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      Innovative modified T-shape oncoplastic technique for early-stage breast cancer: multicenter retrospective study

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          Abstract

          Inadequate tissue volume at the lower pole of the breast following tumor excision can compromise aesthetic outcomes when employing the conventional inverted-T reconstruction technique. With the aim of reducing postoperative deformities, we have refined this technique. A total of 104 patients underwent the T technique, while 32 underwent the modified T technique and 72 underwent the traditional T technique. In this study, we present the surgical outcomes of the modified T technique group and compare both surgical and oncological outcomes with those of the traditional T technique group. In the modified T technique group, the average tumor size was 23.34 mm, and the mean operation duration was 107.75 min, which was significantly shorter than that of the traditional T technique ( p = 0.039). Additionally, the average blood loss was 95.93 mL, which was significantly lower than that of the traditional T technique ( p = 0.011). Although complication rates did not differ significantly between the two groups ( p = 0.839), the modified T technique yielded superior aesthetic outcomes compared to the traditional T technique ( p = 0.019). Survival analysis indicated no significant difference in 5-year recurrence-free survival between the two groups, both before and after propensity score matching ( p = 0.381 vs. p = 0.277). As part of our series of oncoplastic techniques for the lower breast quadrant, the modified inverted-T technique utilizes a cost-effective flap to address lower pole defects, mitigating deformities and restoring the breast’s natural shape.

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          Improving breast cancer surgery: a classification and quadrant per quadrant atlas for oncoplastic surgery.

          Oncoplastic surgery (OPS) has emerged as a new approach for extending breast conserving surgery (BCS) possibilities, reducing both mastectomy and re-excision rates, while avoiding breast deformities. OPS is based upon the integration of plastic surgery techniques for immediate reshaping after wide excision for breast cancer. A simple guide for choosing the appropriate OPS procedure is not available. To develop an Atlas and guideline for oncoplastic surgery (OPS) to help in patient selection and choice of optimal surgical procedure for breast cancer patients undergoing BCS. We stratify OPS into two levels based on excision volume and the complexity of the reshaping technique. For resections less than 20% of the breast volume (level I OPS), a step-by-step approach allows easy reshaping of the breast. For larger resections (level II OPS), a mammoplasty technique is required. We identified three elements that can be used for patient selection and for determination of the appropriate OPS technique: excision volume, tumor location, and glandular density. For level II techniques, we defined a quadrant per quadrant Atlas that offers a different mammoplasty for each quadrant of the breast. OPS is the "third pathway" between standard BCS and mastectomy. The OPS classification and Atlas improves patient selection and allows a uniform approach for surgeons. It proposes a specific solution for different scenarios and helps improve breast conservation outcomes.
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            Trends of female and male breast cancer incidence at the global, regional, and national levels, 1990–2017

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              Oncoplastic surgery for breast cancer based on tumour location and a quadrant-per-quadrant atlas.

              The majority of published techniques for oncoplastic surgery rely on an inverted-T mammoplasty, independent of tumour location. These techniques, although useful, cannot be adapted to all situations. A quadrant-per-quadrant atlas of mammoplasty techniques for large breast cancers was developed in order to offer breast surgeons a technique dependent on tumour location, which reduces the risk of postoperative complications and delay to adjuvant therapy. From 2005 to 2010, a series of eligible women with breast cancer were treated by quadrant-specific oncoplastic techniques. All complications and any delay to adjuvant treatment were recorded prospectively, along with local and distant cancer recurrences. Cosmetic outcome was evaluated using a five-point scale. A total of 175 patients were analysed. The median tumour size, after histological examination, was 25 (range 4-90) mm. Twenty-three patients (13.1 per cent) had involved margins. Seventeen of these patients were treated by mastectomy and three had a re-excision. Complications occurred in 13 patients (7.4 per cent), which led to a delay to adjuvant treatment in three (1.7 per cent). After a median follow-up of 49 (range 23-96) months, three patients had developed a local recurrence. The mean score after cosmetic evaluation was 4.6 of 5. A quadrant-per-quadrant approach to oncoplastic techniques for breast cancer was developed that tailors the mammoplasty for each tumour location. This panel of techniques should be a useful guide for breast surgeons, and extends the possibilities for breast conservation for large or poorly limited cancers, with a low complication rate and good cosmetic results. Copyright © 2012 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
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                Author and article information

                Contributors
                URI : https://loop.frontiersin.org/people/1407666Role: Role: Role: Role: Role: Role:
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                URI : https://loop.frontiersin.org/people/2358078Role: Role: Role: Role: Role: Role: Role: Role:
                URI : https://loop.frontiersin.org/people/1424163Role: Role: Role: Role: Role:
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                URI : https://loop.frontiersin.org/people/1419929Role: Role: Role: Role: Role: Role: Role: Role: Role: Role:
                Journal
                Front Oncol
                Front Oncol
                Front. Oncol.
                Frontiers in Oncology
                Frontiers Media S.A.
                2234-943X
                13 June 2024
                2024
                : 14
                : 1367477
                Affiliations
                [1] 1 Molecular and Experimental Surgery, Faculty of Medicine and University Hospital Magdeburg, Department of General-, Visceral-, Vascular- and Transplant- Surgery, University of Magdeburg , Magdeburg, Germany
                [2] 2 University Hospital for Gynecology, Pius-Hospital, University Medicine Oldenburg , Oldenburg, Germany
                [3] 3 Department of Breast and Thyroid Surgery, Xuzhou No.1 People’s Hospital , Xuzhou, Jiangsu, China
                [4] 4 EUSOMA Certificate Breast Cancer Center (No.1037/00), Guilin TCM Hospital of China , Guilin, China
                [5] 5 Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University Munich , Munich, Germany
                Author notes

                Edited by: Haiyan Li, The Sixth Affiliated Hospital of Sun Yat-sen University, China

                Reviewed by: Darley Ferreira, Federal University of Pernambuco, Brazil

                Jeffrey Jun Xian Hing, Changi General Hospital, Singapore

                Marek Adam Paul, Jan Długosz University, Poland

                *Correspondence: Kai Xu, 87924042@ 123456qq.com ; Rui Zhuo, merstudio@ 123456sina.com

                †These authors have contributed equally to this work

                Article
                10.3389/fonc.2024.1367477
                11208303
                38939332
                cfdc8b02-2012-4b70-abc3-fbb20c14f816
                Copyright © 2024 Shi, Li, Wang, Shi, Li, Torres-de La Roche, Xu and Zhuo

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 08 January 2024
                : 28 May 2024
                Page count
                Figures: 6, Tables: 1, Equations: 0, References: 22, Pages: 9, Words: 3623
                Funding
                The author(s) declare that no financial support was received for the research, authorship, and/or publication of this article.
                Categories
                Oncology
                Original Research
                Custom metadata
                Surgical Oncology

                Oncology & Radiotherapy
                minimally invasive surgery,oncoplastic surgery,breast-conserving surgery,aesthetic,breast cancer

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