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Current practice and short-term outcomes of therapeutic mammaplasty in the international TeaM multicentre prospective cohort study

2018; Oxford University Press; Volume: 105; Issue: 13 Linguagem: Inglês

10.1002/bjs.10959

1365-2168

Rachel O’Connell, Elizabeth A. Baker, Adam Trickey, Tim Rattay, Lisa Whisker, R.D. Macmillan, Shelley Potter, Raj Achuthan, Shweta Aggarwal, Elizabeth A. Baker, Naren Basu, Lisa Brock, Patricia Fairbrother, Matthew D. Gardiner, Chris Holcombe, Charlotte Ives, Abhilash Jain, Baek Kim, R.D. Macmillan, John Murphy, Shelley Potter, Tim Rattay, Dionysios-Dennis Remoundos, Richard Sutton, Adam Trickey, Philip Turton, Kathryn Williams, Colin D. MacLeod, Elizabeth Smyth, Ivan Depasquale, Matthew Fuller, Noora Saeed, Yazan Masannat, Ashish Amin, Amit Agrawal, GW Irwin, Sam Sloan, S Refsum, Stuart McIntosh, Arwa Ibrahim, Ajay Sahu, Srinivas Govindarajulu, Simon Cawthorn, Antonello Accurso, Rathinasabapathy Rathinaezhil, Alex Wilkins, E Khalifa, Kartikae Grover, Penelope McManus, Peter Kneeshaw, Tapan Mahapatra, I. Azmy, J. Massey, Pawel Trapszo, Rondall Lane, Seema Seetharam, Nicola Rocco, Chandeena Roshanlall, Jalal Kokan, Khalid Amin, AD Leeper, Dhananjay Kulkarni, J. Michael Dixon, O. Young, Tayyaba Saleem, Jennifer McIlhenny, Andy Malyon, James Mansell, Keith Ogsto, László Romics, Dimitrios Dragoumis, Jarosław Krupa, Kalliope Valassiadou, K Lambert, Monika Kaushik, S Shokuhi, Simon Pilgrim, Xing Wei, Jeong‐Hoon Lee, Amir Allak, Clare Fowler, Eleanore Massey, Felipe A. Court, Richard Hunt, S.B. Vestey, Hany Ezzat Khalil, Mohsen El-Gammal, Laila Parvanta, Amtul Salam Sami, A Gvaramadze, Dinesh Thekkinkattil, Katharine Kirkpatrick, R James, Arish Noshirwani, T Arif, Zbigniew Kryjak, Amanda Taylor, Fahd Syed, G Safdar, Kian Chin, R. Soulsby, A. Thorne, Francesca Guest, M. Abbar, David A. Munnoch, E. Jane Macaskill, Fiona J. Hogg, Paula McGee, Vasileios Pitsinis, Janet Smith, Sundus Makkiyah, Shaima Mustafa, C. F. Otieno, Dana Photiou, Douglas Macmillan, Eleanor Gutteridge, Fayyaz Mazari, Georgette Oni, Hazem Khout, J. Kelsall, K Hallam, Kristjan Asgeirron, Lisa Whisker, Marta D’Auria, Sattar Zubaidi, Stephen J. McCulley, Tuabin Rasheed, James A. Bailey, Lisa Brock, Nazli Muhibullah, Alexandra Tenovici, Dionysios-Dennis Remoundos, Nikos Chaidos, Octavian Ion Predescu, Pankaj G. Roy, Richard Windle, E Popa, Geeta Shetty, J Rezulski, S. Goh, Tahirah Abdullah, Dinesh Thekkinkattil, Saira Khawaja, Sujatha Udayasankar, Sally Tebbal, Veronica Grassi, Adam Talbot, Naren Basu, Jagdeep Singh, Alexander Smith, Angela Volleamere, C Garnsey, Panagiotis Pikoulas, Charlotte Ives, Douglas Ferguson, Rachel Tillett, S Dean, S Olsen, Richard Rainsbury, Lashan Peiris, Olivia Sjökvist, Siobhan Laws, Anne Tansley, Edisa de Oliveira Sousa, Geraldine M. Mitchell, Joel Henderson, M. Chandrashekar, Shelley Potter, Aikaterini Micha, Amy Godden, Bruno Jorge Pereira, Christodoulos Constantinou, Jennifer Rusby, Katherine Krupa, N. To, Peter Barry, Adam Critchley, Baek Kim, Henry Cain, Joseph A. O’Donoghue, J. Henton, L. Kalra, Louise MacLennan, Rebecca J. Bennett, S Nicholson, Guido Paolini, L. Renzi, Santanelli Di Pompeo, Vitto Ria, Jesse Hu, L Johnson, R. S. Lewis, Sara Hadad, Souganthy Sundaramoorthy, Anup Sharma, Deirdre Toomey, D. Banerjee, Sarah Shuk Kay Tang, Linnet Taylor, Philip Turton, Raj Achuthan, S. McKenzie, Tessnim R. Ahmad, Kathryn Williams, Mohammed Absar, N. Nasir, Igor J. Rychlik, Lynn Darragh, Robert L. Johnston, S Kirk, J Rees Lee, M Green, Anup Sharma, K Chong, L.M. Lai, JH Choong, Shweta Aggarwal, Zeeshan Ullah, Leena Chagla, O. Koshy, Shalu Bathla, Tamara Kiernan, Ajay Ashok Bhojwani, Jonathan N. Lund, Karen James, M Callaghan, Raman Vinayagam, Shabbir Poonawala, John V. Taylor, Michelle Mullan, Rachel Bright Thomas, Ashu Gandhi, Ged Byrne, I. Ibrahim, James Harvey, John Murphy, Lyndsey Highton, Ada Chrysafi, R Hawley Jones, Nicola Barnes, Owen James Morris, Shaunak Chatterjee, Vinod Mathen, Yousef Majeed, Cliona C. Kirwan, Bruce M Jones, D El Sharief, Kailas Munot, Rabie Nasr, Rosemary Frame,

Reconstructive Surgery and Microvascular Techniques

Abstract Background Therapeutic mammaplasty, which combines breast reduction and mastopexy techniques with tumour excision, may extend the boundaries of breast-conserving surgery and improve outcomes for patients, but current practice is unknown and high-quality outcome data are lacking. This prospective multicentre cohort study aimed to explore the practice and short-term outcomes of the technique. Methods Consecutive patients undergoing therapeutic mammaplasty at participating centres between 1 September 2016 and 30 June 2017 were recruited to the study. Demographic, preoperative, operative, oncological and complication data were collected. The primary outcome was unplanned reoperation for complications within 30 days of surgery. Secondary outcomes included re-excision rates and time to adjuvant therapy. Results Overall, 880 patients underwent 899 therapeutic mammaplasty procedures at 50 centres. The most common indications were avoidance of poor cosmetic outcomes associated with standard breast-conserving surgery (702 procedures, 78·1 per cent) or avoidance of mastectomy (379, 42·2 per cent). Wise-pattern skin incisions were the most common (429 of 899, 47·7 per cent), but a range of incisions and nipple–areola pedicles were used. Immediate contralateral symmetrization was performed in one-third of cases (284 of 880, 32·3 per cent). In total, 205 patients (23·3 per cent) developed a complication, but only 25 (2·8 per cent) required reoperation. Median postoperative lesion size was 24·5 (i.q.r. 16–38) mm. Incomplete excision was seen in 132 procedures (14·7 per cent), but completion mastectomy was required for only 51 lesions (5·7 per cent). Median time to adjuvant therapy was 54 (i.q.r. 42–66) days. Conclusion Therapeutic mammaplasty is a safe and effective alternative to mastectomy or standard breast-conserving surgery. Further work is required to explore the impact of the technique on quality of life, and to establish cost-effectiveness.