2015, Number 1-2
Surgical result between breast conserving surgery plus immediate fat graft versus conservative surgery in patients with breast tumors
PDF size: 220.04 Kb.
ABSTRACTIntroduction: Breast reconstruction has gained importance, with the combination of an oncological and aesthetic procedure in a single surgery offering excellent results. There are different techniques that can be used, such as the insertion of an autologous graft. Material and methods: A cases-control study was conducted, which included women › 18 years, with unilateral or bilateral breast tumors ‹ 5 cm, BIRADS IV and V, that required surgical treatment. The cases group were patients undergoing breast-conserving surgery (BCS) with autologous fat grafts, and the control group were those only undergoing conservative breast surgery (CBS). The incidence of complications was recorded, and the pain intensity was evaluated with the visual analogue scale (EVA). Results: The overall incidence of complications (not considering pain) was 29.2%: 12.5% in the BCS group, and 37.5% in the CBS group. The presence of pain 24 hours after surgery was more frequent in the CBS group than in the BCS one (81.2% [n = 13] versus 62.5% [n = 5]), with no statistical difference (p = .36). On the seventh day, 25% (n = 4) of the patients in CBS presented pain, and only one in the BCS group did (12.5%) (p = .63). At the end of the study, only one patient in the CBS group persisted with pain (6.2%), 19% of patients with CBS developed wound retraction, one hematoma, and another one a seroma. Conclusions: Autologous graft surgery is a safe procedure that guarantees the same surgical outcome as CBS, but with a better aesthetic result.
American Cancer Society. Cancer Facts and figures 2012. Atlanta ACS, 2012 [Acceso marzo de 2014]. Disponible en: http://www.cancer.org
Early Breast Cancer Trialists’ Collaborative Group (EBCTCG). Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomized trials. Lancet. 2005; 365: 1687-1717.
Siegel R, Ward E, Brawley O, Jemal A. Cancer statistics, 2011: the impact of eliminating socioeconomic and racial disparities on premature cancer deaths. CA Cancer J Clin. 2011; 61: 212-236.
Secretaría de Salud. Perfil epidemiológico de los tumores malignos en México. México: Secretaría de Salud; 2011.
Winchester D, Trabanino L, Lopez M. The evolution of surgery for breast cancer. Surg Oncol Clin N Am. 2005; 14: 479-498.
Harvey A. Early contributions to the surgery of cancer: William S. Halsted, Hugh H. Young and John G. Clark. Johns Hopkins Med J. 1974; 135: 399-417.
Patey D. A review of 146 cases of carcinoma of the breast operated on between 1930 and 1943. Br J Cancer. 1967; 21: 260-269.
Madden J. Modified radical mastectomy. Surg Gynecol Obstet. 1965; 121: 1221-1230.
Robinson GN, van Heerden JA, Payne WS, Taylor WF, Gaffey TA. The primary surgical treatment of carcinoma of the breast: a changing trend toward modified radical mastectomy. Mayo Clin Proc. 1976; 51: 433-442.
Morrow M, Strom EA, Bassett LW, Dershaw DD, Fowble B, Giuliano A, et al. Standard for breast conservation therapy in the management of invasive breast cancer. CA Cancer J Clin. 2002; 52: 277-300.
Van Dongen JA, Voogd AC, Fentiman IS, Legrand C, Sylvester RJ, Tong D, et al. Long-term results of a randomized trial comparing breast-conserving therapy with mastectomy: European Organization for Research and Treatment of Cancer 10801 trial. J Natl Cancer Inst. 2000; 92: 1143-1150.
Fisher B, Anderson S, Bryant J, Margolese RG, Deutsch M, Fisher ER, et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med. 2002; 347: 1233-1234.
Veronesi U, Cascinelli N, Mariani L, Greco M, Saccozzi R, Luini A, et al. Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med. 2002; 347: 1227-1232.
Association of Breast Surgery at BASO; Association of Breast Surgery at BAPRAS; Training Interface Group in Breast Surgery, Baildam A, Bishop H, Boland G, et al. Oncoplastic breast surgery-a guide to good practice. Eur J Surg Oncol. 2007; 33 Suppl 1: S1-23.
Cárdenas-Sánchez J, Bargalló-Rocha E, Erazo-Valle A. Consenso mexicano sobre diagnóstico y tratamiento del cáncer mamario. Quinta revisión. México: Elsevier; 2013. pp. 18-20.
Lohsiriwat V, Curigliano G, Rietjens M, Goldhirsch A, Petit JY. Autologous fat transplantation in patients with breast cancer: “silencing” or “fueling” cancer recurrence? Breast. 2011; 20: 351-357.
Pearl RA, Leedham SJ, Pacifico MD. The safety of autologous fat transfer in breast cancer: lessons from stem cell biology. J Plast Reconstr Aesthet Surg. 2012; 65: 283-288.
Breest Smallenburg V, Duijm LE, Voogd AC, Jansen FH, Louwman MW. Mammographic changes resulting from benign breast surgery impair breast cancer detection at screening mammography. Eur J Cancer. 2012; 48: 2097-2103.
Ihrai T, Georgiou C, Machiavello JC, Chignon-Sicard B, Figl A, Raoust I, et al. Autologous fat grafting and breast cancer recurrences: retrospective analysis of a series of 100 procedures in 64 patients. J Plast Surg Hand Surg. 2013; 47: 273-275.
Rose M, Manjer J, Ringberg A, Svensson H. Surgical strategy, methods of reconstruction, surgical margins and postoperative complications in oncoplastic breast surgery. Eur J Plast Surg. 2014; 37: 205-214.
Saarela AO, Kiviniemi HO, Rissanen TJ, Haukipuro K, Kaarela O. Cosmetic results after wire-guided biopsy of benign breast lesions. J Am Coll Surg. 1998; 187: 610-615.