Der Stellenwert der onkoplastischen Brustrekonstruktion nach
                    Tumorektomie in der chirurgischen Brustkrebs-Behandlung

Andrea Weinzierl; Daniel Schmauss; Yves Harder

doi:10.1055/a-1773-0968

Handchirurgie · Mikrochirurgie · Plastische Chirurgie, Table of Contents

Handchir Mikrochir Plast Chir 2022; 54(04): 305-313
DOI: 10.1055/a-1773-0968

Übersichtsarbeit

Der Stellenwert der onkoplastischen Brustrekonstruktion nach Tumorektomie in der chirurgischen Brustkrebs-Behandlung

The Significance of Oncoplastic Breast Reconstruction After Tumorectomy in Surgical Breast Cancer Therapy

Authors

Andrea Weinzierl

¹Institut für Klinisch-Experimentelle Chirurgie, Universität des Saarlandes, Homburg/Saar, Deutschland
Daniel Schmauss

²Klinik für Plastische, Rekonstruktive und Ästhetische Chirurgie, Ospedale Regionale di Lugano (ORL), Ente Ospedaliero Cantonale (EOC), Lugano, Schweiz

³Fakultät der Biomedizinischen Wissenschaften, Università della Svizzera Italiana, Lugano, Schweiz
Yves Harder

²Klinik für Plastische, Rekonstruktive und Ästhetische Chirurgie, Ospedale Regionale di Lugano (ORL), Ente Ospedaliero Cantonale (EOC), Lugano, Schweiz

³Fakultät der Biomedizinischen Wissenschaften, Università della Svizzera Italiana, Lugano, Schweiz

Abstract

Zusammenfassung

Brusterhaltende Therapie (BET), also Tumorektomie in Kom- bination mit systemischer Therapie und lokoregionärer Be- strahlung hat sich als bevorzugte Behandlungsmethode bei Brustkrebs im Frühstadium etabliert. Insgesamt exzellente Raten für Rezidiv-freies Überleben und Langzeitüberleben haben dazu geführt, dass Brustchirurgen heute dauerhafte und ästhetisch ansprechende Ergebnisse liefern müssen, um den hohen Patientenansprüchen gerecht zu werden. Die onkoplastische Brustchirurgie (OPBC) ist hierbei ein innovativer Ansatz, um das Indikationenspektrum der BET zu erweitern, beziehungsweise deren Gesamtergebnisse zu verbessern. Meist von einem Team aus einem plastischen Chirurgen und einem Gynäkologen oder onkologischen Brustchirurgen durchgeführt, kann OPBC Brustdeformitäten aktiv vorbeugen, ohne dabei die onkologische Sicherheit zu gefährden. Aufgrund der stetig wachsenden Bedeutsamkeit der OPBC soll die vorliegende Übersichtsarbeit einen Einblick in ihre Grundprinzipien geben, sowie deren Vor- und Nachteile diskutieren, um diese in den Kontext der rekonstruktiven Brustchirurgie einzuordnen.

Abstract

Breast-conserving therapy (BCT), meaning tumorectomy in combination with systemic therapy and locoregional radiation therapy has become the preferred method to treat early-stage breast cancer. With excellent long-term recurrence-free and overall survival rates, breast surgeons today must deliver du- rable and aesthetically appealing results that guarantee a good quality of life to meet the high patient expectations. Oncoplas- tic breast surgery (OPBS) is an innovative approach to improve the overall results of BCT. Often carried out by a team of a plastic surgeon and an oncologic breast surgeon, OPBS can actively prevent breast deformities without compromising oncological safety. In the following, an overview of the principles and techniques of oncoplastic breast surgery will be given due to its ever-increasing significance and its advantages and dis- advantages will be discussed in the context of reconstructive breast surgery.

Schlüsselwörter

Brustrekonstruktion - Brustkrebs - onkoplastische Brustchirurgie - brusterhaltende Therapie

Key words

breast reconstruction - breast cancer - oncoplastic breast surgery - breast conserving therapy

Full Text

References

Literatur
1 Reitsamer R, Menzel C, Glueck S. et al. Predictors of mastectomy in a certified breast center-the surgeon is an independent risk factor. Breast Journal 2008; 14: 324-329
2 de Boniface J, Frisell J, Bergkvist L. et al. Breast-conserving surgery followed by whole-breast irradiation offers survival benefits over mastectomy without irradiation. British Journal of Surgery 2018; 105: 1607-1614
3 Clough KB, Soussaline M, Campana F. et al. Mammoplasty combined with irradiation: conservative treatment of breast cancer localized in the lower quadrant. Annales de chirurgie plastique et esth{é}tique 1990; 35: 117-122
4 Chatterjee A, Gass J, Patel K. et al. A Consensus Definition and Classification System of Oncoplastic Surgery Developed by the Ame- rican Society of Breast Surgeons. Annals of Surgical Oncology 2019; 26: 3436-3444
5 Zaha H, Motonari T, Abe N. et al. Fat necrosis in level I oncoplastic breast-conserving surgery focusing on a modified round block tech- nique. Breast Cancer 2020; 27: 567-572
6 Hoffmann J, Wallwiener D. Classifying breast cancer surgery: A novel, complexity–based system for oncological, oncoplastic and reconstruc- tive procedures, and proof of principle by analysis of 1225 operations in 1166 patients. BMC Cancer 2009; 9: 108
7 Van Deventer PV, Graewe FR. The Blood Supply of the Breast Revisited. Plastic and Reconstructive Surgery 2016; 137: 1388-1397
8 Clough KB, Kaufman GJ, Nos C. et al. Improving breast cancer surgery: A classification and quadrant per quadrant atlas for oncoplastic surgery. Annals of Surgical Oncology 2010; 17: 1375-1391
9 Hashem T, Farahat A. Batwing versus Wise pattern mammoplasty for upper pole breast tumours: A detailed comparison of cosmetic outcome. World Journal of Surgical Oncology 2017; 15: 60
10 Galimberti V, Zurrida S, Luini A. et al. Central small size breast cancer: How to overcome the problem of nipple and areola involvement. European Journal of Cancer 1993; 29: 1093-1096
11 Burnier P, Niddam J, Bosc R. et al. Indocyanine green applications in plastic surgery: A review of the literature. Journal of Plastic, Recon- structive and Aesthetic Surgery 2017; 70: 814-827
12 Masetti R, Di Leone A, Franceschini G. et al. Oncoplastic techniques in the conservative surgical treatment of breast cancer: An overview. Breast Journal 2006; 12: 174-180
13 Straub JM, New J, Hamilton CD. et al. Radiation-induced fibrosis: me- chanisms and implications for therapy. Journal of Cancer Research and Clinical Oncology 2015; 141: 1985-1994
14 Ganju RG, Savvides G, Korentager S. et al. Incidence of breast lym- phedema and predictors of its development in patients receiving whole breast radiation therapy after breast-conservation surgery. Lymphology 2019; 52: 126-133
15 Soyder A, Tastaban E, Ozbas S. et al. Frequency of Early-Stage Lymphedema and Risk Factors in Postoperative Patients with Breast Cancer. The Journal of Breast Health 2014; 10: 92-97
16 Verbelen H, Tjalma W, Dombrecht D. et al. Breast edema, from diagnosis to treatment: state of the art. Archives of Physiotherapy 2021; 11: 8
17 Haviland JS, Hopwood P, Mills J. et al. Do Patient-reported Outcome Measures Agree with Clinical and Photographic Assessments of Normal Tissue Effects after Breast Radiotherapy? The Experience of the Standardisation of Breast Radiotherapy (START) Trials in Early Breast Cancer. Clinical Oncology 2016; 28: 345-353
18 Kim JB, Kim DK, Lee JW. et al. The usefulness of pedicled perforator flap in partial breast reconstruction after breast conserving surgery in Korean women. Archives of Plastic Surgery 2018; 45: 29-36
19 Billig J, Jagsi R, Qi J. et al. Should Immediate Autologous Breast Reconstruction Be Considered in Women Who Require Postmastectomy Radiation Therapy? A Prospective Analysis of Outcomes. Plastic and Reconstructive Surgery 2017; 139: 1279-1288
20 Veronesi U, Cascinelli N, Mariani L. et al. Twenty-Year Follow-up of a Randomized Study Comparing Breast-Conserving Surgery with Radical Mastectomy for Early Breast Cancer. New England Journal of Medicine 2002; 347: 1227-1232
21 Fisher B, Anderson S, Redmond CK. et al. Reanalysis and Results after 12 Years of Follow-up in a Randomized Clinical Trial Comparing Total Mastectomy with Lumpectomy with or without Irradiation in the Treatment of Breast Cancer. New England Journal of Medicine 1995; 333: 1456-1461
22 Wang J, Deng JP, Sun JY. et al. Noninferior outcome after breast-con- serving treatment compared to mastectomy in breast cancer patients with four or more positive lymph nodes. Frontiers in Oncology 2019; 9: 143
23 de Boniface J, Szulkin R, Johansson ALV. Survival After Breast Conser- vation vs Mastectomy Adjusted for Comorbidity and Socioeconomic Status. JAMA Surgery 2021; 156: 628-637
24 Peled AW, Sbitany H, Foster RD. et al. Oncoplastic mammoplasty as a strategy for reducing reconstructive complications associated with postmastectomy radiation therapy. Breast Journal 2014; 20: 302-307
25 Volders JH, Negenborn VL, Spronk PE. et al. Breast-conserving surgery following neoadjuvant therapy–a systematic review on surgical outcomes. Breast Cancer Research and Treatment 2018; 168: 1-12
26 Asgeirsson KS, McCulley SJ, Pinder SE. et al. Size of invasive breast cancer and risk of local recurrence after breast-conservation therapy. European Journal of Cancer 2003; 39: 2462-2469
27 De La Cruz L, Blankenship SA, Chatterjee A. et al. Outcomes After Oncoplastic Breast-Conserving Surgery in Breast Cancer Patients: A Systematic Literature Review. Annals of Surgical Oncology 2016; 23: 3247-3258
28 Gulcelik MA, Dogan L, Yuksel M. et al. Comparison of outcomes of standard and oncoplastic breast-conserving surgery. Journal of Breast Cancer 2013; 16: 193-197
29 Silverstein MJ, Savalia N, Khan S. et al. Extreme oncoplasty: Breast conservation for patients who need mastectomy. Breast Journal 2015; 21: 52-59
30 Losken A, Dugal CS, Styblo TM. et al. A meta-analysis comparing breast conservation therapy alone to the oncoplastic technique. Annals of Plastic Surgery 2014; 72: 145-149
31 Heeg E, Jensen MB, Hölmich LR. et al. Rates of re-excision and conversion to mastectomy after breast-conserving surgery with or without oncoplastic surgery: a nationwide population-based study. British Journal of Surgery 2020; 107: 1762-1772
32 Chand ND, Browne V, Paramanathan N. et al. Patient-Reported Outcomes Are Better after Oncoplastic Breast Conservation than after Mastectomy and Autologous Reconstruction. Plastic and Re- constructive Surgery – Global Open 2017; 5: e1419
33 Potter S, Trickey A, Rattay T. et al. Therapeutic mammaplasty is a safe and effective alternative to mastectomy with or without immediate breast reconstruction. British Journal of Surgery 2020; 107: 832-844
34 Barry M, Kell MR. Radiotherapy and breast reconstruction: A meta-ana- lysis. Breast Cancer Research and Treatment 2011; 127: 15-22
35 Goel A, Agarwal VK, Nayak V. et al. Surgical Management of Locoregio- nal Recurrence in Breast Cancer. Indian Journal of Surgical Oncology 2021; 12: 616-623
36 Asban A, Homsy C, Chen L. et al. A cost-utility analysis comparing large volume displacement oncoplastic surgery to mastectomy with single stage implant reconstruction in the treatment of breast cancer. Breast 2018; 41: 159-164
37 Momoh AO, Ahmed R, Kelley BP. et al. A systematic review of com- plications of implant-based breast reconstruction with prereconstruc- tion and postreconstruction radiotherapy. Annals of Surgical Oncology 2014; 21: 118-124
38 Fitzal F, Bolliger M, Dunkler D. et al. Retrospective, Multicenter Analysis Comparing Conventional with Oncoplastic Breast Conserving Surgery: Oncological and Surgical Outcomes in Women with High-Risk Breast Cancer from the OPBC-01/iTOP2 Study. Annals of Surgical Oncology 2021; 29: 1061-1070
39 Sakina Abidi S, Mushtaque Vohra L, Rizwan Javed M. et al. Oncoplastic surgery: A suitable alternative to conventional breast conserving sur- gery in low – Middle income countries; a retrospective cohort study. Annals of Medicine and Surgery 2021; 68: 102618
40 Kaufman CS. Increasing Role of Oncoplastic Surgery for Breast Cancer. Current Oncology Reports 2019; 21: 111
41 Lansu JTP, Essers M, Voogd AC. et al. The influence of simultaneous integrated boost, hypofractionation and oncoplastic surgery on cos- metic outcome and PROMs after breast conserving therapy. European Journal of Surgical Oncology 2015; 41: 1411-1416
42 Vaidya JS, Bulsara M, Baum M. et al. Long term survival and local con- trol outcomes from single dose targeted intraoperative radiotherapy during lumpectomy (TARGIT-IORT) for early breast cancer: TARGIT-A randomised clinical trial. The BMJ 2020; 370: m2836
43 Ruch M, Brade J, Schoeber C. et al. Long-term follow-up-findings in mammography and ultrasound after intraoperative radiotherapy (IORT) for breast cancer. Breast 2009; 18: 327-334
44 Rose M, Svensson H, Handler J. et al. Patient-reported outcome after oncoplastic breast surgery compared with conventional breast-conser- ving surgery in breast cancer. Breast Cancer Research and Treatment 2020; 180: 247-256
45 Nyrop KA, Williams GR, Muss HB. et al. Weight gain during adjuvant endocrine treatment for early-stage breast cancer: What is the evidence?. Breast Cancer Research and Treatment 2016; 158: 203-217
46 Amitai Y, Golan O, Barnea Y. et al. Follow-up of patients undergoing oncoplastic surgery – more palpable masses and benign biopsies. Breast Disease 2018; 37: 115-121
47 Gigli S, Amabile MI, Di Pastena F. et al. Magnetic resonance imaging after breast oncoplastic surgery: An update. Breast Care 2017; 12: 260-265
48 Kosasih S, Tayeh S, Mokbel K. et al. Is oncoplastic breast conserving surgery oncologically safe? A meta-analysis of 18,103 patients. American Journal of Surgery 2020; 220: 385-392
49 Clough KB, Van La Parra RFD, Thygesen HH. et al. Long-term Results after Oncoplastic Surgery for Breast Cancer: A 10-year Follow-up. Annals of Surgery 2018; 268: 165-171
50 Margolese RG. Cosmesis in segmental mastectomy. Canadian Journal of Surgery 1981; 24: 198-201
51 Carmichael AR, Mokbel K. Evolving trends in breast surgery: Onco- plastic to onco-aesthetic surgery. Archives of Plastic Surgery 2016; 43: 222-223