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Complications after surgery
Source publication
Breast conserving surgery (BCS) has replaced modified radical mastectomy as the standard treatment for early breast cancer. However, even though the original shape of the breast is preserved, the significant scarring after BCS detracts from the natural appearance of the breast. Endoscopy-assisted breast surgery can be performed with small incisions...
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Background
With the development of new surgical techniques in breast cancer, such as oncoplastic breast surgery, increased knowledge of risk factors for poor satisfaction with conventional breast-conserving surgery (BCS) is needed in order to determine which patients to offer these techniques to. The aim of this study was to investigate patient sat...
Background:
Oxidized regenerated cellulose polymer (ORCP) may be used for reshaping and filling lack of volume in breast-conserving surgery (BCS). The study aimed to observe both the aesthetic and diagnostic outcomes in patients with different age, BMI, breast volume, and breast tissue composition over 36 months after BCS with ORCP.
Patients and...
Background:
Choosing the optimal mastectomy incision must account for oncologic, reconstructive, and aesthetic considerations, including nipple preservation, mastectomy skin margins and potential for skin involvement, mastectomy skin perfusion and viability, mastectomy skin excess, previous breast scars, the reconstructive plan, and inconspicuous...
Background:
Textured breast implants have been used in aesthetic breast surgery to decrease the rates of implant malposition. A recent analysis of a large-volume single-surgeon experience found statistically similar rates of malposition in smooth vs micro-textured breast implants.
Objectives:
Prophylactic use of a polydioxanone (PDO) internal su...
Citations
... was described in 2008 by Yamasita. In 1998, Kitamura reported the first use of endoscopic surgery for removal of benign breast tumors in six patients, and in 2001 he reported a more extensive experience in 36 patients with benign breast lesions (Kitamura et al., 1998;Yamashita and Shimizu, 2008;Hong and Shin, 2010). ...
Objective:
This study aimed to compare the patients' satisfaction level after fibroadenoma surgery with Video-Assisted Breast Surgery (VABS) and Vacuum-Assisted Breast Biopsy (VABB) techniques.
Methods:
Patients who underwent VABS or VABB for a diagnosis of fibroadenoma mammae at the Oncology Clinic in Solo, Indonesia were included in this study. Clinical and demographic data were obtained from medical records. Direct or telephone interviews were performed and the patients were asked to complete Universitas Sebelas Maret Breast Satisfaction Questionnaire 8 (UNS-BsQ8) questionnaire.
Results:
A total sample of 16 patients with VABS and 26 patients with VABB were recruited. All the patients were confirmed to have fibroadenoma based on the pathological result. The mean total scores for VABS and VABB were 34.50 ± 2.094 and 31.57 ± 3.081, respectively (P= 0.137). Out of 8 questions, only 3 items had statistically significant differences. VABS had higher mean score than VABB in terms of surgery cost (P = 0.002), pain in surgery site (P = 0.006), and pain in shoulder (P = 0.013).
Conclusion:
There was no significant difference in terms of overall patients' satisfaction level between both groups. However, VABS had a higher mean score than VABB in terms of cost and pain.
... Endoscopic-assisted mastectomy was first performed and popularized in a few Asian countries (1,5,(7)(8)(9)(10), where the obvious advantage seemed to be better aesthetic outcomes for women with small breasts in whom a breast conserving surgery resulted in poor aesthetic outcomes as well as the risk of inadequate resection or margin involvement. Endoscopic-assisted breast conserving surgery (E-BCS) (11)(12)(13)(14)(15)(16) was also subsequently performed Review Article with glandular rearrangement or level I oncoplastic techniques. There were multiple studies reporting on the technical feasibility, aesthetic and safety outcomes of the technique over the years but it has yet to become the mainstream or standard in the surgical management of breast cancer (1,5,(7)(8)(9)(10)(11)(12)(13)(14)(15)(16). ...
... Endoscopic-assisted breast conserving surgery (E-BCS) (11)(12)(13)(14)(15)(16) was also subsequently performed Review Article with glandular rearrangement or level I oncoplastic techniques. There were multiple studies reporting on the technical feasibility, aesthetic and safety outcomes of the technique over the years but it has yet to become the mainstream or standard in the surgical management of breast cancer (1,5,(7)(8)(9)(10)(11)(12)(13)(14)(15)(16). Possible reason for this includes the lack of long-term follow-up data to establish oncologic safety in terms of loco-regional and distant recurrence as well as disease survival outcomes data. ...
Surgical management of breast cancer has been evolving rapidly over the past 20–30 years. Prior to this, conventional surgical options were limited to either a mastectomy or breast conserving surgery. The demand for better aesthetic outcomes had driven the development of oncoplastic breast conserving surgery where glandular rearrangement or replacement coupled with thoughtfully placed incisions became the standard approach to breast conserving surgery. As breast surgeons and patients demand for improved aesthetic outcomes, minimally invasive or minimal access breast surgery has gained much attention over the past two decades, from endoscopic assisted to robotic-assisted breast surgery more recently. However, there has been a lack of review articles discussing this relatively recent but under-reported subset of surgical techniques in the management of breast cancer. This article aims to discuss the concept and development of minimal access breast surgery along with a review of current literature on its indications, techniques and outcome measures as well as a discussion on the strengths, limitations as well as future directions. Continued improvement in techniques and advancement of technology will definitely increase the likelihood of minimal access techniques being placed as the standard of care in the management of breast cancer.
... Dissection in the retromammary space is performed between the posterior face of the breast and the pectoral muscle ( Figure 4). Retractors with optical systems (Vein Harvest, Ultra Retractor, Vein Retractor) are also used for blunt dissection while bipolar scissors or electro-cautery is used for coagulation (1,5,8,11,16,17) (Figure 5, 6). Techniques for creating the work area using pre-peritoneal dissection balloon (17,21) or insufflation (22) were used in the past as part of posterior dissection; however, they are not preferred today. ...
... This method is not recommended in patients with collagen disease or on steroids (17). Furthermore, "Oxidized Cellulose" (Surgicel, Johnson&Johnson) was also tested in order to wrap the mesh used for filling in the cavity (1,5,16,17,25). The mesh here causes the growth of granulation, reactive fluid and fibrosis tissue while "oxidized cellulose" prevents the mesh from adhering to the skin (25). ...
... The scoring is done using a 4-points scoring system (excellent=3, good=2, moderate=1, poor=0). A score of 11 points in total or above is considered as good or excellent breast aesthetics (1,5,7,8). ...
Endoscopic oncoplastic breast surgery represents a minimal invasive approach with the aim of both removing cancer safely and also restoring the breast image. It has less noticeable scar, excellent cosmetic outcomes, high patient satisfaction rate and recently reported relatively long term safety. Operative techniques for both endoscopic breast conserving surgery and endoscopic nipple/areola/skin sparing mastectomy have been described in detail. Two different working planes in which one of them is subcutaneous and the other one is sub-mammary planes are being used during the surgery. Surgical techniqe needs some instruments such as endoscopic retractor, light guided specific mammary retractor, wound protector and bipolar scissor. Endoscopic breast retractors provide magnified visualization and extensive posterior dissection facility. Tunneling method and hydrodissection simplify the technique in the subcutaneous field. Oncoplastic reconstruction techniques are also applied after the tumor resection by endoscopic method. Complication rates of endoscopic breast surgery are similar to open breast surgery rates. Quite succesful local recurrence, distant metastasis and overall survival rates have been declared. However it looks reasonable to wait for the results with longer follow-up before having a judgement about oncologic efficiency and safety of the endoscopic breast cancer surgery.
... The feasibility of EABCS was analyzed in terms of operative time, resection margin status, and RFS. Operative time is usually affected by the number of cumulative cases or operation type [5,10], and it has been reported that EABCS takes longer than conventional BCS [6]. However, although we included EABCS cases during the earlier period, which usually took longer than those after the learning period, to calculate the mean operative time, the difference in the mean operative time between EABCS and conventional BCS was only about 10 minutes, and it was not significant. ...
... Although the Japanese health authority agreed to reimburse the cost for endoscopic breast surgery, no definite reimbursement consensus was reached for endoscopic breast surgery in Europe and North America [11]. Compared with previous techniques performed with various endoscopic devices, retractors, or enhanced coagulating and cutting devices such as the harmonic scalpel [5,6,13], our technique can be performed with only one set of endoscopic devices including an Endosector LE and an endoscopic video system for dissecting the retromammary space. Therefore, the cost for using the additional devices might be reduced. ...
... Resection margin status is a risk factor for local recurrence in patients with early breast cancer [14,15], and it may be a crucial factor for accessing EABCS feasibility. The resection margin positive rate for EABCS is 0-5% [5,6,10], compared with about a 10% margin positive rate for conventional BCS [1,16]. A direct comparison of the differences in the positive margin rates between EABCS and conventional BCS is difficult due to heterogeneous study designs, including the definition of a positive margin, surgeon experience, and extent of surgery. ...
Breast conservation surgery (BCS) has become a standard treatment method for patients with early breast cancer. Endoscopy-assisted BCS (EABCS) can be performed through an inconspicuous periareolar and a small axillary incision for sentinel node biopsy, which may give better cosmetic outcomes than conventional BCS skin incisions. This study was designed to evaluate the feasibility of EABCS for patients with early breast cancer.
Forty-three patients were candidates for EABCS, and EABCS was performed in 40 patients with breast cancer between January 2008 and July 2010. Their clinicopathological features were retrospectively analyzed. Operative time, margin status, complications, and relapse-free survival were compared with those of patients treated by conventional BCS and who were treated at the same institute during the same period.
The most common lesion site of the EABCS and conventional BCS groups was the upper area of the breast. Tumor size in all patients was less than 4 cm (range, 0.4-3.7 cm), and nodal involvement was found in eight (20%) patients in the BCS group. The mean operative time was 110 minutes for the EABCS group and 107 minutes for the conventional BCS group, and those were not significantly different. No significant difference in frozen or final margin status was observed between the EABCS and conventional BCS groups. Relapse-free survival was statistically equivalent between the groups with a median follow-up of 12 months. Postoperative complications occurred in five cases in four patients with EABCS, which was not significantly different from conventional BCS.
Performing EABCS in patients with early breast cancer seems to be feasible and safe. Further study with a longer-term follow-up may be needed to confirm the clinical value of EABCS.
Background:
Endoscopy-assisted breast conserving surgery (E-BCS) was developed over 10 years ago as a method for breast cancer treatment with the potential advantage of less noticeable scarring. However, the evidence supporting its superiority over conventional breast conserving surgery (C-BCS) remains unclear.
Objective:
This study aims to compare the outcomes of E-BCS and C-BCS for the treatment of early breast cancer.
Methods:
A comprehensive search for relevant articles was performed using specific keywords in Medline, Scopus, ClinicalTrials.gov, and Cochrane Library PubMed up to October 17th, 2022. Clinical trials that compared E-BCS with C-BCS in early breast cancer patients were collected.
Results:
Our analysis of nine studies revealed that E-BCS was associated with shorter incision length [Mean Difference (MD) -6.50 cm (95% CI -10.75, -2.26), p = 0.003, I2 = 99%] and higher cosmetic score [MD 2.69 (95% CI 1.46, 3.93), p < 0.0001, I2 = 93%] compared with C-BCS. However, E-BCS had a longer operation time [MD 35.95 min (95% CI 19.12, 52.78), p < 0.0001, I2 = 93%] and greater drainage volume [MD 62.91 mL (95% CI 2.55, 123.27), p = 0.04, I2 = 79%]. There was no significant difference in blood loss volume (p = 0.06), drainage duration (p = 0.28), postoperative complications (p = 0.69), or local recurrence (p = 0.59) between the two groups.
Conclusion:
Our study suggests that E-BCS offers a shorter incision length and better cosmetic outcome compared with C-BCS in the treatment of early breast cancer. However, E-BCS requires a longer operation time and has greater drainage volume. Further studies are needed to confirm these findings.
Minimal invasiveness has become the mainstream of breast cancer surgeries to achieve more satisfaction and quality of life. Breast-conserving surgery combined with postoperative radiotherapy is accepted widely as a standard therapy for early breast cancer. Currently, the aim of breast-conserving surgery is not only to perform a curative resection of cancerous lesions with adequate surgical margins but also to preserve the shape and appearance of the treated breast. However, achieving cosmesis can be challenging in addition to the therapeutic approach and sometimes it fails because of difficulty in removing tissue with endoscopic instruments and repairing the excised breast volume. In this chapter, we review clinical studies that have been conducted so far and discuss current issues regarding video-endoscopic breast-conserving surgery techniques for breast cancer.
Endoscopic oncoplastic breast surgery represents a minimal invasive approach with the aim of both safe excision of cancer and preserving the breast shape. It has less noticeable scar, excellent cosmetic outcomes, high patient satisfaction rate. Recently, relative long-term follow-up results have been reported to be very safe (Soybir and Fukuma, J Breast Health 11:52–58, 2015; Fan et al., Chin Med J 122:2945–2950, 2009; Jiang, Zhonghua Wai Ke Za Zhi 45:439–441, 2007).
Structured Summary
Background
Breast cancer is the second most prevalent form of cancer in women worldwide, with surgery remaining the standard treatment. The adverse impact of the surgery remains controversial. It has been suggested that systemic factors during the postoperative period may increase the risk of recurrence, specifically surgical site infection (SSI).
Aim
To critically appraise current published literature regarding the influence of SSIs, after primary breast cancer surgery, on breast cancer recurrence, and to delve into potential links between these.
Methods
This systematic review adopted two approaches; to identify the incidence rates and risk factors related to SSI after primary breast cancer surgery and, secondly, examine breast cancer recurrence following SSI occurrence.
Findings
99 studies with 484605 patients were eligible in the SSI-focused searches, and 53 studies with 17569 patients for recurrence-focused. There was a 13.07% mean incidence of SSI. 638 Gram positive and 442 Gram negative isolates were identified, with methicillin-susceptible Staphylococcus aureus and Escherichia coli most commonly identified. There were 2077 cases of recurrence (10.8%), with 563 cases of local recurrence, 1186 cases of distant and 25 cases which recurred both locally and distantly. Five studies investigated the association between SSI and breast cancer recurrence with three concluding that an association did exist.
Conclusions
There is association between SSI and adverse cancer outcomes, but the cellular-link between them remains elusive. Confounding factors of retrospective study design, surgery type and SSI definition make results challenging to compare and interpret. A standardised prospective study with appropriate statistical power is justified.
Background:
Endoscopic assisted breast surgery was associated with small and inconspicuous scar and endoscopic assisted breast conserving surgery (E-BCS) for breast cancer was increasingly performed as well. The clinical outcomes, learning curve analysis and patient reported cosmetic result of E-BCS for breast cancer were reported along with a review of the current literature.
Methods:
A retrospective study analyzing the outcomes of E-BCS for breast cancer patients through an endoscopic breast surgery database in a single institution from June 2009 to May 2019 was performed and a literature review through Pubmed and Medline was conducted as well.
Results:
100 consecutive breast cancer patients who underwent E-BCS were analyzed. The mean age of patients was 52.5 years old. Furthermore, the mean pathologic tumor size was 1.6 cm and majority of patients had early stage (13% stage 0, 56% stage I, and 30% stage II) breast cancer. The mean operation time of E-BCS in the current study was 133 ± 50 min and in learning curve analysis, after accumulation of 15 consecutive cases the operation time significantly decreased. The morbidities of E-BCS were minor and most of them were skin flap related. The margin involvement rate was 4%. About 98% of patients surveyed were satisfied with the incision length, location and scar appearance of E-BCS whereas all of them were satisfied with E-BCS in general. With a mean follow-up of 29.2 ± 24.4 months, 3% of patients developed locoregional recurrences, 3% had distant metastasis and there were 2 mortalities observed.
Conclusion:
In our preliminary experience, E-BCS is a promising surgical technique for selected early breast cancer patients with low morbidity, acceptable oncological outcomes and high patient satisfaction.
To review current literature on the outcomes, techniques and trend of endoscopic-assisted breast surgery (EABS) in the management of breast cancer over a 20 years period Materials and Methods: Literature search was performed using PubMed/Medline database from 1st January 1998 to 31st December 2018 using the terms "endoscopy", "endoscopy-assisted", "breast cancer", "mastectomy" and "breast conserving surgery". Additional studies were also identified by reviewing references of relevant articles. Only case series and cohort studies were included in this review. Oncological and surgical outcome measures as well as detailed technical aspects were discussed. Results: EABS was comparable in terms of oncological, surgical as well as aesthetic outcomes if compared to conventional techniques. Patient selection and important adjuncts are essential to ensure successful and safe conduct of EABS. Conclusions: Standardization of techniques, practice guidelines and objective outcome assessments methods might pave the way for better conduct of EABS and place EABS as one of the standards of care for breast cancer care.
