Extending breast conservation and other new oncoplastic techniques

Size: px
Start display at page:

Download "Extending breast conservation and other new oncoplastic techniques"

Transcription

1 Extending breast conservation and other new oncoplastic techniques Dick Rainsbury BSBR November 2013 Liverpool

2 What s the maximum volume of the breast which can be resected during lumpectomy without causing major local deformity? 1. 10% 2. 20% 3. 30% 4. 40% 5. 50%

3 In which of the following situations is oncoplastic breast conserving surgery contraindicated? 1. when treating multifocal tumours 2. when treating tumours >50mm 3. following NAC 4. in patients with very small breasts 5. when treating multicentric tumours

4 Which of the following statements is correct about intra-operative specimen radiology? 1. images take 30 seconds to generate 2. it can t be used for big specimens (~15cm) 3. it increases delayed re-excision rates 4. it is unhelpful after NAC 5. it reduces specimen weights

5 The expanding role of oncoplastic breast conservation... the clinical problem role of radiology and pathology new oncoplastic techniques current solutions to the problem clinical and radiological outcomes

6 The clinical problem: major deformity which follows WLE for bulky cancers breast volume resected % mastectomy indicated risk of major local deformity increases conservation indicated Bulstrode et al, Breast 2001; 10:117 Cochrane et al, BJS 2003; 90:1505

7 The clinical problem: patients still present with bulky cancers cancers screen-detected cases : 27% mastectomy rate symptomatic cases: 52% mastectomy rate patients per year risk deformity after WLE or face a mastectomy <15mm 15-20mm 21-35mm 36-50mm >50mm All Breast Cancer Report NCIN: 2009

8 current solutions which avoid mastectomy

9 Current solutions: oncoplastic breast conserving techniques volume displacement volume replacement breast volume reduced breast volume unchanged

10 Volume displacement techniques: two groups Level 1 procedures dense breasts skin and nipple undermined full thickness glandular excision glandular mobilization and approximation nipple-areola repositioned resection volume <20% Clough K et al Ann Surg Oncol 2010;17:

11 Level 1 procedures: example

12 Volume displacement techniques: two groups Level 2 procedures dense or fatty breasts major glandular excision range of mammoplasty techniques used resection volume 20-70% specific training required Clough K et al Ann Surg Oncol 2010;17:

13 Superior pedicle mammoplasty for lower pole tumour

14 V- mammoplasty for lower inner quadrant tumour

15 inferior pedicle mammoplasty for upper pole tumour

16 J-mammoplasty for lower outer tumour

17 Volume replacement techniques* flap free techniques implants saline injection lipofilling pedicle flaps lateral adipofascial flap inferior adipofascial LD miniflap pectoralis major omentum thoracoepigastric perforator flaps thoracodorsal artery lateral intercostal artery anterior intercostal artery superior epigastric artery free flaps omentum DIEP SIEP TRAM TUG * Rusby J, Rainsbury R Recon Breast Cancer Surg 2013; Eds: Reitjens M, Urban C

18 pedicled flaps latissimus dorsi miniflap

19 Operative details: LD miniflaps

20 LD miniflap reconstruction of 250gm defect: on table appearance

21 LD miniflap reconstruction: appearance 5yr post-operatively

22 perforator flaps thoracodorsal artery TDAP perforator flaps

23 TDAP Images provided by Douglas Macmillan, Nottingham Breast Institute

24 Images provided by Douglas Macmillan, Nottingham Breast Institute

25 role of radiology in oncoplastic resections?

26 Pre-operative localisation and rapid intra-operative large-specimen imaging <15 seconds post-resection 15 cm

27 Rapid intra-operative specimen radiology (IOSR) BioVision FaxitronBioptics mobile easy to use in the theatre images 10-15sec clear display image manipulation re-excision images 10x15cm capacity 52UK 2/3 theatre 1/3 shared

28 IOSR generated during volume replacement for 58mm tumour <15 seconds post-resection 15 cm

29 IOSR generated during volume displacement for 65mm tumour post-neoadjuvant Rx 12 cm <15 seconds post-resection

30 IOSR during volume replacement enabling immediate re-excision for 80mm tumour post-neoadjuvant Rx <15 seconds post-reexcision <15 seconds post-resection 11 cm

31 Impact of IOSR on specimen weights and re-excision rates? pre-iosr post-iosr p-value specimen weight (g) re-excision (%) Layfield DM et al Breast 2012; 21: Naeem H et al EJSO submitted abstract 2013

32 role of pathology in oncoplastic resections?

33 Pathology support: frozen section margin analysis primary tumour bed biopsies inked re-excision bed biopsies

34 Operative details: frozen section margin analysis technique

35 Pathology support for therapeutic mammoplasty

36 Impact of frozen section on further surgery? 100 therapeutic mammoplasty patients FS status of BB negative number 44 further surgery 1 (2%) equivocal or not done 56 7 (14%) Winchester Oncoplastic Database: 2013

37 outcomes of oncoplastic BCS?

38 Outcomes of OPBCS summarised for 23 studies involving 1,447 patients studies (no) patients (no) T-size (mm) follow up (mo) local recurrence (%) good cosmesis (%) volume displacement volume replacement* Franceschini G et al Eur Rev Med Pharm Sci 2012; 16: * Rusby J, Rainsbury R Recon Breast Cancer Surg 2013; Eds: Reitjens M, Urban C

39 Clinical outcomes: tumour details in 100 VDs and 246 VRs volume displacement position of tumours volume replacement position of tumours mean tumour size: 32mm mean specimen weight: 409g multifocal tumours: 22% mean tumour size: 33mm mean specimen weight: 193g multifocal tumours: 15%

40 Clinical outcomes of OPBCS: complications requiring intervention volume replacements (12%) 100 volume displacements (23%) NMBRA full breast reconstruction (28%) (%) infection haematoma delayed healing NAC necrosis other infection Data on file: Winchester Oncoplastic Database

41 Long-term oncological outcomes: local recurrence 371 cases oncoplastic BCS and DXT 121 volume replacements 100 volume displacements 150 volume displacements follow up 95 mo follow up 45 mo follow up 60 mo 3LR 0.3% pa 1 LR 0.3% pa 3 LR 0.6% pa personal communication D Macmillan, S McCulley, Nottingham Breast Institute, 2013

42 Long-term radiological outcomes: typical mammographic appearances MLO CC MLO isodense flap radiolucent rim minimal scar WLE Monticciolo D et al. AJR 1996;130:385

43 Trends in oncoplastic BCS: Mx +BR versus OPBCS 62 versus 21 cases PA 25 volume replacement volume displacement all cases Data on file: Winchester Oncoplastic Database

44 new oncoplastic techniques

45 New techniques: lipomodelling for correction of deformity Courtesy of Eva Weiler-Mithoff

46 New techniques: lipomodelling for correction of deformity

47 Lipomodelling: for total breast reconstruction Ueberreiter K et al. Handchir Mikrochir Plast Chir 2010; 42:

48 Radiological changes following lipomodelling? cysts increased density microcalcification macrocalcifications calcification without mass calcification with mass incidence of radiological changes in 2560 patients = 13.0% Claro F et al Br J Surgery 2012; 99:

49 Lipomodelling and risk of local recurrence: the skeleton in the cupboard lipomodelling (37 patients) no lipomodelling (74 patients) cumulative incidence of recurrence (%) 10 5 p-value< months from baseline Petit JY et al Ann Oncol 2012; 23:

50 New techniques: the rising popularity of the acellular dermal matrix

51 Placement of an acellular dermal matrix

52 US trends in reconstruction : the ADM effect number of cases PA US Plastic Surgery Statistics Report

53 Complications following ADM-assisted versus implant only reconstruction? complication seroma infection cellulitis haematoma skin necrosis implant loss OR (95% CI) 3.89 ( ) 3.52 ( ) 2.00 ( ) 1.99 ( ) 1.85 ( ) 2.96 ( ) NS NS NS trend towards less capsular contracture meta-analysis of 4,800 patients in 16 studies Ho G et al Annals Plast Surg 2012; 68:

54

55

56 New best practice guidelines for oncoplastic breast reconstruction key recommendations better patient information improved patient access informed patient choice rigorous infection control multimodal analgesia standardised monitoring service redesign oncoplastic units oncoplastic centres ISBN

57

58 What s the maximum volume of the breast which can be resected during lumpectomy without causing major local deformity? 1. 10% 2. 20% 3. 30% 4. 40% 5. 50%

59 In which of the following situations is oncoplastic breast conserving surgery contraindicated? 1. when treating multifocal tumours 2. when treating tumours >50mm 3. following NAC 4. in patients with very small breasts 5. when treating multicentric tumours

60 Which of the following statements is correct about intra-operative specimen radiology? 1. images can be viewed in 30 seconds 2. it can t be used for big specimens (~15cm) 3. it increases delayed re-excision rates 4. it is unhelpful after NAC 5. it reduces specimen weights

61 1 st ABS Multidisciplinary Meeting Neoadjuvant chemotherapy: an MDT approach 20 January 2014 Royal College of Surgeons of England The ABS is hosting its first MDT meeting on neoadjuvant chemotherapy. Topics will include: patient selection pre-nac imaging & pathology timing of sentinel node biopsy non responders imaging residual disease future developments

62 Radiological outcomes of OPBCS: which bit of the breast should be boosted...?

63 IOSRs during oncoplastic procedures confirming clearance of multifocal disease

64 Round block technique for upper pole tumour

65 Racquet technique for upper outer tumour

66 Lipomodelling: for total breast reconstruction Courtesy of Susanna Kauhanen, Helsinki

67 Pathology support for therapeutic mammoplasty typical request form, specimens and report

68 Clinical outcomes of OPBCS: complications requiring intervention

BSBR conference Nottingham 10th Nov 2015

BSBR conference Nottingham 10th Nov 2015 BSBR conference Nottingham 10th Nov 2015 Breast imaging after oncoplastic and risk adapted conservation Fiona MacNeill FRCS, MD Breast Surgeon, London With thanks to Miss Katy Green SSM Medical Student

More information

Ms Katherine Gale. Oncoplastic Breast Surgeon Waitemata District Health Board Auckland

Ms Katherine Gale. Oncoplastic Breast Surgeon Waitemata District Health Board Auckland Ms Katherine Gale Oncoplastic Breast Surgeon Waitemata District Health Board Auckland 16:30-17:25 WS #167: Update on Breast Cancer 17:35-18:30 WS #179: Update on Breast Cancer (Repeated) Update on Breast

More information

Oncoplastic breast surgery in a Danish perspective II: Reconstructive strategy in oncoplastic breast surgery

Oncoplastic breast surgery in a Danish perspective II: Reconstructive strategy in oncoplastic breast surgery Oncoplastic breast surgery in a Danish perspective II: Reconstructive strategy in oncoplastic breast surgery Michael Rose, MD Department of Surgery and Plastic Surgery, Hospital of Southwest Jutland, Denmark

More information

ONCOLOGIC AND COSMETIC CHALLENGES DO NOT ROUTINELY OPPOSE BREAST CONSERVING SURGERY IN RETRO-AREOLA PRIMARY LESIONS

ONCOLOGIC AND COSMETIC CHALLENGES DO NOT ROUTINELY OPPOSE BREAST CONSERVING SURGERY IN RETRO-AREOLA PRIMARY LESIONS ONCOLOGIC AND COSMETIC CHALLENGES DO NOT ROUTINELY OPPOSE BREAST CONSERVING SURGERY IN RETRO-AREOLA PRIMARY LESIONS SURGERY SYMPOSIUM Ines Buccimazza Breast Unit Department of Surgery Nelson R. Mandela

More information

Oncoplastic breast surgery

Oncoplastic breast surgery Oncoplastic breast surgery Laszlo Romics New Victoria Hospital Gartnavel General Hospital Queen Elizabeth University Hospital Evolution of breast surgery Partial breast reconstruction Total breast reconstruction

More information

NIPPLE SPARING PRE-PECTORAL BREAST RECONSTRUCTION

NIPPLE SPARING PRE-PECTORAL BREAST RECONSTRUCTION NIPPLE SPARING PRE-PECTORAL BREAST RECONSTRUCTION 42 yo female healthy athlete Right breast mass. Past medical history: none Family history: aunt with Breast cancer Candidates for nipple-sparing mastectomy

More information

Breast Reconstruction: Current Strategies and Future Opportunities

Breast Reconstruction: Current Strategies and Future Opportunities Breast Reconstruction: Current Strategies and Future Opportunities Hani Sbitany, MD Assistant Professor of Surgery University of California, San Francisco Division of Plastic and Reconstructive Surgery

More information

The Case FOR Oncoplastic Surgery in Small Breasts. Barbara L. Smith, MD, PhD Massachusetts General Hospital Harvard Medical School Boston, MA USA

The Case FOR Oncoplastic Surgery in Small Breasts. Barbara L. Smith, MD, PhD Massachusetts General Hospital Harvard Medical School Boston, MA USA The Case FOR Oncoplastic Surgery in Small Breasts Barbara L. Smith, MD, PhD Massachusetts General Hospital Harvard Medical School Boston, MA USA Changing issues in breast cancer management Early detection

More information

Current Strategies in Breast Reconstruction

Current Strategies in Breast Reconstruction Current Strategies in Breast Reconstruction Hani Sbitany, MD Assistant Professor of Surgery University of California, San Francisco Division of Plastic and Reconstructive Surgery 12 th Annual School of

More information

Advances in Localized Breast Cancer

Advances in Localized Breast Cancer Advances in Localized Breast Cancer Melissa Camp, MD, MPH and Fariba Asrari, MD June 18, 2018 Moderated by Elissa Bantug 1 Advances in Surgery for Breast Cancer Melissa Camp, MD June 18, 2018 2 Historical

More information

Mitchell Buller, MEng, a Adee Heiman, BA, a Jared Davis, MD, b ThomasJ.Lee,MD, b Nicolás Ajkay, MD, FACS, c and Bradon J. Wilhelmi, MD, FACS b

Mitchell Buller, MEng, a Adee Heiman, BA, a Jared Davis, MD, b ThomasJ.Lee,MD, b Nicolás Ajkay, MD, FACS, c and Bradon J. Wilhelmi, MD, FACS b Immediate Breast Reconstruction of a Nipple Areolar Lumpectomy Defect With the L-Flap Skin Paddle Breast Reduction Design and Contralateral Reduction Mammoplasty Symmetry Procedure: Optimizing the Oncoplastic

More information

Diagnosis and Treatment of Patients with Primary and Metastatic Breast Cancer. Oncoplastic and Reconstructive Surgery

Diagnosis and Treatment of Patients with Primary and Metastatic Breast Cancer. Oncoplastic and Reconstructive Surgery Diagnosis and Treatment of Patients with Primary and Metastatic Breast Cancer Oncoplastic and Reconstructive Surgery Plastic-reconstructive aspects after mastectomy Versions 2002 2017: Audretsch / Bauerfeind

More information

Controversies in Breast Cancer

Controversies in Breast Cancer I Have Breast Cancer Now What? Katherine Gale FRACS Oncoplastic Breast Surgeon Controversies in Breast Cancer Katherine Gale FRACS Oncologic Controversies Margins in BCS Nipple Sparing Mastectomy:? Safe

More information

Breast cancer reconstruction surgery (immediate and delayed) across Ontario: Patient indications and appropriate surgical options

Breast cancer reconstruction surgery (immediate and delayed) across Ontario: Patient indications and appropriate surgical options A Quality Initiative of the Program in Evidence-Based Care (PEBC), Cancer Care Ontario (CCO) Breast cancer reconstruction surgery (immediate and delayed) across Ontario: Patient indications and appropriate

More information

Clinical Study Breast-Volume Displacement Using an Extended Glandular Flap for Small Dense Breasts

Clinical Study Breast-Volume Displacement Using an Extended Glandular Flap for Small Dense Breasts Plastic Surgery International Volume 2011, Article ID 359842, 7 pages doi:10.1155/2011/359842 Clinical Study Breast-Volume Displacement Using an Extended Glandular Flap for Small Dense Breasts Tomoko Ogawa,

More information

Advances in Breast Surgery. Catherine Campo, D.O. Breast Surgeon Meridian Health System April 17, 2015

Advances in Breast Surgery. Catherine Campo, D.O. Breast Surgeon Meridian Health System April 17, 2015 Advances in Breast Surgery Catherine Campo, D.O. Breast Surgeon Meridian Health System April 17, 2015 Objectives Understand the surgical treatment of breast cancer Be able to determine when a lumpectomy

More information

Updates in Breast Care. Truth or Hype. History of Breast Cancer Surgery. Dr Karen Barbosa 5/3/2017 4/20/2017

Updates in Breast Care. Truth or Hype. History of Breast Cancer Surgery. Dr Karen Barbosa 5/3/2017 4/20/2017 Updates in Breast Care Dr Karen Barbosa 4/20/2017 Truth or Hype Princess Bust Developer Sears, Roebuck and Co. 1897 Promised to make the breast round, firm and beautiful History of Breast Cancer Surgery

More information

Oncoplastic volume replacement with latissimus dorsi myocutaneous flap in patients with large ptotic breasts. Is it feasible?

Oncoplastic volume replacement with latissimus dorsi myocutaneous flap in patients with large ptotic breasts. Is it feasible? Journal of the Egyptian National Cancer Institute (2011) 23, 163 169 Cairo University Journal of the Egyptian National Cancer Institute www.nci.cu.adu.eg www.sciencedirect.com ORIGINAL ARTICLE Oncoplastic

More information

Monday 25 th Wednesday 27 th September 2017 East Midlands Conference Centre and Orchard Hotel Nottingham

Monday 25 th Wednesday 27 th September 2017 East Midlands Conference Centre and Orchard Hotel Nottingham 2017 Monday 25 th Wednesday 27 th September 2017 East Midlands Conference Centre and Orchard Hotel Nottingham 9. Monday 25th September Breast-conserving surgery Local control 9.00 Modern risk factors for

More information

Staged approach to partial breast reconstruction to avoid mastectomy in women with breast cancer

Staged approach to partial breast reconstruction to avoid mastectomy in women with breast cancer Original Article Staged approach to partial breast reconstruction to avoid mastectomy in women with breast cancer Pankaj G. Roy, Alexandra A. Tenovici Department of Breast Surgery, John Radcliffe Hospital,

More information

Breast Reconstruction Options

Breast Reconstruction Options Breast Reconstruction Options Natural reconstruction using your ABDOMINAL tissue: TRAM Flap (Transverse Rectus Abdominis Myocutaneous) There are various forms of TRAM flap reconstruction that are commonly

More information

National Mastectomy & Breast Reconstruction Audit Datasheet - Mastectomy +/- Immediate Reconstruction

National Mastectomy & Breast Reconstruction Audit Datasheet - Mastectomy +/- Immediate Reconstruction Patient Registration data Surname Forename NHS/Private Hospital Number Date of birth Postcode Ethnicity Patient-reported outcomes consent Has this patient consented to being sent outcome questionnaires?

More information

Recent Advances in Breast Cancer Treatment

Recent Advances in Breast Cancer Treatment Recent Advances in Breast Cancer Treatment Pornchai O-charoenrat MD, PhD, FRCST, FICS Professor Chief, Division of Head-Neck & Breast Surgery Department of Surgery, Siriraj Hospital, THAILAND Recent Advances

More information

BREAST RECONSTRUCTION FOLLOWING PROPHYLACTIC OR THERAPEUTIC MASTECTOMY FOR BREAST CANCER

BREAST RECONSTRUCTION FOLLOWING PROPHYLACTIC OR THERAPEUTIC MASTECTOMY FOR BREAST CANCER BREAST RECONSTRUCTION FOLLOWING PROPHYLACTIC OR THERAPEUTIC MASTECTOMY FOR BREAST CANCER Effective Date: September 2013 The recommendations contained in this guideline are a consensus of the Alberta Provincial

More information

How To Make a Good Mastectomy for Reconstruction Based on the Anatomy. Zhang Jin, Ph.D MD

How To Make a Good Mastectomy for Reconstruction Based on the Anatomy. Zhang Jin, Ph.D MD How To Make a Good Mastectomy for Reconstruction Based on the Anatomy Zhang Jin, Ph.D MD Deputy Director and Professor Tianjin Medical University Cancer Institute and Hospital People s Republic of China

More information

Partial Breast Reconstruction Using Various Oncoplastic Techniques for Centrally Located Breast Cancer

Partial Breast Reconstruction Using Various Oncoplastic Techniques for Centrally Located Breast Cancer Partial Breast Reconstruction Using Various Oncoplastic Techniques for Centrally Located Breast Cancer Original Article Hyo Chun Park 1, Hong Yeul Kim 1, Min Chul Kim 2, Jeong Woo Lee 2, Ho Yun Chung 2,

More information

Central Breast Excision With Immediate Autologous Reconstruction for Recurrent Periductal Sepsis: An Application of Oncoplastic Surgical Techniques

Central Breast Excision With Immediate Autologous Reconstruction for Recurrent Periductal Sepsis: An Application of Oncoplastic Surgical Techniques Central Breast Excision With Immediate Autologous Reconstruction for Recurrent Periductal Sepsis: An Application of Oncoplastic Surgical Techniques Sinclair M. Gore, FRCS(Plast), a Gordon C. Wishart, FRCS,

More information

The surgical treatment of breast cancer has undergone

The surgical treatment of breast cancer has undergone Blackwell Malden, TBJ The 1075-122X 2006 September/October 12 5 Original Oncoplastic masetti suppl Breast Blackwell et Article USA al. Publishing Journal Techniques Publishing 2006 Inc ORIGINAL ARTICLE

More information

Prophylactic Mastectomy & Reconstructive Implications

Prophylactic Mastectomy & Reconstructive Implications Prophylactic Mastectomy & Reconstructive Implications Minas T Chrysopoulo, MD PRMA Center For Advanced Breast Reconstruction Prophylactic Mastectomy Surgical removal of one or both breasts to reduce the

More information

Breast Imaging: Multidisciplinary Approach. Madelene Lewis, MD Assistant Professor Associate Program Director Medical University of South Carolina

Breast Imaging: Multidisciplinary Approach. Madelene Lewis, MD Assistant Professor Associate Program Director Medical University of South Carolina Breast Imaging: Multidisciplinary Approach Madelene Lewis, MD Assistant Professor Associate Program Director Medical University of South Carolina No Disclosures Objectives Discuss a multidisciplinary breast

More information

The decision to repair a partial mastectomy CME. State of the Art and Science in Postmastectomy Breast Reconstruction.

The decision to repair a partial mastectomy CME. State of the Art and Science in Postmastectomy Breast Reconstruction. CME State of the Art and Science in Postmastectomy Breast Reconstruction Steven J. Kronowitz, M.D. Houston, Texas Learning Objectives: After reading this article, the participant should be able to: 1.

More information

Research Article Current Practice of Therapeutic Mammaplasty: A Survey of Oncoplastic Breast Surgeons in England

Research Article Current Practice of Therapeutic Mammaplasty: A Survey of Oncoplastic Breast Surgeons in England International Surgical Oncology Volume 2016, Article ID 1947876, 5 pages http://dx.doi.org/10.1155/2016/1947876 Research Article Current Practice of Therapeutic Mammaplasty: A Survey of Oncoplastic Breast

More information

The biplanar oncoplastic technique case series: a 2-year review

The biplanar oncoplastic technique case series: a 2-year review Original Article The biplanar oncoplastic technique case series: a 2-year review Alexander J. Kaminsky 1, Ketan M. Patel 2, Costanza Cocilovo 1, Maurice Y. Nahabedian 2, Reza Miraliakbari 3 1 INOVA Fairfax

More information

Breast Reconstruction

Breast Reconstruction Steven E. Copit, M.D. Chief- Division of Plastic Surgery Thomas Jefferson University Hospital Philadelphia, PA analysis of The Defect Skin Breast Volume Nipple Areola Complex analysis of The Defect the

More information

complicanze in chirurgia senologica ricostruttiva Tecniche per la prevenzione delle complicanze nelle mastectomie conservative

complicanze in chirurgia senologica ricostruttiva Tecniche per la prevenzione delle complicanze nelle mastectomie conservative Il trattamento delle complicanze in chirurgia senologica ricostruttiva Tecniche per la prevenzione delle complicanze nelle mastectomie conservative Dr. Christian Rizzetto UOC Chirurgia Senologica - Breast

More information

Current Approaches to Managing Partial Breast Defects: The Role of Conservative Breast Surgery Reconstruction

Current Approaches to Managing Partial Breast Defects: The Role of Conservative Breast Surgery Reconstruction Review Current Approaches to Managing Partial Breast Defects: The Role of Conservative Breast Surgery Reconstruction ALEXANDRE MENDONÇA MUNHOZ 1, EDUARDO MONTAG 2, JOSÉ ROBERTO FILASSI 3 and ROLF GEMPERLI

More information

SIMPOSIO Ricostruzione mammaria ed implicazioni radioterapiche Indicazioni

SIMPOSIO Ricostruzione mammaria ed implicazioni radioterapiche Indicazioni SIMPOSIO Ricostruzione mammaria ed implicazioni radioterapiche Indicazioni Icro Meattini, MD Radiation Oncology Department - University of Florence Azienda Ospedaliero Universitaria Careggi Firenze Breast

More information

Reconstructive Breast Surgery following Mastectomy for Breast Cancer: A Review

Reconstructive Breast Surgery following Mastectomy for Breast Cancer: A Review Research Article http://www.alliedacademies.org/advanced-surgical-research/ Reconstructive Breast Surgery following Mastectomy for Breast Cancer: A Review Gurnam Virdi* Department of surgery, Queen Elizabeth

More information

Classification System

Classification System Classification System A graduate of the Breast Oncology training program should be able to care for all aspects of disease and/or provide comprehensive management. When referring to a discipline of training

More information

NCIN Breast Cancer Workshop 13 March 2014 Hilton Metropole, NEC, Birmingham. Kieran Horgan, Dick Rainsbury, Mark Sibbering, Gill lawrence

NCIN Breast Cancer Workshop 13 March 2014 Hilton Metropole, NEC, Birmingham. Kieran Horgan, Dick Rainsbury, Mark Sibbering, Gill lawrence NCIN Breast Cancer Workshop 13 March 2014 Hilton Metropole, NEC, Birmingham Kieran Horgan, Dick Rainsbury, Mark Sibbering, Gill lawrence 1 Interactive Workshop Session Professor Kieran Horgan Workshop

More information

Advances and Innovations in Breast Reconstruction and Brest Surgery Presented by PCMC plastic surgeons

Advances and Innovations in Breast Reconstruction and Brest Surgery Presented by PCMC plastic surgeons Advances and Innovations in Breast Reconstruction and Brest Surgery Presented by PCMC plastic surgeons Options for reconstruction after mastectomy Implants Autologous tissue = from your own body: skin

More information

Post-mastectomy breast reconstruction

Post-mastectomy breast reconstruction Follow the link from the online version of this article to obtain certified continuing medical education credits Post-mastectomy breast reconstruction Paul T R Thiruchelvam, 1 Fiona McNeill, 2 Navid Jallali,

More information

How can surgeons help the Radiation Oncologists?

How can surgeons help the Radiation Oncologists? How can surgeons help the Radiation Oncologists? Lorna Weir BC Surgical Oncology fall breast cancer update Oct 24, 2009 Disclosure no conflict of interest Outline Introduction OR reports Marking of surgical

More information

Journal of Breast Cancer

Journal of Breast Cancer CSE REPORT Journal of reast Cancer J reast Cancer 2013 June; 16(2): 236-243 bdominal dvancement Flap as Oncoplastic reast Conservation: Report of Seven Cases and Their Cosmetic Results Tomoko Ogawa, Noriko

More information

PRINCIPLES OF BREAST SURGERY & COMPLICATIONS

PRINCIPLES OF BREAST SURGERY & COMPLICATIONS PRINCIPLES OF BREAST SURGERY & COMPLICATIONS Adam Cichowitz The Royal Melbourne Hospital ANATOMY Lies in subcutaneous tissue Base: midline to midaxillary line, 2nd to 6th rib Overlies pec major, serratus

More information

CASE REPORT Oncoplastic Reduction Pattern Technique Following Removal of Giant Fibroadenoma

CASE REPORT Oncoplastic Reduction Pattern Technique Following Removal of Giant Fibroadenoma CASE REPORT Oncoplastic Reduction Pattern Technique Following Removal of Giant Fibroadenoma Andrea Hiller, BS, a Thomas J. Lee, MD, b Joshua Henderson, BA, a Nicolas Ajkay, MD, FACS, c and Bradon J. Wilhelmi,

More information

Breast Cancer Reconstruction

Breast Cancer Reconstruction Breast Cancer Jerome H. Liu, MD Tom S. Liu, MD Jerome H. Liu, MD Undergraduate: Brown University Medical School: University of California, Los Angeles Residency: UCLA Medical Center Fellowship:UCLA Medical

More information

ONCOPLASTIC SURGERY. Dr. Sadir Alrawi Director of Surgical Oncology Services. Dr. Humaa Darr Surgical Oncology Fellow

ONCOPLASTIC SURGERY. Dr. Sadir Alrawi Director of Surgical Oncology Services. Dr. Humaa Darr Surgical Oncology Fellow Hessa St ONCOPLASTIC SURGERY Dr. Sadir Alrawi Director of Surgical Oncology Services Dr. Humaa Darr Surgical Oncology Fellow Al Sufouh Rd AL SUFOUH AL SUFOUH Sharaf DG Mall of the Emirates Mall Of the

More information

Oncoplasty for Breast Carcinoma

Oncoplasty for Breast Carcinoma Med. J. Cairo Univ., Vol. 77, No. 3, June: 327-333, 2009 www.medicaljournalofcairouniversity.com Oncoplasty for Breast Carcinoma TAMER F. YOUSSEF, M.D.*; YASSER SALEH, M.D.** and ADEL BADRAWY, M.D.***

More information

What is an Adequate Lumpectomy Margin in 2018?

What is an Adequate Lumpectomy Margin in 2018? What is an Adequate Lumpectomy Margin in 2018? Stuart J. Schnitt, M.D. Brigham and Women s Hospital, Dana-Farber Cancer Institute, and Harvard Medical School Boston, MA None Disclosures Topics Current

More information

Oncoplastic Breast Surgery

Oncoplastic Breast Surgery Disclosures Oncoplastic Breast Surgery Newfoundlander OAGS 2016 Dr Renee Hanrahan General Surgeon Oncologic and Reconstructive Breast Surgeon Objectives What is Oncoplastic Surgery Define Oncoplastic Surgery

More information

Breast Reconstruction Surgery

Breast Reconstruction Surgery Breast Reconstruction Surgery I. Policy University Health Alliance (UHA) will reimburse for Breast Reconstruction Surgery when it is determined to be medically necessary and when it meets the medical criteria

More information

The Use of Vertical Scar Techniques in Reconstructive Surgery

The Use of Vertical Scar Techniques in Reconstructive Surgery The Use of Vertical Scar Techniques in Reconstructive Surgery 12 Moustapha Hamdi, Phillip Blondeel, Koenraad Van Landuyt, Stan Monstrey H e who does not possess a thing cannot give it. Folk tradition Introduction

More information

Oncoplastic breast reconstruction after IORT

Oncoplastic breast reconstruction after IORT IORT for breast cancer Oncoplastic breast reconstruction after IORT Wolfram Malter, Verena Kirn, Peter Mallmann, Stefan Kraemer Breast Center, University Hospital of Cologne, Kerpener Str. 34, 50931 Cologne,

More information

BREAST RECONSTRUCTION POST MASTECTOMY

BREAST RECONSTRUCTION POST MASTECTOMY UnitedHealthcare Commercial Coverage Determination Guideline BREAST RECONSTRUCTION POST MASTECTOMY Guideline Number: SUR057 Effective Date: January 1, 2019 Table of Contents Page INSTRUCTIONS FOR USE...

More information

Therapeutic Mammoplasty in Management of Breast Cancer: A Prospective Clinical Study

Therapeutic Mammoplasty in Management of Breast Cancer: A Prospective Clinical Study Advances in Breast Cancer Research, 2017, 6, 107-116 http://www.scirp.org/journal/abcr ISSN Online: 2168-1597 ISSN Print: 2168-1589 Therapeutic Mammoplasty in Management of Breast Cancer: A Prospective

More information

PROS AND CONS OF IMMEDIATE PROSTHETIC IMPLANTS VS USE OF EXPANDER FOR POST MASTECTOMY BREAST RECONSTRUCTIONS

PROS AND CONS OF IMMEDIATE PROSTHETIC IMPLANTS VS USE OF EXPANDER FOR POST MASTECTOMY BREAST RECONSTRUCTIONS PROS AND CONS OF IMMEDIATE PROSTHETIC IMPLANTS VS USE OF EXPANDER FOR POST MASTECTOMY BREAST Dr Tienie van Rooyen Mediclinic Kloof Hospital Pretoria IMMEDIATE Since 1990 s Skin sparing mastectomies proven

More information

Medical Policy Original Effective Date: Revised Date: Page 1 of 8

Medical Policy Original Effective Date: Revised Date: Page 1 of 8 Page 1 of 8 Disclaimer Description Coverage Determination Refer to the member s specific benefit plan and Schedule of Benefits to determine coverage. This may not be a benefit on all plans, or the plan

More information

ANNEX 1 OBJECTIVES. At the completion of the training period, the fellow should be able to:

ANNEX 1 OBJECTIVES. At the completion of the training period, the fellow should be able to: 1 ANNEX 1 OBJECTIVES At the completion of the training period, the fellow should be able to: 1. Breast Surgery Evaluate and manage common benign and malignant breast conditions. Assess the indications

More information

Loco-Regional Management After Neoadjuvant Chemotherapy

Loco-Regional Management After Neoadjuvant Chemotherapy 1 Loco-Regional Management After Neoadjuvant Chemotherapy Terry Mamounas, M.D., M.P.H., F.A.C.S. Medical Director, Comprehensive Breast Program UF Health Cancer Center at Orlando Health Professor of Surgery,

More information

The usefulness of pedicled perforator flap in partial breast reconstruction after breast conserving surgery in Korean women

The usefulness of pedicled perforator flap in partial breast reconstruction after breast conserving surgery in Korean women The usefulness of pedicled perforator flap in partial breast reconstruction after breast conserving surgery in Korean women Jae Bong Kim 1, Dong Kyu Kim 1, Jeong Woo Lee 1, Kang Young Choi 1, Ho Yun Chung

More information

What the surgeon wants from the radiologist before breast cancer surgery. Erica Patocskai Isabelle Trop

What the surgeon wants from the radiologist before breast cancer surgery. Erica Patocskai Isabelle Trop What the surgeon wants from the radiologist before breast cancer surgery Erica Patocskai Isabelle Trop Centre Hospitalier de l université de Montréal CAR, April 2013 Plan What is the role of MRI for breast

More information

Exercise & Breast Cancer Recovery

Exercise & Breast Cancer Recovery Exercise & Breast Cancer Recovery LEARNING OBJECTIVES Demonstrate an understanding of the diagnosis and treatment of breast cancer Demonstrate an understanding of how breast cancer surgery and treatment

More information

Oncoplastic breast surgery: indications, techniques and perspectives

Oncoplastic breast surgery: indications, techniques and perspectives Review Article Oncoplastic breast surgery: indications, techniques and perspectives Alexandre Mendonça Munhoz 1, Eduardo Montag 2, Rolf Gemperli 3 1 Plastic Surgery Division, Hospital Sírio-Libanês, São

More information

Breast cancer: an update

Breast cancer: an update Breast cancer: an update Dr. Sanjeewa Seneviratne M.D, MRCS, Ph.D. Senior Lecturer and Honorary Consultant Surgeon Department of Surgery Faculty of Medicine, Colombo Plan The problem Screening & early

More information

A Combined Practice. Why Its Worked. Barriers to Breast Reconstruction. As a breast oncologist the patient gets seemless care

A Combined Practice. Why Its Worked. Barriers to Breast Reconstruction. As a breast oncologist the patient gets seemless care A Combined Practice A Combined Breast Oncology and Plastic Surgery Practice Why It Works Anne M. Wallace, MD, FACS Director, Comprehensive Breast Health Center Professor of Clinical Surgery, Surgical Oncology

More information

MAASTRO- CLINIC More than just an institute for radiotherapy Patientcare research training & education

MAASTRO- CLINIC More than just an institute for radiotherapy Patientcare research training & education MAASTRO- CLINIC More than just an institute for radiotherapy Patientcare research training & education Breast reconstruction: Before or after post mastectomy radiotherapy? Prof. dr. Liesbeth Boersma May

More information

Surgery for Breast Cancer

Surgery for Breast Cancer Surgery for Breast Cancer 1750 Mastectomy - Petit 1894 Radical mastectomy Halsted Extended, Super radical mastectomy 1948 Modified radical mastectomy Patey 1950-60 WLE & RT Baclesse, Mustakallio 1981-85

More information

BREAST RECONSTRUCTION FOLLOWING PROPHYLACTIC OR THERAPEUTIC MASTECTOMY FOR BREAST CANCER

BREAST RECONSTRUCTION FOLLOWING PROPHYLACTIC OR THERAPEUTIC MASTECTOMY FOR BREAST CANCER Page 1 of 44 BREAST RECONSTRUCTION FOLLOWING PROPHYLACTIC OR THERAPEUTIC MASTECTOMY FOR BREAST CANCER Effective Date: February, 2017 The recommendations contained in this guideline are a consensus of the

More information

BREAST RECONSTRUCTION POST MASTECTOMY

BREAST RECONSTRUCTION POST MASTECTOMY UnitedHealthcare Commercial Coverage Determination Guideline BREAST RECONSTRUCTION POST MASTECTOMY Guideline Number: SUR057 Effective Date: February 1, 2018 Table of Contents Page INSTRUCTIONS FOR USE...

More information

Bilateral Reduction Mammaplasty as an Oncoplastic Technique for the Management of Early-Stage Breast Cancer in Women with Macromastia

Bilateral Reduction Mammaplasty as an Oncoplastic Technique for the Management of Early-Stage Breast Cancer in Women with Macromastia Bilateral Reduction Mammaplasty as an Oncoplastic Technique for the Management of Early-Stage Breast Cancer in Women with Macromastia Russell E. Ettinger, MD, a Shailesh Agarwal, MD, a Paul H. Izenberg,

More information

AESTHETIC SURGERY OF THE BREAST: MASTOPEXY, AUGMENTATION & REDUCTION

AESTHETIC SURGERY OF THE BREAST: MASTOPEXY, AUGMENTATION & REDUCTION CHAPTER 18 AESTHETIC SURGERY OF THE BREAST: MASTOPEXY, AUGMENTATION & REDUCTION Ali A. Qureshi, MD and Smita R. Ramanadham, MD Aesthetic surgery of the breast aims to either correct ptosis with a mastopexy,

More information

Oncoplastic techniques in breast surgery for special therapeutic problems

Oncoplastic techniques in breast surgery for special therapeutic problems Surgical Technique Oncoplastic techniques in breast surgery for special therapeutic problems Prakasit Chirappapha, Panuwat Lertsithichai, Thongchai Sukarayothin, Monchai Leesombatpaiboon, Chairat Supsamutchai,

More information

Author's response to reviews

Author's response to reviews Author's response to reviews Title: Classifying breast cancer surgery: a novel, complexity-based system for oncological, oncoplastic and reconstructive procedures, and proof of principle by analysis of

More information

Pre-Conference Courses Rome Breast Surgery Symposium 2014 Reconstruction and Aestethic: Excellence as the Common Challenge.

Pre-Conference Courses Rome Breast Surgery Symposium 2014 Reconstruction and Aestethic: Excellence as the Common Challenge. Pre-Conference Courses Rome Breast Surgery Symposium 2014 Reconstruction and Aestethic: Excellence as the Common Challenge Rome, 4 June 2014 08.00 08.30 REGISTRATION 08.30 10.30 NEW TRENDS AND REFINEMENTS

More information

Breast Cancer Update 2018 The Latest in Diagnosis and Treatment SARATH K, PALAKODETI, DO, FAACS GENERAL, BREAST, AND COSMETIC SURGEON TOLEDO CLINIC

Breast Cancer Update 2018 The Latest in Diagnosis and Treatment SARATH K, PALAKODETI, DO, FAACS GENERAL, BREAST, AND COSMETIC SURGEON TOLEDO CLINIC Breast Cancer Update 2018 The Latest in Diagnosis and Treatment SARATH K, PALAKODETI, DO, FAACS GENERAL, BREAST, AND COSMETIC SURGEON TOLEDO CLINIC Objectives Identify breast lesions and masses, and know

More information

Figure 1. Anatomy of the breast

Figure 1. Anatomy of the breast CHAPTER 12 BREAST RECONSTRUCTION Mihaela Rapolti, MD and Michelle Roughton, MD I. BREAST ANATOMY A. Mastering breast anatomy is essential for understanding how the breast changes with aging and principles

More information

NEW TECHNIQUES IN BREAST RECONSTRUCTION

NEW TECHNIQUES IN BREAST RECONSTRUCTION NEW TECHNIQUES IN BREAST RECONSTRUCTION J Van Geertruyden and J-V Berthe Plastic Surgery Erasme University Hospital and Clinique Edith Cavell Brussels What s new in breast reconstruction? New materials

More information

Loco-Regional Management After Neoadjuvant Chemotherapy

Loco-Regional Management After Neoadjuvant Chemotherapy 1 Loco-Regional Management After Neoadjuvant Chemotherapy Terry Mamounas, M.D., M.P.H., F.A.C.S. Medical Director, Comprehensive Breast Program UF Health Cancer Center at Orlando Health Professor of Surgery,

More information

Algorithm for Autologous Breast Reconstruction for Partial Mastectomy Defects

Algorithm for Autologous Breast Reconstruction for Partial Mastectomy Defects Algorithm for Autologous Breast Reconstruction for Partial Mastectomy Defects Joshua L. Levine, M.D., Nassif E. Soueid, M.D., and Robert J. Allen, M.D. New Orleans, La. Background: The use of lateral thoracic

More information

The progress in microsurgical procedures has led

The progress in microsurgical procedures has led Original Article Breast reconstruction with free anterolateral thigh flap Ranjit Raje, Ramesh Chepauk, Kanti Shetty, Rajendra Prasad J. S. Plastic & Reconstructive Services, Department of Surgical Oncology,

More information

Surgical Therapy: Sentinel Node Biopsy and Breast Conservation

Surgical Therapy: Sentinel Node Biopsy and Breast Conservation Surgical Therapy: Sentinel Node Biopsy and Breast Conservation Stephen B. Edge, MD Professor of Surgery and Oncology Roswell Park Cancer Institute University at Buffalo Dr. Roswell Park: Tradition in Cancer

More information

Plastic Reconstructive Aspects after Mastectomy

Plastic Reconstructive Aspects after Mastectomy Diagnosis and Treatment of Patients with Primary and Metastatic Breast Cancer Plastic Reconstructive Aspects after Mastectomy Plastic Reconstructive Aspects after Mastectomy Version 2002: Brunnert Version

More information

Goals of Care. Restore shape and function after cancer

Goals of Care. Restore shape and function after cancer Goals of Care Restore shape and function after cancer Aid in physiological and psychological benefit Relationship with significant other Self esteem and positive body image Feeling of a whole body Avoid

More information

MASTECTOMY AND IMMEDIATE BREAST RECONSTRUCTION IN INVASIVE CARCINOMA

MASTECTOMY AND IMMEDIATE BREAST RECONSTRUCTION IN INVASIVE CARCINOMA MASTECTOMY AND IMMEDIATE BREAST RECONSTRUCTION IN INVASIVE CARCINOMA Node-postive breast cancer Delayed-immediate reconstruction versus delayed reconstruction DBCG RT Recon-Protocol Tine Engberg Damsgaard

More information

Medical Policy An independent licensee of the Blue Cross Blue Shield Association

Medical Policy An independent licensee of the Blue Cross Blue Shield Association Breast Reconstructive Surgery After Mastectomy Page 1 of 8 Medical Policy An independent licensee of the Blue Cross Blue Shield Association Title: Breast Reconstructive Surgery After Mastectomy PRE-DETERMINATION

More information

Case Scenario 1 History and Physical 3/15/13 Imaging Pathology

Case Scenario 1 History and Physical 3/15/13 Imaging Pathology Case Scenario 1 History and Physical 3/15/13 The patient is an 84 year old white female who presented with an abnormal mammogram. The patient has a five year history of refractory anemia with ringed sideroblasts

More information

How many procedures to make a breast?

How many procedures to make a breast? British Journal of Plastic Surgery (00 ), 5, 7-3 9 00 The British Association of Plastic Surgeons doi: 0.05/bjps.000.3538 BRITISH JOURNAL OF PLASTIC SURGERY How many procedures to make a breast? A. D.

More information

Oncoplastic Techniques Allow Extensive Resections for Breast-Conserving Therapy of Breast Carcinomas

Oncoplastic Techniques Allow Extensive Resections for Breast-Conserving Therapy of Breast Carcinomas ADVANCES IN SURGICAL TECHNIQUE ANNALS OF SURGERY Vol. 237, No. 1, 26 34 2003 Lippincott Williams & Wilkins, Inc. Oncoplastic Techniques Allow Extensive Resections for Breast-Conserving Therapy of Breast

More information

Nipple Sparing Mastectomy: Tips & Tricks. Rebecca Nelson, MD MSc FRCSC Plastic & Reconstructive Surgeon, Burnaby Hospital

Nipple Sparing Mastectomy: Tips & Tricks. Rebecca Nelson, MD MSc FRCSC Plastic & Reconstructive Surgeon, Burnaby Hospital Nipple Sparing Mastectomy: Tips & Tricks Rebecca Nelson, MD MSc FRCSC Plastic & Reconstructive Surgeon, Burnaby Hospital Nipple Sparing Mastectomy (NSM) Introduction & Technique Safety Evidence Indications/Contraindications

More information

Breast implant-associated anaplastic large cell lymphoma. (BIA-ALCL): a collaborative effort for diagnosis and treatment

Breast implant-associated anaplastic large cell lymphoma. (BIA-ALCL): a collaborative effort for diagnosis and treatment Case Report Page 1 of 5 Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL): a collaborative effort for diagnosis and treatment Kerry E. Fine, Matthew Wi, Della C. Bennett Department of

More information

Breast Restoration Surgery After a mastectomy

Breast Restoration Surgery After a mastectomy UW MEDICINE PATIENT EDUCATION Breast Restoration Surgery After a mastectomy This handout explains the most common procedures that are used at University of Washington Medical Center (UWMC) to restore a

More information

White Rose Research Online URL for this paper: Version: Supplemental Material

White Rose Research Online URL for this paper:   Version: Supplemental Material This is a repository copy of Complications in DIEP Flap Breast Reconstruction After Mastectomy for Breast Cancer: A Prospective Cohort Study Comparing Unilateral Versus Bilateral Reconstructions. White

More information

Resection Margins in Breast Conserving Surgery. Alberto Costa, MD Canton Ticino Breast Unit Lugano, Switzerland

Resection Margins in Breast Conserving Surgery. Alberto Costa, MD Canton Ticino Breast Unit Lugano, Switzerland Resection Margins in Breast Conserving Surgery Alberto Costa, MD Canton Ticino Breast Unit Lugano, Switzerland Breast Conserving Surgery 1 Probably one of the most important innovation in cancer surgery

More information

Breast Reconstruction. Westmead Breast Cancer Institute

Breast Reconstruction. Westmead Breast Cancer Institute Breast Reconstruction Westmead Breast Cancer Institute What is breast reconstruction? Breast reconstruction is a surgical procedure that creates a shape on the chest wall following a mastectomy. Occasionally,

More information

Recurrence following Treatment of Ductal Carcinoma in Situ with Skin-Sparing Mastectomy and Immediate Breast Reconstruction

Recurrence following Treatment of Ductal Carcinoma in Situ with Skin-Sparing Mastectomy and Immediate Breast Reconstruction Recurrence following Treatment of Ductal Carcinoma in Situ with Skin-Sparing Mastectomy and Immediate Breast Reconstruction Aldona J. Spiegel, M.D., and Charles E. Butler, M.D. Houston, Texas Skin-sparing

More information

Breast Reconstruction Postmastectomy. Using DermaMatrix Acellular Dermis in breast reconstruction with tissue expander.

Breast Reconstruction Postmastectomy. Using DermaMatrix Acellular Dermis in breast reconstruction with tissue expander. Breast Reconstruction Postmastectomy. Using DermaMatrix Acellular Dermis in breast reconstruction with tissue expander. Strong and flexible Bacterially inactivated Provides implant support Breast Reconstruction

More information

LIPOFILLING AND ONCOPLASTIC BREAST SURGERY : oncologic safety

LIPOFILLING AND ONCOPLASTIC BREAST SURGERY : oncologic safety LIPOFILLING AND ONCOPLASTIC BREAST SURGERY : oncologic safety JY Petit IEO Milan December 13-15, 2012 29 th Annual New York Controversies, Problems & Techniques in Surgery SYMPOSIUM COURSE DIRECTORS Robert

More information