Therapeutic mammaplasty is a safe and effective alternative to mastectomy with or without immediate breast reconstruction.
Journal
The British journal of surgery
ISSN: 1365-2168
Titre abrégé: Br J Surg
Pays: England
ID NLM: 0372553
Informations de publication
Date de publication:
06 2020
06 2020
Historique:
received:
18
08
2019
revised:
14
10
2019
accepted:
17
11
2019
pubmed:
20
2
2020
medline:
12
1
2021
entrez:
20
2
2020
Statut:
ppublish
Résumé
Therapeutic mammaplasty (TM) may be an alternative to mastectomy, but few well designed studies have evaluated the success of this approach or compared the short-term outcomes of TM with mastectomy with or without immediate breast reconstruction (IBR). Data from the national iBRA-2 and TeaM studies were combined to compare the safety and short-term outcomes of TM and mastectomy with or without IBR. The subgroup of patients in the TeaM study who underwent TM to avoid mastectomy were identified, and data on demographics, complications, oncology and adjuvant treatment were compared with those of patients undergoing mastectomy with or without IBR in the iBRA-2 study. The primary outcome was the percentage of successful breast-conserving procedures in the TM group. Secondary outcomes included postoperative complications and time to adjuvant therapy. A total of 2916 patients (TM 376; mastectomy 1532; mastectomy and IBR 1008) were included in the analysis. Patients undergoing TM were more likely to be obese and to have undergone bilateral surgery than those having IBR. However, patients undergoing mastectomy with or without IBR were more likely to experience complications than the TM group (TM: 79, 21·0 per cent; mastectomy: 570, 37·2 per cent; mastectomy and IBR: 359, 35·6 per cent; P < 0·001). Breast conservation was possible in 87·0 per cent of patients who had TM, and TM did not delay adjuvant treatment. TM may allow high-risk patients who would not be candidates for IBR to avoid mastectomy safely. Further work is needed to explore the comparative patient-reported and cosmetic outcomes of the different approaches, and to establish long-term oncological safety. La mamoplastia terapéutica (therapeutic mammaplasty, TM) puede ser una alternativa a la mastectomía, pero hay pocos estudios bien diseñados que hayan evaluado el éxito de esta estrategia o hayan comparado los resultados a corto plazo de la TM con la mastectomía con o sin (+/-) reconstrucción mamaria inmediata (immediate breast reconstruction, IBR). Para comparar la seguridad y los resultados a corto plazo de la TM y la mastectomía +/- IBR se combinaron los datos de los estudios nacionales iBRA-2 y TeaM. MÉTODOS: En el estudio TeaM se identificó el subgrupo de pacientes al que se realizó una TM para evitar la mastectomía y se compararon los datos demográficos, las complicaciones, los resultados oncológicos y el tratamiento adyuvante con las pacientes sometidas a mastectomía +/- IBR del estudio iBRA-2. La variable principal fue el porcentaje de éxito de la cirugía conservadora de mama en el grupo TM. Las variables secundarias fueron las complicaciones postoperatorias y el intervalo de tiempo hasta el inicio del tratamiento adyuvante. Se incluyeron en el análisis 2.916 pacientes (TM n = 376; mastectomía n = 1.532; IBR n = 1.008). La TM era más frecuente en pacientes obesas o en las sometidas a cirugía bilateral en comparación con las pacientes con IBR. Sin embargo, las pacientes sometidas a una mastectomía +/- IBR tenían más probabilidades de desarrollar complicaciones que las del grupo TM (TM n = 79, 21,0%; mastectomía n = 570, 37,2%; mastectomía y IBR n = 359, 35,6%; P < 0,001). La conservación de la mama fue posible en el 87% de las pacientes con TM y el procedimiento no retrasó el inicio del tratamiento adyuvante. CONCLUSIÓN: La TM puede permitir que pacientes de alto riesgo que no serían candidatas a IBR eviten la mastectomía de una forma segura. Se necesitan más trabajos para comparar los resultados percibidos por las pacientes y los estéticos de las diferentes estrategias terapéuticas y establecer la seguridad oncológica a largo plazo.
Sections du résumé
BACKGROUND
Therapeutic mammaplasty (TM) may be an alternative to mastectomy, but few well designed studies have evaluated the success of this approach or compared the short-term outcomes of TM with mastectomy with or without immediate breast reconstruction (IBR). Data from the national iBRA-2 and TeaM studies were combined to compare the safety and short-term outcomes of TM and mastectomy with or without IBR.
METHODS
The subgroup of patients in the TeaM study who underwent TM to avoid mastectomy were identified, and data on demographics, complications, oncology and adjuvant treatment were compared with those of patients undergoing mastectomy with or without IBR in the iBRA-2 study. The primary outcome was the percentage of successful breast-conserving procedures in the TM group. Secondary outcomes included postoperative complications and time to adjuvant therapy.
RESULTS
A total of 2916 patients (TM 376; mastectomy 1532; mastectomy and IBR 1008) were included in the analysis. Patients undergoing TM were more likely to be obese and to have undergone bilateral surgery than those having IBR. However, patients undergoing mastectomy with or without IBR were more likely to experience complications than the TM group (TM: 79, 21·0 per cent; mastectomy: 570, 37·2 per cent; mastectomy and IBR: 359, 35·6 per cent; P < 0·001). Breast conservation was possible in 87·0 per cent of patients who had TM, and TM did not delay adjuvant treatment.
CONCLUSION
TM may allow high-risk patients who would not be candidates for IBR to avoid mastectomy safely. Further work is needed to explore the comparative patient-reported and cosmetic outcomes of the different approaches, and to establish long-term oncological safety.
ANTECEDENTES
La mamoplastia terapéutica (therapeutic mammaplasty, TM) puede ser una alternativa a la mastectomía, pero hay pocos estudios bien diseñados que hayan evaluado el éxito de esta estrategia o hayan comparado los resultados a corto plazo de la TM con la mastectomía con o sin (+/-) reconstrucción mamaria inmediata (immediate breast reconstruction, IBR). Para comparar la seguridad y los resultados a corto plazo de la TM y la mastectomía +/- IBR se combinaron los datos de los estudios nacionales iBRA-2 y TeaM. MÉTODOS: En el estudio TeaM se identificó el subgrupo de pacientes al que se realizó una TM para evitar la mastectomía y se compararon los datos demográficos, las complicaciones, los resultados oncológicos y el tratamiento adyuvante con las pacientes sometidas a mastectomía +/- IBR del estudio iBRA-2. La variable principal fue el porcentaje de éxito de la cirugía conservadora de mama en el grupo TM. Las variables secundarias fueron las complicaciones postoperatorias y el intervalo de tiempo hasta el inicio del tratamiento adyuvante.
RESULTADOS
Se incluyeron en el análisis 2.916 pacientes (TM n = 376; mastectomía n = 1.532; IBR n = 1.008). La TM era más frecuente en pacientes obesas o en las sometidas a cirugía bilateral en comparación con las pacientes con IBR. Sin embargo, las pacientes sometidas a una mastectomía +/- IBR tenían más probabilidades de desarrollar complicaciones que las del grupo TM (TM n = 79, 21,0%; mastectomía n = 570, 37,2%; mastectomía y IBR n = 359, 35,6%; P < 0,001). La conservación de la mama fue posible en el 87% de las pacientes con TM y el procedimiento no retrasó el inicio del tratamiento adyuvante. CONCLUSIÓN: La TM puede permitir que pacientes de alto riesgo que no serían candidatas a IBR eviten la mastectomía de una forma segura. Se necesitan más trabajos para comparar los resultados percibidos por las pacientes y los estéticos de las diferentes estrategias terapéuticas y establecer la seguridad oncológica a largo plazo.
Autres résumés
Type: Publisher
(spa)
La mamoplastia terapéutica (therapeutic mammaplasty, TM) puede ser una alternativa a la mastectomía, pero hay pocos estudios bien diseñados que hayan evaluado el éxito de esta estrategia o hayan comparado los resultados a corto plazo de la TM con la mastectomía con o sin (+/-) reconstrucción mamaria inmediata (immediate breast reconstruction, IBR). Para comparar la seguridad y los resultados a corto plazo de la TM y la mastectomía +/- IBR se combinaron los datos de los estudios nacionales iBRA-2 y TeaM. MÉTODOS: En el estudio TeaM se identificó el subgrupo de pacientes al que se realizó una TM para evitar la mastectomía y se compararon los datos demográficos, las complicaciones, los resultados oncológicos y el tratamiento adyuvante con las pacientes sometidas a mastectomía +/- IBR del estudio iBRA-2. La variable principal fue el porcentaje de éxito de la cirugía conservadora de mama en el grupo TM. Las variables secundarias fueron las complicaciones postoperatorias y el intervalo de tiempo hasta el inicio del tratamiento adyuvante.
Types de publication
Comparative Study
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
832-844Subventions
Organisme : Research Trainees Coordinating Centre
ID : CS-2016-16-019
Pays : International
Organisme : Association of Breast Surgery
ID : The TeaM study
Pays : International
Organisme : Department of Health
ID : PB-PG-0214-33065
Pays : United Kingdom
Organisme : Research Trainees Coordinating Centre
ID : DRF-2014-07-079
Pays : International
Organisme : Medical Research Council
ID : MR/K025643/1
Pays : United Kingdom
Organisme : Department of Health
ID : CS-2016-16-019
Pays : United Kingdom
Organisme : Department of Health
ID : DRF-2014-07-079
Pays : United Kingdom
Investigateurs
S Potter
(S)
A Trickey
(A)
T Rattay
(T)
R Dave
(R)
E Baker
(E)
L Whisker
(L)
J Skillman
(J)
M D Gardiner
(MD)
R D Macmillan
(RD)
C Holcombe
(C)
Nicola Lp Barnes
(NL)
Jane Blazeby
(J)
Elizabeth Conroy
(E)
Rajiv V Dave
(RV)
Matthew D Gardiner
(MD)
Adrian Harnett
(A)
Chris Holcombe
(C)
Shelley Potter
(S)
Tim Rattay
(T)
Joanna Skillman
(J)
Paula Williamson
(P)
Rajgopal Achuthan
(R)
Shweta Aggarwal
(S)
Elizabeth Baker
(E)
Naren Basu
(N)
Lisa Brock
(L)
Patricia Fairbrother
(P)
Matthew D Gardiner
(MD)
Chris Holcombe
(C)
Charlotte Ives
(C)
Abhilash Jain
(A)
Baek Kim
(B)
R Douglas Macmillan
(RD)
John Murphy
(J)
Shelley Potter
(S)
Tim Rattay
(T)
Dennis Remoundos
(D)
Richard Sutton
(R)
Adam Trickey
(A)
Philip Turton
(P)
Kathryn Williams
(K)
Alain Curnier
(A)
Amir Tadros
(A)
Ivan Depasquale
(I)
Mairi Fuller
(M)
Roger Bourne
(R)
Steven Heys
(S)
Ishrak Hamo
(I)
Fatima Aloraifi
(F)
Laura Fopp
(L)
Radhika Bali
(R)
Sarah Bache
(S)
Sarah L Benyon
(SL)
Michael S Irwin
(MS)
Amit Agrawal
(A)
Charles M Malata
(CM)
Claire Murphy
(C)
Adam Misky
(A)
Dennis Wayne Chicken
(DW)
Nassreen Abdullah
(N)
Arnold D K Hill
(ADK)
Carolyn Cullinane
(C)
Gareth Irwin
(G)
Stuart A McIntosh
(SA)
Sigi Refsum
(S)
Samantha Sloan
(S)
Peter Mallon
(P)
Chiara Sirianni
(C)
Ilyas Khattak
(I)
Chiara Sirianni
(C)
Geerthan Nagachandra
(G)
Pasupathy Kiruparan
(P)
Debasish Debanth
(D)
Simon Davey
(S)
Terry-Ann Curran
(TA)
Matilda Svenning
(M)
Sasirekha Govindarajulu
(S)
Zenon Rayter
(Z)
Rachel Ainsworth
(R)
Simon Cawthorn
(S)
Ajay Sahu
(A)
Sherif Wilson
(S)
Elena Prousskaia
(E)
Antonello Accurso
(A)
Nicola Rocco
(N)
Rosa Di Micco
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Antonello Accurso
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Raffaele Ceccarino
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Raffaele Liccardo
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Guido Coco
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Mary Morgan
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(V)
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(P)
Peter Kneeshaw
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Kartikae Grover
(K)
Tapan Mahapatra
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(N)
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(C)
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(DC)
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(RM)
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