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Therapeutic mammaplasty is a safe and effective alternative to mastectomy with or without immediate breast reconstruction

Research output: Contribution to journalArticle

Original languageEnglish
JournalBritish Journal of Surgery
DateAccepted/In press - 17 Nov 2019

Abstract

Introduction: 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 +/- IBR Method: The subgroup of patients in the TeaM study who underwent TM to avoid mastectomy were identified and demographic, complication, oncology, and adjuvant treatment data compared to patients undergoing mastectomy +/- IBR in the iBRA-2 study. The primary outcome was the percentage of successful breast conserving surgery (BCS) in the TM group. Secondary outcomes included post-operative complications and time to adjuvant therapy. Results: 2,916 patients; (TM n=376; mastectomy n=1532; IBR n=1008; [implant-based n=675; pedicled-flap n=105; free-flap n=228]) were included in the analysis. Patients undergoing TM were more likely to be obese and to have undergone bilateral surgery than those undergoing IBR. However, patients undergoing mastectomy +/- IBR were more likely to experience complications than the TM group (TM n=79, 21.0%; mastectomy n=570, 37.2%; mastectomy and IBR n=359, 35.6%; p<0.001). Breast conservation was possible in 87% of TM patients. TM did not delay adjuvant treatment. Conclusion: TM may allow high-risk patients who would not be candidates for IBR to safely avoid mastectomy. Further work is needed to explore the comparative patient-reported and cosmetic outcomes of the different approaches and to establish long-term oncological safety.

    Research areas

  • therapeutic mammaplasty, breast cancer, mastectomy, breast reconstruction, cohort study, collaborative

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    Embargo ends: 1/01/99

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