring operative intervention. RESULTS: Median patient age was 65 (range; 29-94). 116 patients had invasive disease, 74 had DCIS, 179 had both, and 29 had no residual cancer at the time of Partial Mastectomy. The median invasive cancer size was 1.2 cm (range; 0.05-8.00 cm); the median extent of DCIS was 0.9 cm (range; 0.05-6.40 cm). The “shave” and “no shave” groups were well matched at baseline for clinicopathologic and demographic factors. Prior to randomization, positive margin rates were similar in the “shave” and “no shave” groups (38.1% vs. 37.3%, respectively, p=0.918). After randomization, however, those in the “shave” group were significantly less likely than those in the “no shave” group to have positive margins (8.6% vs. 37.3%, respectively, p CONCLUSION: Resection of cavity shave margins significantly reduces positive margin and re-excision rates in patients with stage 0-III breast cancer undergoing Partial Mastectomy. Citation Format: Chagpar AB, Tsangaris T, Garcia-Cantu C, Howard-McNatt M, Chiba A, Berger AC, Levine E, Gass JS, Gallagher K, Lum SS, Martinez RD, Willis AI, Pandya SV, Brown EA, Fenton A, Mendiola A, Murray M, Haddad V, Solomon NL, Senthil M, Bansil H, Ollila D, Snyder SK, Edmonson D, Lazar M, Namm JP, Li F, Butler M, McGowan NE, Herrera ME, Avitan YP, Yoder B, Dupont E. Does resection of cavity shave margins result in lower positive margin and re-excision rates in patients with stage 0-III breast cancer? Results from a prospective multicenter randomized controlled trial [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr PD8-07.

  • do all positive margins in breast cancer patients undergoing a Partial Mastectomy need to be resected
    Journal of The American College of Surgeons, 2018
    Co-Authors: Anees B Chagpar, Theodore N Tsangaris, Donald R Lannin
    Abstract:

    Background Positive margins have been reported in 20% to 40% of patients undergoing a Partial Mastectomy, often resulting in re-excision. How often the re-excision yields additional cancer and whether there are predictors of residual disease remain unknown. Study Design Patients who had a positive margin (defined as tumor at ink for patients with invasive disease or within 1 mm for patients with ductal carcinoma in situ) in the SHAVE (A Randomized Controlled Trial of Routine Shave Margins Versus Standard Partial Mastectomy in Breast Cancer Patients) trial before randomization were evaluated to determine the rate of additional disease either in cavity shave margins or at re-excision. Details of the SHAVE trial can be found elsewhere. Results Of the 235 patients in the trial, 82 (34.9%) had a positive margin before randomization; 58 of these patients underwent either cavity shave margins excision or a re-excision of the positive margin(s). Twenty-one (36.2%) patients had residual disease. On bivariate analysis, residual disease was associated with younger patient age (median 51 vs 62 years; p = 0.007), and the presence of high-grade ductal carcinoma in situ (57.1% vs 31.3% for grade 2 and 0% for grade 1; p = 0.025). The following factors were not associated with further disease: patient race; ethnicity; BMI; volume of resection; number of positive margins; extent of ductal carcinoma in situ; and extent, grade, and histologic subtype of invasive cancer. On multivariate analysis, only patient age younger than 60 years remained a significant predictor of residual disease (odds ratio 3.920; 95% CI 1.081 to 14.220; p = 0.038). Conclusions Positive margins are associated with further disease in more than one-third of patients and, aside from young age, there are no predictors of this. These findings support continued re-excision of positive margins, particularly in patients younger than 60 years of age.

  • economic impact of routine cavity margins versus standard Partial Mastectomy in breast cancer patients results of a randomized controlled trial
    Annals of Surgery, 2017
    Co-Authors: Anees B Chagpar, Karen Stavris, Brigid K Killelea, Theodore N Tsangaris, Nina R Horowitz, Peter Longley, Sonia Grizzle, Michael Loftus, Meghan Butler, Xiaopan Yao
    Abstract:

    Objective:The aim of the study was to compare costs associated with excision of routine cavity shave margins (CSM) versus standard Partial Mastectomy (PM) in patients with breast cancer.Background:Excision of CSM reduces re-excision rates by more than 50%. The economic implications of this is, howev

  • can routine cavity shave margins csm improve local control in breast cancer initial results of the shave trial a prospective randomized controlled trial of routine csm vs standard Partial Mastectomy spm
    Journal of Clinical Oncology, 2015
    Co-Authors: Anees B Chagpar, Karen Stavris, Brigid K Killelea, Theodore N Tsangaris, Meghan Butler, Xiaopan Yao, Veerle Bossuyt, Lajos Pusztai, Nina R Horowitz
    Abstract:

    1012 Background: Considerable controversy exists regarding the utility of routine CSM in patients undergoing Partial Mastectomy for breast cancer. We performed a prospective RCT to determine whethe...

Nina R Horowitz - One of the best experts on this subject based on the ideXlab platform.

Geoffrey L Robb - One of the best experts on this subject based on the ideXlab platform.

  • obese women experience fewer complications after oncoplastic breast repair following Partial Mastectomy than after immediate total breast reconstruction
    Plastic and Reconstructive Surgery, 2016
    Co-Authors: Winnie Tong, Steven J Kronowitz, Geoffrey L Robb, Donald P Baumann, Mark T Villa, Elizabeth A Mittendorf, Jun Liu, Patrick B Garvey
    Abstract:

    Background:The authors hypothesized that obese patients would experience fewer complications after oncoplastic breast reconstruction following Partial Mastectomy than after immediate breast reconstruction following total Mastectomy.Methods:Complication rates were compared for oncoplastic breast reco

  • immediate versus delayed repair of Partial Mastectomy defects in breast conservation
    Breast Cancer Research, 2009
    Co-Authors: Steven J Kronowitz, Kelly K Hunt, Henry Mark Kuerer, Eric A Strom, Thomas A Buchholz, Joe Ensor, Cindy Koutz, Geoffrey L Robb
    Abstract:

    The authors previously compared the local tissue rearrangement, breast reduction, and latissimus dorsi flap reconstruction techniques for repairing Partial Mastectomy defects and showed the benefits of breast reduction.

  • practical guidelines for repair of Partial Mastectomy defects using the breast reduction technique in patients undergoing breast conservation therapy
    Plastic and Reconstructive Surgery, 2008
    Co-Authors: Steven J Kronowitz, Kelly K Hunt, Henry Mark Kuerer, Eric A Strom, Thomas A Buchholz, Joe Ensor, Cindy Koutz, Geoffrey L Robb
    Abstract:

    Background The authors previously compared the local tissue rearrangement, breast reduction, and latissimus dorsi flap reconstruction techniques for repairing Partial Mastectomy defects and showed the benefits of breast reduction. Methods In this study, the authors focused solely on factors influencing outcome in 41 patients who underwent repair of a Partial Mastectomy defect using breast reduction. Results Tumor location had a significant effect on the design of the parenchymal pedicle (p = 0.05). Most repairs were performed with an inferior pedicle. Fifty percent of the lower outer and central quadrant tumors required an amputative design with a free nipple graft. The complication rates for immediate and delayed repair were 24 and 50 percent, respectively. The superior pedicle was associated with the highest complication rates. Tumors in the upper outer quadrant of the breast were associated with the highest complication rate (35 percent). Ninety percent of patients with planned repairs had a viable nipple-areola complex (p = 0.05) and did not require a free nipple graft. More favorable cosmetic outcomes were achieved using an inferior pedicle; less favorable cosmetic outcomes were achieved for tumors in the upper inner quadrant of the breast. Larger defects did not result in less favorable cosmetic outcomes than smaller defects. Only 7 percent of patients had a positive tumor margin. Five percent of patients developed local breast cancer recurrence after a mean follow-up of 36 months. Conclusion The authors provide practical guidelines for repairing a Partial Mastectomy defect using breast reduction that should minimize the occurrence of complications and optimize the cosmetic outcome.

  • determining the optimal approach to breast reconstruction after Partial Mastectomy
    Plastic and Reconstructive Surgery, 2006
    Co-Authors: Steven J Kronowitz, Kelly K Hunt, Henry Mark Kuerer, Cindy Koutz, Jules A Feledy, Adel Youssef, Geoffrey L Robb
    Abstract:

    Background: Unfortunately, patients who desire repair of contour deformities after Partial Mastectomy unually present after radiation therapy, which may increase the risk of complications an result in a poor aesthetic outcome. The authors reviewed their experience with repair of Partial Mastectomy defects to determine the optimal approach to breast reconstruction ater Partial Mastectomy. Methods: Sixty-nine patients who underwent repair of a Partial Mastectomy defect and received radiation therapy were included in this analysis. The reconstructive techniques were categorized as local tissue rearrangement (LTR), breast reduction, or use of a latissimus dorsi myocutaneous flap or thoracoepigastric skin flap (here-after referred to as flap). Results: fifty patients underwent immediate reconstruction before radiation therapy, and 19 underwent delayed rreconstruction after radiation therapy. The reconstructive techniques in patients with immediate reconstruction were local tissue rearrangement in 28 percent, breast reduction in 66 percent, and flaps in 6 percent. In patient with delayed reconstruction, 32 percent had local tissue rearrangement, 42 percent had breast reduction, and 26 percent had flaps. The complication rates for immediate and delayed reconstruction were 26 percent and 42 percent, respectively. Overall, and in the setting of immediate reconstruction, the flap technique was associated with a higher complication rate than local tissue rearrangement and breast reduction. However, in the setting of delayed reconstruction, the flap technique was associated with a lower complication rate than the other two techniques. Fifty-seven percent of the immediate reconstructions performed with the local tissue rearrangement or breast reduction technique, but only 33 percent of the immediate reconstructions performed with the flap technique, were associated with an excellent or good aesthetic outcome. Conclusion: Immediate repair of Partial Mastectomy defects with local tissues results in a lower risk of complications and better aesthetic outcomes than immediate repair of Partial Mastectomy defects with a latissimus dorsi flap.

Steven J Kronowitz - One of the best experts on this subject based on the ideXlab platform.

  • obese women experience fewer complications after oncoplastic breast repair following Partial Mastectomy than after immediate total breast reconstruction
    Plastic and Reconstructive Surgery, 2016
    Co-Authors: Winnie Tong, Steven J Kronowitz, Geoffrey L Robb, Donald P Baumann, Mark T Villa, Elizabeth A Mittendorf, Jun Liu, Patrick B Garvey
    Abstract:

    Background:The authors hypothesized that obese patients would experience fewer complications after oncoplastic breast reconstruction following Partial Mastectomy than after immediate breast reconstruction following total Mastectomy.Methods:Complication rates were compared for oncoplastic breast reco

  • immediate versus delayed repair of Partial Mastectomy defects in breast conservation
    Breast Cancer Research, 2009
    Co-Authors: Steven J Kronowitz, Kelly K Hunt, Henry Mark Kuerer, Eric A Strom, Thomas A Buchholz, Joe Ensor, Cindy Koutz, Geoffrey L Robb
    Abstract:

    The authors previously compared the local tissue rearrangement, breast reduction, and latissimus dorsi flap reconstruction techniques for repairing Partial Mastectomy defects and showed the benefits of breast reduction.

  • a management algorithm and practical oncoplastic surgical techniques for repairing Partial Mastectomy defects
    Plastic and Reconstructive Surgery, 2008
    Co-Authors: Steven J Kronowitz, Henry Mark Kuerer, Thomas A Buchholz, Vicente Valero, Kelly K Hunt
    Abstract:

    Background: In patients undergoing a Partial Mastectomy, choosing the best method with which to repair the defect is essential to optimizing outcomes and minimizing the potential for postoperative complications. Methods: The authors present a management algorithm for repairing Partial Mastectomy defects based on clinically relevant parameters to allow clinicians to better select the most appropriate indications for the various reparative oncoplastic procedures. The clinicopathologic factors considered in surgical decision-making for reconstruction after Partial Mastectomy include timing of reconstruction in relation to radiation therapy, status of the tumor margin, extent of breast skin resection, breast size, and whether the cosmetic outcome would be better after a total Mastectomy with immediate breast reconstruction, thereby avoiding the need for radiation therapy. Results: Most patients with medium or large breasts will likely benefit from immediate repair, whereas some with small breasts may not. Immediate repair of Partial Mastectomy defects is preferred with the use of local breast tissue (local tissue rearrangement or breast reduction techniques) because of the simplicity of these approaches and because techniques using local tissue maintain the color and texture of the breast. Waiting to repair a large deformity until after whole-breast radiation therapy usually necessitates a complex transfer of a large volume of autologous tissue, which many patients who undergo breast conservation therapy are not willing to pursue. Use of lower abdominal flaps to repair Partial breast defects is generally discouraged. Conclusion: Although the authors' management algorithm and practical oncoplastic techniques should prove useful, it is up to the multidisciplinary breast team and the patient to determine the best approach.

  • practical guidelines for repair of Partial Mastectomy defects using the breast reduction technique in patients undergoing breast conservation therapy
    Plastic and Reconstructive Surgery, 2008
    Co-Authors: Steven J Kronowitz, Kelly K Hunt, Henry Mark Kuerer, Eric A Strom, Thomas A Buchholz, Joe Ensor, Cindy Koutz, Geoffrey L Robb
    Abstract:

    Background The authors previously compared the local tissue rearrangement, breast reduction, and latissimus dorsi flap reconstruction techniques for repairing Partial Mastectomy defects and showed the benefits of breast reduction. Methods In this study, the authors focused solely on factors influencing outcome in 41 patients who underwent repair of a Partial Mastectomy defect using breast reduction. Results Tumor location had a significant effect on the design of the parenchymal pedicle (p = 0.05). Most repairs were performed with an inferior pedicle. Fifty percent of the lower outer and central quadrant tumors required an amputative design with a free nipple graft. The complication rates for immediate and delayed repair were 24 and 50 percent, respectively. The superior pedicle was associated with the highest complication rates. Tumors in the upper outer quadrant of the breast were associated with the highest complication rate (35 percent). Ninety percent of patients with planned repairs had a viable nipple-areola complex (p = 0.05) and did not require a free nipple graft. More favorable cosmetic outcomes were achieved using an inferior pedicle; less favorable cosmetic outcomes were achieved for tumors in the upper inner quadrant of the breast. Larger defects did not result in less favorable cosmetic outcomes than smaller defects. Only 7 percent of patients had a positive tumor margin. Five percent of patients developed local breast cancer recurrence after a mean follow-up of 36 months. Conclusion The authors provide practical guidelines for repairing a Partial Mastectomy defect using breast reduction that should minimize the occurrence of complications and optimize the cosmetic outcome.

  • determining the optimal approach to breast reconstruction after Partial Mastectomy
    Plastic and Reconstructive Surgery, 2006
    Co-Authors: Steven J Kronowitz, Kelly K Hunt, Henry Mark Kuerer, Cindy Koutz, Jules A Feledy, Adel Youssef, Geoffrey L Robb
    Abstract:

    Background: Unfortunately, patients who desire repair of contour deformities after Partial Mastectomy unually present after radiation therapy, which may increase the risk of complications an result in a poor aesthetic outcome. The authors reviewed their experience with repair of Partial Mastectomy defects to determine the optimal approach to breast reconstruction ater Partial Mastectomy. Methods: Sixty-nine patients who underwent repair of a Partial Mastectomy defect and received radiation therapy were included in this analysis. The reconstructive techniques were categorized as local tissue rearrangement (LTR), breast reduction, or use of a latissimus dorsi myocutaneous flap or thoracoepigastric skin flap (here-after referred to as flap). Results: fifty patients underwent immediate reconstruction before radiation therapy, and 19 underwent delayed rreconstruction after radiation therapy. The reconstructive techniques in patients with immediate reconstruction were local tissue rearrangement in 28 percent, breast reduction in 66 percent, and flaps in 6 percent. In patient with delayed reconstruction, 32 percent had local tissue rearrangement, 42 percent had breast reduction, and 26 percent had flaps. The complication rates for immediate and delayed reconstruction were 26 percent and 42 percent, respectively. Overall, and in the setting of immediate reconstruction, the flap technique was associated with a higher complication rate than local tissue rearrangement and breast reduction. However, in the setting of delayed reconstruction, the flap technique was associated with a lower complication rate than the other two techniques. Fifty-seven percent of the immediate reconstructions performed with the local tissue rearrangement or breast reduction technique, but only 33 percent of the immediate reconstructions performed with the flap technique, were associated with an excellent or good aesthetic outcome. Conclusion: Immediate repair of Partial Mastectomy defects with local tissues results in a lower risk of complications and better aesthetic outcomes than immediate repair of Partial Mastectomy defects with a latissimus dorsi flap.