Oncoplastic Breast Conservation for Central Tumors: Definition, Classification, and the Analysis of Single Institution Experience.

Background: Tumors in the central part of the breast are usually considered more aggressive and technically difficult, which limits breast conservation. The definition of central tumors from a surgical point of view, classification of the techniques for partial breast reconstruction, and conceptual algorithm of choice based on tumor and breast characteristics are proposed, along with the estimation of surgical and oncological safety. Methods: This is a retrospective analysis of the single-institution experience, with a focus on the decision-making process for choosing the oncoplastic breast-conserving surgery technique. To evaluate the safety of breast conservation for central tumors, a comparative analysis of early surgical complications and oncological long-term results of treatment in patients with central breast tumor location and other breast tumor locations was performed. Results: A total of 940 lumpectomies were performed in 926 patients during 15 years. The central breast tumor location group included 128 patients with 130 lumpectomies (13.8%), and the other breast tumor locations group included 798 patients with 810 lumpectomies (86.2%). We did not find any significant differences in the rate of early surgical complications and involved margins, local and systemic recurrence rates, time to progression, or overall survival between the groups. Conclusions: Oncoplastic breast-conserving surgery is a safe procedure for the treatment of central tumors. In our opinion, the proposed classification of partial breast reconstruction techniques and an algorithm of their choice allow for effective restoration of the breast shape and volume according to the parameters of the tumor, breast, surgeon, and patient preferences.

Modifications of the LICAP/LTAP Flap Technique in Partial Breast Reconstruction for Difficult Tumor Locations.

SUMMARY: The authors propose modifications of the lateral thoracic artery perforator/lateral intercostal artery perforator flap partial breast reconstruction that can help achieve improved aesthetic results, especially for centrally and medially located tumors. Lumpectomy is performed using the retromammary approach through lateral contour access without skin mobilization from parenchyma. This minimizes trauma and scarring of parenchyma and skin in the lateral part of the breast. In case of central or medial location of the tumor, the authors propose moving the flap into the tumor bed through a cut ("window") in the musculus pectoralis major. This helps stabilize the flap in an optimal position and redistribute the tissue without compression on the flap pedicle or bulge in the lateral sector of the gland. The authors have used this modification in 18 patients. The average tumor size was 2.8 cm (range, 1.2 to 5.4 cm) and the average weight of the specimens was 46.6 g (range, 14 to 110 g). Two patients had a tumor in the upper-inner quadrant close to the breast meridian, two in a central-lateral tumor location, and 14 in the upper-outer quadrant. Early complications occurred in four cases: two seromas of the wound, one partial flap necrosis with revision and resection of the flap, and one cellulite in the axillary region after axillary dissection because of long-standing lymphorrhea and drainage. The proposed modification of the lateral thoracic artery perforator/lateral intercostal artery perforator flap technique in partial breast reconstruction can lead to better aesthetic results and improved safety.

Response to neoadjuvant chemotherapy in breast cancer: do microRNAs matter?

BACKGROUND: Conventionally, breast cancer (BC) prognosis and prediction of response to therapy are based on TNM staging, histological and molecular subtype, as well as genetic alterations. The role of various epigenetic factors has been elucidated in carcinogenesis. However, it is still unknown to what extent miRNAs affect the response to neoadjuvant chemotherapy (NACT). This pilot study is focused on evaluating the role of miR-34a, miR-124a, miR-155, miR-137 and miR-373 in response to NACT. METHODS: That was a prospective study enrolling 34 patients with histologically confirmed BC of II-III stages. The median age of patients was 53 (47-59.8) years old, 70.6% of whom were HR-positive. MiRs levels were measured in the primary tumor before and after NACT. The response to therapy was assessed after surgery using the Miller-Payne scoring system. To establish the role of miRs in modulating response to NACT the Cox model was applied for analysis. RESULTS: BC demonstrated a great variability of miRs expression before and after NACT with no strong links to tumor stage and molecular subtype. Only miR-124a and miR-373 demonstrated differential expression between malignant and normal breast tissues before and after therapy though these distinctions did not impact response to NACT. Besides miR-124a and miR-137 levels after NACT were found to be dependent on HR status. While miR-124a levels increased (p = 0.021) in the tumor tissue, the expression of miR-137 was downregulated (p = 0.041) after NACT in HR positive BC. CONCLUSIONS: The study revealed differences in miR-124a and miR-373 expression after NACT in primary BC tissues. Although miRs levels did not impact the response to NACT, we found miR-124a and miR-137 levels to be related to hormonal sensitivity of BC.

Invisible Surgery Concept and Scenario Strategy: How to Get the Best Aesthetic Results in Oncoplastic Breast-Conserving Surgery.

SUMMARY: The authors believe that oncoplastic breast surgery has to achieve the best possible aesthetic results. In this article, they propose the concept of "invisible surgery." This is a combination of certain oncoplastic techniques that allows for restoration of the original appearance of the breast without obvious scars on the breast. Further, the authors classify the techniques as follows: the "level 1 technique," with contour approach; the "from inside" technique; the lateral parenchymal flap; the axillary subcutaneous adipofascial flap; the rotational lateral thoracic flap; regional island perforator flaps (lateral intercostal artery perforator, lateral thoracic artery perforator, anterior intercostal artery perforator, and medial intercostal artery perforator flaps); and the nipple-sparing mastectomy with immediate expander reconstruction. These techniques were combined by internal logic-one can move from one to another according to the preoperative planning and margins status during the operation. They call their approach the "scenario strategy." The authors have performed 138 operations in 137 patients using this approach. Most of them involved the "from inside" technique and perforator flaps. The average tumor size was 2.4 cm, and the average specimen weight was 43.2 g. The total rate of complications was 14.6 percent. According to this concept, the surgery should be performed in such way that breast appearance will not change. It should be planned as one would plan a staged procedure, taking into account possible changes in the scenario during the operation to achieve the best possible aesthetic result.

Advanced Oncoplastic Breast Conserving Surgery: Single Institution Experience with 823 Patients.

Background: Oncoplastic breast conserving surgery (BCS) becomes the standard of care in multidisciplinary breast cancer treatment. From our perspective, the aim of oncoplastic BCS is the best oncological, aesthetic and functional surgical treatment results. The study's objective is to present our approaches to the selection of surgical techniques and determine operative and oncological outcomes of oncoplastic surgery. Methods: This retrospective study presents a single institution experience with patients who underwent oncoplastic BCS for breast cancer between 2007 and December 2020. Demographic and clinicopathologic characteristics as well as postoperative complications were analyzed. The analysis was performed by taking into account the types of procedures. Surgeries were categorized into two types: 1. volume displacement (level 1; advanced parenchyma displacements; therapeutic mammaplasties) and 2. volume replacement techniques (regional flaps with wide base, regional island perforant flaps). We consider as oncoplastic all the operations that are planned and performed taking into account an optimal aesthetic result regardless of the specific technique. Results: There were 833 surgeries performed for 823 cancer patients. In 153 cases, patients had symmetrized procedures. The average weight of specimens was 112,9 g (2-1034 g); the average size of tumors was 2,8 cm (0,2-15,8 cm). 106 patients (12,7%) had multifocal/multicentric tumors. In (3,8%) 32 cases involved margins were found and re-excision was required. 793 (96,4%) patients were on follow up. The median follow-up period was 48 months (6 164 months). Local recurrence was found in 10 (1,2%) patients, regional axillary recurrence in 2 (0,3%), systemic progression in 87 (11,0%) patients and 50 (6,2%) of them have died. Complications were observed in 190 (23,1%) patients, mostly seromas and ischemic disorders. Conclusions: We present our approaches to oncoplastic breast conserving surgery with focusing on the aesthetic results of the procedures. Oncological outcomes demonstrate the safety of advanced oncoplastic BCS in the framework of multidisciplinary teamwork.