Principles and Techniques in Oncoplastic Breast Cancer Surgery

Description

Oncoplastic breast cancer surgery is one of the fastest-growing domains in breast surgery. This approach is continuing to gain practice acceptance due to increased emphasis on both optimum cosmetic outcome and maintenance of a sound oncologic basis. This book summarizes the basic principles and techniques using evidence-based data. Patient images and comprehensive drawings complete this practical guide for surgeons who treat diseases of the breast. CONTENTS List of Contributors Acknowledgments Introduction 1. Surgical Anatomy of the Breast Mahmoud El-Tamer and Sunny Mitchell 1.1 Topology of the Breast: An Overview 1.2 Fascia 1.3 Raising Flaps 1.4 Ligaments of Cooper and Horizontal Septum 1.5 Arterial Supply of the Breast 1.5.1 Lateral Mammary Artery 1.5.2 Internal Mammary Artery 1.5.3 Thoracoacromial Artery 1.5.4 Posterior Intercostal Arteries 1.6 Venous Drainage of the Breast 1.7 Lymphatics 1.8 Nerve Supply 1.9 Nipple Areola Complex 1.9.1 Innervation 1.9.2 Blood Supply 1.9.3 Areola References 2. Surgical Landmarks and Measurements Suri Ponamgi and Mahmoud El-Tamer 2.1 Breast Measurement 2.2 Breast Markings 2.3 Vertical Mastopexy/Reduction Markings References 3. Neoadjuvant Therapy Laurie Kirstein, Susan K. Boolbol, and Mahmoud El-Tamer 3.1 Introduction 3.2 Background 3.2.1 Early Trials 3.2.2 Patient Selection 3.2.2.1 Exclusionary criteria 3.2.3 Tumor Size 3.3 Staging 3.3.1 Current Staging Guidelines 3.3.2 The Role of Imaging 3.3.3 Mammogram 3.3.4 Ultrasonography 3.3.5 Magnetic Resonance Imaging (MRI) 3.4 Predictors of Response 3.4.1 Response to NCT Based on Molecular Subtype 3.4.1.1 Triple negative 3.4.1.2 HER2 positive 3.5 Gene Profiling 3.6 Hormone Receptor-Positive Tumors 3.7 Invasive Lobular Carcinoma 3.8 Surgery After NCT 3.8.1 Surgical Decision Making 3.8.2 Resection Volume and Margins 3.8.3 Axillary Evaluation 3.8.4 Sentinel Node Biopsy Prior to NCT 3.8.5 Sentinel Node Biopsy After NCT 3.9 Locoregional Failure: Incidence and Predictors 3.10 Predictors of Relapse 3.10.1 Tumor and Patient Characteristics 3.10.2 Residual Disease After NCT 3.11 Future Directions 3.11.1 PARP Inhibitors 3.11.2 Vascular Endothelial Growth Factor (VEGF) Inhibitors 3.12 Conclusion 3.12.1 Patient Vignettes 3.12.1.1 Patient 1 3.12.1.2 Patient 2 References 4. Skin Incisions Mahmoud El-Tamer 4.1 Periareolar Incision 4.2 Inframammary Incision 4.3 Skin Closure References 5. Margins in Breast Cancer Surgery Adriana D. Corben and Monica Morrow 5.1 Methods of Margin Evaluation 5.1.1 Radial Margin Approach 5.1.2 Shaved Margin Approach 5.1.3 Cavity Shave Approach 5.1.4 Other Issues Related to Margin Assessment 5.2 Margin Width and Local Recurrence: Invasive Cancer 5.2.1 The Influence of Histology on Margin Width 5.2.2 Other Factors Influencing Local Control in Invasive Cancer 5.2.3 Margins After Neoadjuvant Chemotherapy 5.2.4 Summary and Conclusions: Invasive Cancer 5.3 Margin Width and Local Recurrence: DCIS 5.3.1 DCIS: Summary and Conclusions References 6. Resection of the Tumor Mahmoud El-Tamer 6.1 General Principles and Preoperative Planning 6.2 Resection of the Primary 6.2.1 General Principles 6.2.2 Technical Aspects References 7. Repair of Breast Defects Mahmoud El-Tamer 7.1 General Principles 7.1.1 Transverse Closure 7.1.2 Radial Closure 7.1.3 Triangular Closure (Also Known as “Mercedes” Closure) 7.1.4 Purse-String Closure 7.1.5 Mobilization of Surrounding Subcutaneous Tissue References 8. Oncoplastic Breast Reduction Tara L. Huston, Christine H. Rohde, Mahmoud El-Tamer, and Jeffrey Ascherman 8.1 Introduction 8.2 The Oncoplastic Approach 8.3 Patient Selection and Preoperative Breast Evaluation 8.4 History and Physical 8.5 Types of Breast Reduction 8.6 Relevant Anatomy 8.7 Technical Considerations 8.8 Incision 8.9 Pedicle 8.10 Radiation Therapy 8.11 Complications 8.12 Long-Term Oncologic Results 8.13 Breast Cancer Surveillance 8.14 Cosmetic and Functional Outcomes 8.15 Future Directions References 9. Mastopexy Mahmoud El-Tamer 9.1 Introduction 9.2 Dome Mastopexy 9.3 Benelli Mastopexy References 10. Skin-Sparing Mastectomy Walter Paul Weber and Mahmoud El-Tamer 10.1 Introduction 10.2 Incision 10.3 Mastectomy 10.4 Axillary Staging 10.5 Reconstruction 10.6 Safety 10.7 Postoperative Complications 10.8 Completeness of Mastectomy 10.9 Completeness of Tumor Removal and Local Recurrence Rates 10.10 Cosmesis References 11. Nipple-Sparing Mastectomy Sunny Mitchell and Sheldon Feldman 11.1 Introduction 11.2 Rationale 11.3 Why Not Perform NSM? 11.4 Most Frequently Cited Landmark Study 11.5 Basic Science 11.5.1 Breast Ductal Anatomy 11.5.2 The Terminal Ductal Lobular Unit 11.6 Proposed Metrics 11.7 Selection 11.7.1 Size 11.7.2 Presence and Degree of Ptosis (Grade 1–3, Pseudoptosis) 11.8 Exclusionary Criteria 11.9 Preoperative Evaluation 11.9.1 Clinical Breast Exam 11.9.2 Patient History 11.9.3 Imaging 11.9.4 Planning 11.10 Plastic Reconstructive Surgery Considerations 11.11 Comorbidities 11.12 Intraoperative Technique 11.12.1 Incision Planning 11.12.2 Spy Device 11.12.3 Inframammary Fold Incision 11.12.4 Lateral Radial Incision 11.12.5 Radial 6 O’clock Incision 11.12.6 Previous Lumpectomy Scar Incision 11.12.7 Transareolar Incision 11.12.8 Tumor Site Incision 11.13 Endoscopy 11.13.1 Endoscopic Technique 11.13.2 Accessing SLNB 11.13.3 Dissection 11.13.4 Coring 11.14 Additional Technical Notes 11.15 Intraoperative Radiation with Electrons (ELIOT) 11.16 Outcomes 11.16.1 Viability 11.16.2 Sensation 11.16.3 Aesthetics 11.16.4 Recurrence Rates 11.16.5 Prophylactic NSM 11.17 Clinical Pearls 11.17.1 What Is the Learning Curve? 11.17.2 What Special Instruments Are Required? 11.18 Summary and Conclusions 11.18.1 Unresolved Issues Postmastectomy References 12. Radiation Therapy Robert R. Kuske, Jr. 12.1 Background 12.2 Oncoplastic Surgery and 5-Day Interstitial Brachytherapy 12.3 Oncoplastic Surgery with 3-Dimensional Conformal PBI 12.4 Intraoperative Radiotherapy During Oncoplastic Surgery 12.5 Conclusions References Index