The adoption of oncoplastic surgery using breast reduction or mastopexy techniques in an academic breast cancer center program can increase breast conservation rates
Yurie Sekigami, MD, Krishna Patel, MD, Ritam Chowdhury, MBBS, MPH, PhD, SM, Abhishek Chatterjee, MD, MBA.
Tufts Medical Center, Boston, MA, USA.
Oncoplastic surgery (OCS) using breast reduction or mastopexy techniques provides an opportunity for plastic surgeons to collaborate with breast surgeons to increase options for breast conservation in appropriate patients with larger breast cancers. Scarce literature exists showing the impact of oncoplastic surgery adoption to breast conservation surgery (BCS) and mastectomy rates at the institutional level in the US. The purpose of this study was to investigate whether the introduction of OCS to an academic breast cancer center increases BCS rates and decreases mastectomy rates. We hypothesize that with the adoption of OCS, BCS rates increase, especially for patients with larger tumors.
We performed a retrospective study of breast cancer patients in a single institution database. Patients were excluded if they did not undergo surgery or if surgery type was unknown. All patients had immediate oncoplastic reconstruction after their partial mastectomy with contralateral symmetry surgery when appropriate. Rates of BCS vs mastectomy and partial mastectomy vs OCS were measured between 2012 and 2018 to capture 3 years prior and 3 years after the hiring of an oncoplastic surgeon in 2015. These rates were further stratified by pathologic T stage. Z-test for proportions was used to test the difference between mastectomy and BCS rates in 2012 and 2018.
Overall, 674 patients were included in the study. From 2012, the percentage of breast cancer patients receiving BCS showed a statistically significant (p<0.0001) increase from 51% to 83%. The point of maximum divergence favoring BCS was in 2015. As expected, the introduction of an oncoplastic surgeon in 2015 was noted with a subsequent increase of oncoplastic operations performed in the following years when compared to standard partial mastectomy. Of the oncoplastic operations performed, 90% were Level 2 volume displacement (using breast reduction or mastopexy designs) and 10% were Level 1 volume displacement (local tissue rearrangement) oncoplastic surgeries. When stratified by pathologic T stage, rates of mastectomy for T2 tumors decreased precipitously after 2015 and BCS increased proportionately (Figure 1). The rate for BCS over the same time period for T1 tumors also increased but less drastically.
The adoption of oncoplastic surgery in an academic breast cancer center can result in significantly higher rates of BCS, particularly for those with larger tumors (T2). This supports the use of plastic surgery in breast conservation surgery.
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