The practice of oncoplasticsurgery requires that surgeons obtain a level of under- standing of each of the critical components of cancer care, including those of other disciplines, in order to integrate the knowledge when devising a surgical plan. This can be accomplished in a variety of practice settings but is important particularly if surgeons are in an environment that does not have access to a multidisciplinary clinic or team. Often there is a surgical oncologist working in concert with a plastic and reconstructive surgeon. Even in this situation, it is crucial for the two surgical teams to confer prior to surgery in order to optimize the oncologic and aesthetic outcomes. In some environments, breast surgeons need to be able to integrate this knowledge independently and even perform both aspects of the surgery. Thus, the need for changes in the training curriculum for oncologic breast surgeons becomes obvious and should include the addition of aesthetic and reconstructive techniques. Currently, an international steering committee has been challenged with the task of developing standardized recommendations for training, and a preliminary outline of proposed skills for various levels of training is listed in (Table 1).
Until recently, the breast surgeon could provide only two options for patients with breast cancer: either a mod- ified radical mastectomy or a segmental excision followed by radiation. Integration of plastic surgery techniques at time of tumor excision has delivered a third pathway, enabling surgeons to perform major resections involving more than 20% of breast volume without causing defor- mity. This new combination of oncologic and reconstruc- tive surgery is commonly referred to as oncoplasticsurgery. This ‘‘third pathway’’ allows surgeons to extend the indications for BCS without compromise of oncologic goals or the esthetic outcome. It is a logical extension of the quadrantectomy technique described by Veronesi. 34 With immediate reshaping employed through OPS, major resections can now be achieved with enhanced cosmetic outcomes. 35–37
Oncoplasticsurgery is considered the standard of care for breast cancer therapy in numerous Western World countries, particularly in Europe. Despite the advancement of knowledge, Canada still lags in adoption of oncoplasty into the standard surgical practice. In our study, a mentorship program was used to introduce oncoplasticsurgery to practicing breast surgeons at LHSC. The change in perception and adoption of oncoplasticsurgery were evaluated using semi-structured interviews, before and after the intervention, by qualitative thematic analysis method. Mentorship program was validated as a superior method of learning new surgical techniques by practicing surgeons, demonstrating acceptance of different levels of oncoplasticsurgery. Identified barriers to acceptance included surgeon satisfaction with their initial work, lack of formal training, limited availability of courses, and the limitations within the Canadian healthcare system. Mentorship program was found to be a valid, accessible method for adopting new surgical techniques and needs. As a result, oncoplasticsurgery started to be adopted at LHSC, providing an example of how to facilitate the adoption to other surgical communities.
Background: The impact of breast appearance after breast cancer surgical treatment on patients’ quality of life led to the development of the oncoplastic approach. However, studies reporting oncologic results associated with this treat- ment strategy are scarce. This cross-sectional study was designed to assess oncologic outcomes among patients who underwent oncoplasticsurgery. Methods: A total of 190 breast cancer patients who underwent breast-conserving sur- gery were enrolled. Fifty of them underwent oncoplasticsurgery and 140 had none breast reconstruction procedure (control group). All surgeries were performed by the same surgical team. Results: Groups were similar with regard to staging, histological type, grade of the tumor, presence of intraductal component, hormone receptors and nodal com- mitment. Patients in oncoplasticsurgery group had larger tumors (ρ = 0.001) and more lymphovascular invasion (ρ = 0.047). Further, a higher proportion of them underwent chemotherapy (ρ = 0.030). Follow-up time of control group was longer (ρ = 0.05), and these patients also had a longer relapse-free survival time (ρ = 0.001). Local recurrence rate was 5.8% (11/190) and it was significantly greater in the oncoplasticsurgery group (8/11, ρ = 0.001). Time to local recur- rence after surgery was longer in oncoplasticsurgery group (ρ = 0.002). Overall, patients in oncoplasticsurgery group were younger (ρ = 0.001), but at the time of local recurrence, patients in oncoplasticsurgery group were older than those in control group (ρ = 0.0002). Conclusions: Among the studied patients, local recurrence rate was greater in those who underwent oncoplasticsurgery.
Oncoplastic Breast Surgery (OBS), which combine the concepts of oncologic and plastic surgery, are becoming more common, especially in Western countries [1,2]. There are many different oncoplastic surgical techniques, one of which involves careful planning of skin and par- enchymal excisions, reshaping of the gland after the par- enchymal excisions, and repositioning of the nipple are- ola complex (NAC) to the center of the breast mound with or without correction of the contralateral breast to achieve better symmetry [3-5]. We have reported that oncoplasticsurgery combining partial mastectomy and recentralization of the NAC with/without a contralateral operation produced excellent results in Japanese patients
Breast-conserving surgery followed by radiation therapy has become the preferred option of locoregional treatment for the majority of patients with early-stage breast cancer. It provides equivalent survival to that of mastectomy and improves body image [12, 13]. Although standard lumpec- tomy use is reasonable for small cancers with favourable breast/tumour size relation, in patients with an expected volume reduction of more than 10–20 %, oncoplastic methods should be performed due a clear risk of deform- ity [5, 12, 13]. A breast volume reduction of more than 10 % impairs the cosmetic outcome by 50 % . In con- trast, oncoplasticsurgery using advanced mammoplasty techniques allows resection of up to 50 % of breast volume [5, 6, 12, 13]. It results in excellent cosmesis of ipsilateral breast and also in good symmetry, when combined with immediate or delayed symmetrisation of contralateral breast . On the other hand, oncoplasticsurgery is associated with some disadvantages as prolongation of operative time and increased rate of local morbidity . In the last decade, numerous oncoplastic techniques have been described and published. The optimal choice should be individual and based on the potential benefits balanced with possible disadvantages. All tumour-related (size, location), breast-related (ptosis, volume, NAC projection), and patient-related (age, concomitant diseases, smoking status) factors must be taken into account.
In this study cohort of breast cancer patients, treated unilaterally with oncoplastic volume displacement sur- gery and with an untouched contralateral breast, the me- dian Q-score of the BREAST-Q™ domain “Satisfaction with breast” was slightly higher than those presented in other previously published studies evaluating BCS with BREAST-Q™, despite larger resections. The results indi- cate that oncoplastic volume displacement techniques can be beneficial in the surgical treatment of breast can- cer for selected patients. In this study, no independent risk factor for lower patient satisfaction was identified. Larger study cohorts are needed to further investigate potential risk factors for lower patient satisfaction after oncoplasticsurgery. Most patients in the current study were not interested in a contralateral procedure. In pa- tients treated with oncoplastic volume displacement sur- gery, contralateral surgery for symmetry is suggested to be performed only after individual evaluation and as a delayed procedure.
One of the predictors for oncological safety is the margin status, we had 5 cas- es (15.6%) with positive margins with mean width 9.63 ± 5.72 mm, In Brazil Mathes et al .  operated 17 patient with LABC utilizing advanced oncoplastic techniques with no positive margins, Similary Viera et al .  reported margin length 16.44 mm by oncoplasticsurgery with no positive margins, Emiroglu et al .  found that the mean surgical margin length was 8.7 mm (range 5 - 17 mm) with positive margins in 7.1% of cases, in a study done by Clough et al .  patients who received NACT and OS had a positive margins rate 10.9%.
margin width and maintain the breast’s shape and appearance. 5 The undertaking of both goals together in the same operation can be challenging, depending on the tumour location and relative size in the breast . If a lesion is large or located in a region that is too difficult to excise without the risk of cosmetic deformity, special approaches to resection should be considered. The value of full-thickness excision with breast-flap mastopexy closure is intuitively apparent.The term oncoplasticsurgery is used differently depending on the specialty in which it is being referred. 6-10 In plastic surgery, the term typically refers to large partial mastectomy combined with a volume replacement technique of partial breast- myo cutaneous flap reconstruction using the latissimus dorsi or transrectus abdominus muscle In the present study 41 cases of breast cancer underwent oncoplasticsurgery using volume ORIGINAL ARTICLE
follow-up was 7.4 years. There was no significant difference in OS, 87.3% (OBCS) and 87.1% (Mx) at 10 years. DFS was similar in both groups: 60.9% (OBCS) and 56.3% (Mx) at 10 years. The incidence of local events was slightly higher in the OBCS group (7.3 vs 3% at 10 years), whereas the incidence of regional events was slightly higher in the mastectomy group. These differences were not statistically significant. The oncoplastic procedures described in both these studies were quite heterogenous involving advancement of glandular flaps, which suggests level 1 oncoplasticsurgery only. Nev- ertheless, these 2 retrospective studies, which include a large series of patients with matched control groups, provide the best available evidence that OBCS is a safe treatment option for early breast cancer patients.
DOI: 10.4236/abcr.2018.72011 190 Advances in Breast Cancer Research associated postoperative complications were surveyed. These surgical experts were all practitioners of oncoplasticsurgery and breast surgery in the United States, and managed complications associated to these operations. To increase generalizability, surveys were multi-institutional (9 total) with each institution having a comprehensive breast cancer center. Half of the surveys were per- formed by fellowship trained breast surgical oncologists and half by plastic surgeons. Utilities were obtained using visual scales. These experts were posed with identical scenarios involving each health state (but different surgical ap- proaches) and were asked to rank their preferences such that the quality of life for each health state was marked on a “feeling thermometer”, a vertical ladder of 100 units ascending from a score of 0 (death) to 100 (perfect health). The overall utility of each health state was obtained by averaging the expert opinion. Health state utility score values amongst institutions and breast surgical specialties had minimal variation with a standard deviation score range of 6 to 13 amongst questions asked.
Breast cancer is the most commonly diagnosed malig- nancy in women worldwide [1, 2] and in the twentieth century, mastectomy was the primary surgical treatment for breast cancer patients. Advances in breast-conserving surgery (BCS) propelled a change in treatment rational from “maximum tolerable” to “minimum effective” ther- apy. Oncoplastic breast surgery aims to restore the shape of the breast and has been widely adopted since the past decade. Although the cosmetic outcome has been sig- nificantly improved, the scar remaining on the surgeried breast skin is still a major pitfall that urges urgent consid- eration. In this editorial, we review a series of techniques that can be incorporated in oncoplastic breast surgery to minimize scarring, signifying the beginning of an era for scarless oncoplasticsurgery.
Goal: Evaluate the techniques and results obtained from the mammary On- coplastic in the conservative treatment of breast cancer. Patients and me- thods: This is a retrolective descriptive study conducted during the period from 3 April 2017 to 3 April 2019, the Gynecologic Breast pole of the Oncol- ogy National Institute of Rabat. Results: Out of 105 files listed, the locations of the tumours were: 35% 37/105 QSE, QSI QSE + 21/105 or 20%, QSI 19/105 or 18%, QSI 12/105 or 11%, other maps 16/105 or 16%. The techniques were Oncoplastic: Pamectomy 10/105 or 10% Round Block 58/105 or 55%, plasty inverted T 21/105 or 20%, and other technical 16/105 or 15%. The aesthetic results and the quality of resection were correct and above all stable at 82/105 patients 78% of cases. The lymphocele 13/105 or 12% 5/105 5% lymphoedema represented early complications occurred as late complications consisted of retractile unsightly scars 15/105 or 14%, breast asymmetry 13/105 soit12% and cutaneous sclerosis 3/105 or 3%. Conclusion: The oncoplasticsurgery is a part of multidisciplinary management of breast cancer. It imposes oncologic resections and reassuring cosmetic results for the patient and the practitioner.
All the patients continued their preoperative medications till the morning of the surgery. The antiplatelet agents were stopped 5 to 7 days prior to the scheduled date of surgery. On the day of the surgery, patient was induced with midazolam, fentanyl and pancuronium. Intraoperative monitoring was done by using arterial blood pressure monitoring and central venous pressure monitoring and using a cardiac output monitor through out the surgery. The on-pump patients received heparin at a dose of 3mg/kg and an activated clotting time of > 400s was maintained. The off-pump patients were administered heparin at a dose of 1.5mg/kg and ACT was maintained at >250s. In all the patients , LIMA LAD anastomosis was constructed first.
The continuous publication of new trials in time leads to the production and dissemination of new systematic reviews as a means to provide a synthesis of the litera- ture that relies upon the latest data. For systematic reviews to be considered useful for end users, they must be up to date. In the current study, at least three groups of reviewers have provided updates of their own work in subsequent publications [10,17,19,23,29,39]. However, these were not specifically labeled as such, a finding that may lead to confusion on the part of the reader. In con- trast, all three Cochrane Reviews documented having undergone substantive amendments since their original publication, as a result of new data pertinent data in the literature [26,30,38]. This difference between Cochrane and non-Cochrane reviews is not surprising. Indeed, Jadad et al. have previously demonstrated that only 3% of systematic reviews published in traditional journals underwent update within 2 years of publication, com- pared with 38% of Cochrane Reviews . Although the timing at which systematic reviews should be updated remains controversial, it seems intuitive that, in a rapidly progressing field of healthcare such as laparo- scopic surgery for colorectal cancer, existing systematic reviews should be updated frequently [87,88]. The case for updating systematic reviews becomes particularly compelling when one considers the large number of overlapping reviews identified in this study, and when registration of systematic reviews is considered.
Since cataract surgeries are performed in the operation room in Iran, this stage is appropriate for patient evaluation. After identifying the number of cataract surgeries in surgery centers through providing a list of eye surgery operating rooms of Iran and estimating their activities, the researchers attended the centers and supervised the process of retrieving the files and extracting the required data after obtaining authorization from hospital managers. The required information included age, sex, type of surgery, type of lens, admission and discharge dates, type of cataract, and intraoperative complications.
• Although small trials have shown glycemic benefit of bariatric surgery in patients with type 2 diabetes and BMI of 30–35kg/m2, there is currently insufficient evidence to generally recommend surgery in patients with BMI35 kg/m2 outside of a research protocol. (E)
Abstract: The erbium-doped yttrium aluminium garnet (Er:YAG) laser has emerged as a possible alternative to conventional methods of bone ablation because of its wavelength of 2.94 µm, which coincides with the absorption peak of water. Over the last decades in several experimental and clinical studies, the widespread initial assumption that light amplification for stimulated emission of radiation (laser) osteotomy inevitably provokes profound tissue damage and delayed wound healing has been refuted. In addition, the supposed disadvantage of prolonged osteotomy times could be overcome by modern short-pulsed Er:YAG laser systems. Currently, the limiting factors for a routine application of lasers for bone ablation are mainly technical drawbacks such as missing depth control and a difficult and safe guidance of the laser beam. This article gives a short overview of the development process and current possibilities of noncontact Er:YAG laser osteotomy in oral and implant surgery.
deformities exist. In addition, the plastic surgeon treats injuries to the face, including fractures of the bone of the jaw and face. Craniofacial surgery is a discipline developed to reposition and reshape the bones of the face and skull through inconspicuous incisions. Severe deformities of the cranium and face, which previously were uncorrectable or corrected with great difficulty, can now be better reconstructed employing these new techniques. Such deformities may result from a tumor resection, congenital defect, previous surgery, or previous injury. Treatment of tumors of the head and neck and reconstruction of these regions after the removal of these tumors is also within the scope of plastic surgery.
To generate a new set of surgeries, the tool generates a waiting list, which is used as input for the schedule. The initial waiting list contains a workload of two weeks and is filled to the same amount of surgeries after each scheduled week. Surgeries are not allowed to be on the waiting list longer than four weeks. Schedules are constructed per week, as is the case in practice. First, surgeries with a critical due date are scheduled. Next, surgeries are assigned to the reserved MSS slots. Finally, the remaining surgeries are scheduled, using largest surgery duration first. When a surgery does not fit into the schedule, it is postponed to the next week. The surgeries are scheduled in the OR where the remaining surgery time after scheduling is the least. This is called a ‘best fit’ heuristic. After scheduling one week, new surgeries from a random surgery type are generated, to restore the initial number of surgeries on the waiting list.