Download PDF
CC BY-NC-ND 4.0 · Senologie - Zeitschrift für Mammadiagnostik und -therapie 2024; 21(03): 227-237
DOI: 10.1055/a-2284-7661
Review

Future challenges in the surgical treatment of breast cancer – Oncoplastic, prophylactic procedures and reconstructive surgery

Article in several languages: English | deutsch
Markus Hahn
1   Department für Frauengesundheit, Universitätsklinikum Tübingen, Tübingen, Deutschland (Ringgold ID: RIN27203)
,
Bettina Böer
2   Department für Frauengesundheit, Universitätsklinikum Tübingen, Tübingen, Deutschland
,
Selin Gürgan
3   Department für Frauengesundheit, Universitätsklinikum Tübingen, Tübingen, Deutschland
,
Mario Marx
4   Klinik für Plastische, Rekonstruktive und Brustchirurgie, Elblandklinikum Radebeul, Radebeul, Deutschland
5   Department für Frauengesundheit, Universitätsklinikum Tübingen, Tübingen, Deutschland
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Corrected by:

Correction: Future challenges in the surgical treatment of breast cancer – Oncoplastic, prophylactic procedures and reconstructive surgerySenologie - Zeitschrift für Mammadiagnostik und -therapie 2024; 21(03): e2-e2
DOI: 10.1055/a-2423-1685

Abstract

Medical knowledge is doubling faster and faster. Surgeons are highly specialized and must be trained not only in surgery, but also in imaging and oncology to meet the modern requirements of a breast center. This article describes what has changed in the surgical treatment of breast cancer over the past 20 years since the introduction of certified breast centers in Germany, and what could change in the future. Pre- and post-operative conferences have become a central component of the interdisciplinary exchange of information. Every breast-conserving operation must be precisely planned, marked and carried out in a controlled manner. Basic anatomical knowledge is not sufficient enough to perform a prophylactic mastectomy. Implant-based reconstructions change their shape and strength over time and usually lead to follow-up operations. Tissue engineering offers interesting approaches to replace the disadvantages of conventional implants in order to achieve the durability and quality similar to autologous tissue reconstructions.

Keywords

Breast cancer - oncoplastic - reconstruction - prophylactic - risk-reducing


Publication History

Article published online:
13 September 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Morton DL, Wen DR, Wong JH. et al. Technical details of intraoperative lymphatic mapping for early stage melanoma. Arch Surg 1992; 127 (04) 392-399 DOI: 10.1001/archsurg.1992.01420040034005. (PMID: 1558490)
    CrossrefPubMedGoogle Scholar
  • 2 Giuliano AE, Kirgan DM, Guenther JM. et al. Lymphatic mapping and sentinel lymphadenectomy for breast cancer [see comments]. Ann Surg 1994; 220 (03) 391-398
    CrossrefPubMedGoogle Scholar
  • 3 Giuliano AE, Ballman KV, McCall L. et al. Effect of Axillary Dissection vs No Axillary Dissection on 10-Year Overall Survival Among Women With Invasive Breast Cancer and Sentinel Node Metastasis: The ACOSOG Z0011 (Alliance) Randomized Clinical Trial. Jama 2017; 318 (10) 918-926
    CrossrefPubMedGoogle Scholar
  • 4 Caudle AS, Yang WT, Krishnamurthy S. et al. Improved Axillary Evaluation Following Neoadjuvant Therapy for Patients With Node-Positive Breast Cancer Using Selective Evaluation of Clipped Nodes: Implementation of Targeted Axillary Dissection. J Clin Oncol 2016; 34 (10) 1072-1078
    CrossrefPubMedGoogle Scholar
  • 5 Miki Y, Swensen J, Shattuck-Eidens D. et al. A strong candidate for the breast and ovarian cancer susceptibility gene BRCA1. Science 1994; 266: 66-71 DOI: 10.1126/science.7545954. (PMID: 7545954)
    CrossrefPubMedGoogle Scholar
  • 6 Snyderman RK, Starzynski TE. Breast reconstruction. Surg Clin North Am 1969; 49 (02) 303-311 DOI: 10.1016/s0039-6109(16)38789-8. (PMID: 4886904)
    CrossrefPubMedGoogle Scholar
  • 7 Schneider WJ, Hill HL, Brown RG. Latissimus dorsi myocutaneous flap for breast reconstruction. Br J Plast Surg 1977; 30 (04) 277-281 DOI: 10.1016/0007-1226(77)90117-5. (PMID: 338072)
    CrossrefPubMedGoogle Scholar
  • 8 Hartrampf CR, Scheflan M, Black PW. Breast reconstruction with a transverse abdominal island flap. Plast Reconstr Surg 1982; 69 (02) 216-225 (PMID: 7071252)
    CrossrefPubMedGoogle Scholar
  • 9 Brucker SY, Bamberg M, Jonat W. et al. Certification of breast centres in Germany: proof of concept for a prototypical example of quality assurance in multidisciplinary cancer care. BMC cancer 2009; 9: 228 DOI: 10.1186/1471-2407-9-228. (PMID: 19602242)
    CrossrefPubMedGoogle Scholar
  • 10 Brucker SY, Schumacher C, Sohn C. et al. Benchmarking the quality of breast cancer care in a nationwide voluntary system: the first five-year results (2003–2007) from Germany as a proof of concept. BMC cancer 2008; 8: 358
    CrossrefPubMedGoogle Scholar
  • 11 Katalinic A, Eisemann N, Kraywinkel K. et al. Breast cancer incidence and mortality before and after implementation of the German mammography screening program. Int J Cancer 2020; 147 (03) 709-718
    CrossrefPubMedGoogle Scholar
  • 12 Veronesi U, Cascinelli N, Mariani L. et al. Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. NEngl J Med 2002; 347 (16) 1227-1232
    CrossrefPubMedGoogle Scholar
  • 13 Hennigs A, Fuchs V, Sinn HP. et al. Do Patients After Reexcision Due to Involved or Close Margins Have the Same Risk of Local Recurrence as Those After One-Step Breast-Conserving Surgery?. Ann Surg Oncol 2016; 23 (06) 1831-1837 DOI: 10.1245/s10434-015-5067-1. (PMID: 26732272)
    CrossrefPubMedGoogle Scholar
  • 14 Nessa A, Shaikh S, Fuller M. et al. Postoperative complications and surgical outcomes of robotic versus conventional nipple-sparing mastectomy in breast cancer: meta-analysis. Br J Surg 2024; 111 (01) znad336 DOI: 10.1093/bjs/znad336.. (PMID: 37890072)
    CrossrefPubMedGoogle Scholar
  • 15 Hermanns S, Dammeier S, Neugebauer A. et al. Methods, applications, and future perspectives of intraoperative tissue identification. Pathologie (Heidelb) 2023; 44 (Suppl. 03) 183-187 DOI: 10.1007/s00292-023-01257-7. (PMID: 37966557)
    CrossrefPubMedGoogle Scholar
  • 16 Guergan S, Boeer B, Fugunt R. et al. Optical Emission Spectroscopy for the Real-Time Identification of Malignant Breast Tissue. Diagnostics (Basel) 2024; 14 (03) 338 DOI: 10.3390/diagnostics14030338.. (PMID: 38337854)
    CrossrefPubMedGoogle Scholar
  • 17 Banys-Paluchowski M, Rubio IT, Karadeniz Cakmak G. et al. Intraoperative Ultrasound-Guided Excision of Non-Palpable and Palpable Breast Cancer: Systematic Review and Meta-Analysis. Ultraschall Med 2022; 43 (04) 367-379
    Article in Thieme ConnectPubMedGoogle Scholar
  • 18 Boeer B, Obermoser J, Marx M. et al. Ultrasound-guided breast-conserving surgery compared to conventional breast-conserving surgery. Ultraschall Med 2024; DOI: 10.1055/a-2290-1543. (PMID: 38901438)
    Article in Thieme ConnectPubMedGoogle Scholar
  • 19 Goker M, Marcinkowski R, Van Bockstal M. et al. 18F-FDG micro-PET/CT for intra-operative margin assessment during breast-conserving surgery. Acta Chir Belg 2020; 120 (05) 366-374
    CrossrefPubMedGoogle Scholar
  • 20 Darr C, Costa PF, Kahl T. et al. Intraoperative Molecular Positron Emission Tomography Imaging for Intraoperative Assessment of Radical Prostatectomy Specimens. Eur Urol Open Sci 2023; 54: 28-32 DOI: 10.1016/j.euros.2023.05.017. (PMID: 37361199)
    CrossrefPubMedGoogle Scholar
  • 21 Christenhusz A, Pouw JJ, Simonis FFJ. et al. Breast MRI in patients after breast conserving surgery with sentinel node procedure using a superparamagnetic tracer. Eur Radiol Exp 2022; 6 (01) 3
    CrossrefPubMedGoogle Scholar
  • 22 Aribal E, Celik L, Yilmaz C. et al. Effects of iron oxide particles on MRI and mammography in breast cancer patients after a sentinel lymph node biopsy with paramagnetic tracers. Clin Imaging 2021; 75: 22-26
    CrossrefPubMedGoogle Scholar
  • 23 van Haaren ERM, Spiekerman van Weezelenburg MA, van Bastelaar J. et al. Impact of low dose superparamagnetic iron oxide tracer for sentinel node biopsy in breast conserving treatment on susceptibility artefacts on magnetic resonance imaging and contrast enhanced mammography. Surg Oncol 2024; 53: 102045
    CrossrefPubMedGoogle Scholar
  • 24 Bove S, Fragomeni SM, Romito A. et al. Techniques for sentinel node biopsy in breast cancer. Minerva Surg 2021; 76 (06) 550-563 DOI: 10.23736/S2724-5691.21.09002-X. (PMID: 34338468)
    CrossrefPubMedGoogle Scholar
  • 25 Kedrzycki MS, Leiloglou M, Ashrafian H. et al. Meta-analysis Comparing Fluorescence Imaging with Radioisotope and Blue Dye-Guided Sentinel Node Identification for Breast Cancer Surgery. Ann Surg Oncol 2021; 28 (07) 3738-3748
    CrossrefPubMedGoogle Scholar
  • 26 Mathelin C, Lodi M. Narrative review of sentinel lymph node biopsy in breast cancer: a technique in constant evolution with still numerous unresolved questions. Chin Clin Oncol 2021; 10 (02) 20 DOI: 10.21037/cco-20-207. (PMID: 33353365)
    CrossrefPubMedGoogle Scholar
  • 27 Grischke EM, Rohm C, Hahn M. et al. ICG Fluorescence Technique for the Detection of Sentinel Lymph Nodes in Breast Cancer: Results of a Prospective Open-label Clinical Trial. Geburtshilfe Frauenheilkd 2015; 75 (09) 935-940 DOI: 10.1055/s-0035-1557905. (PMID: 26500370)
    Article in Thieme ConnectPubMedGoogle Scholar
  • 28 Boeer B, Helms G, Pasternak J. et al. Back to the future: breast surgery with tumescent local anesthesia (TLA)?. Archives of gynecology and obstetrics 2023; 308 (03) 935-940
    CrossrefPubMedGoogle Scholar
  • 29 Rehnke RD, Groening RM, Van Buskirk ER. et al. Anatomy of the Superficial Fascia System of the Breast: A Comprehensive Theory of Breast Fascial Anatomy. Plast Reconstr Surg 2018; 142 (05) 1135-1144 DOI: 10.1097/PRS.0000000000004948. (PMID: 30511967)
    CrossrefPubMedGoogle Scholar
  • 30 Griepsma M, de Roy van Zuidewijn DB, Grond AJ. et al. Residual breast tissue after mastectomy: how often and where is it located?. Ann Surg Oncol 2014; 21 (04) 1260-1266
    CrossrefPubMedGoogle Scholar
  • 31 Kaidar-Person O, Boersma LJ, Poortmans P. et al. Residual Glandular Breast Tissue After Mastectomy: A Systematic Review. Ann Surg Oncol 2020; 27 (07) 2288-2296 DOI: 10.1245/s10434-020-08516-4. (PMID: 32390098)
    CrossrefPubMedGoogle Scholar
  • 32 Andersson MN, Sund M, Svensson J. et al. Prophylactic mastectomy – Correlation between skin flap thickness and residual glandular tissue evaluated postoperatively by imaging. Journal of plastic, reconstructive & aesthetic surgery : JPRAS 2022; 75 (06) 1813-1819
    CrossrefPubMedGoogle Scholar
  • 33 Rebbeck TR, Friebel T, Lynch HT. et al. Bilateral prophylactic mastectomy reduces breast cancer risk in BRCA1 and BRCA2 mutation carriers: the PROSE Study Group. J Clin Oncol 2004; 22 (06) 1055-1062 DOI: 10.1200/JCO.2004.04.188. (PMID: 14981104)
    CrossrefPubMedGoogle Scholar
  • 34 Coroneos CJ, Selber JC, Offodile 2nd AC. et al. US FDA Breast Implant Postapproval Studies: Long-term Outcomes in 99,993 Patients. Ann Surg 2019; 269 (01) 30-36 DOI: 10.1097/SLA.0000000000002990. (PMID: 30222598)
    CrossrefPubMedGoogle Scholar
  • 35 Kabir R, Stanton E, Sorenson TJ. et al. Breast Implant Illness as a Clinical Entity: A Systematic Review of the Literature. Aesthetic surgery journal 2024; 44 (09) NP629-NP636 DOI: 10.1093/asj/sjae095.. (PMID: 38636098)
    CrossrefPubMedGoogle Scholar
  • 36 Rohrich RJ, Bellamy JL, Alleyne B. Assessing Long-Term Outcomes in Breast Implant Illness: The Missing Link? A Systematic Review. Plast Reconstr Surg 2022; 149 (04) 638e-45e DOI: 10.1097/PRS.0000000000009067. (PMID: 35103633)
    CrossrefPubMedGoogle Scholar
  • 37 Elameen AM, AlMarakby MA, Atta TI. et al. The Risk of Breast Implant-Associated Anaplastic Large Cell Lymphoma; A Systematic Review and Meta-Analysis. Aesthetic plastic surgery 2024; DOI: 10.1007/s00266-024-03956-9.. (PMID: 33220906)
    CrossrefPubMedGoogle Scholar
  • 38 Yamauchi H, Okawa M, Yokoyama S. et al. High rate of occult cancer found in prophylactic mastectomy specimens despite thorough presurgical assessment with MRI and ultrasound: findings from the Hereditary Breast and Ovarian Cancer Registration 2016 in Japan. Breast Cancer Res Treat 2018; 172 (03) 679-687
    CrossrefPubMedGoogle Scholar
  • 39 Lee JW, Lee YC, Chang TW. Microvascularly augmented transverse rectus abdominis myocutaneous flap for breast reconstruction--reappraisal of its value through clinical outcome assessment and intraoperative blood gas analysis. Microsurgery 2008; 28 (08) 656-662 DOI: 10.1002/micr.20555. (PMID: 18846569)
    CrossrefPubMedGoogle Scholar
  • 40 Chen C, Nguyen MD, Bar-Meir E. et al. Effects of vasopressor administration on the outcomes of microsurgical breast reconstruction. Ann Plast Surg 2010; 65 (01) 28-31 DOI: 10.1097/SAP.0b013e3181bda312. (PMID: 20548236)
    CrossrefPubMedGoogle Scholar
  • 41 Acosta R, Enajat M, Rozen WM. et al. Performing two DIEP flaps in a working day: an achievable and reproducible practice. Journal of plastic, reconstructive & aesthetic surgery : JPRAS 2010; 63 (04) 648-654
    CrossrefPubMedGoogle Scholar
  • 42 Baumann DP, Lin HY, Chevray PM. Perforator number predicts fat necrosis in a prospective analysis of breast reconstruction with free TRAM, DIEP, and SIEA flaps. Plast Reconstr Surg 2010; 125 (05) 1335-1341
    CrossrefPubMedGoogle Scholar
  • 43 Chen CM, Halvorson EG, Disa JJ. et al. Immediate postoperative complications in DIEP versus free/muscle-sparing TRAM flaps. Plast Reconstr Surg 2007; 120 (06) 1477-1482 DOI: 10.1097/01.prs.0000288014.76151.f7. (PMID: 18040176)
    CrossrefPubMedGoogle Scholar
  • 44 Gill PS, Hunt JP, Guerra AB. et al. A 10-year retrospective review of 758 DIEP flaps for breast reconstruction. Plast Reconstr Surg 2004; 113 (04) 1153-1160 DOI: 10.1097/01.prs.0000110328.47206.50. (PMID: 15083015)
    CrossrefPubMedGoogle Scholar
  • 45 Nelson JA, Guo Y, Sonnad SS. et al. A Comparison between DIEP and muscle-sparing free TRAM flaps in breast reconstruction: a single surgeon’s recent experience. Plast Reconstr Surg 2010; 126 (05) 1428-1435
    CrossrefPubMedGoogle Scholar
  • 46 Parrett BM, Caterson SA, Tobias AM. et al. DIEP flaps in women with abdominal scars: are complication rates affected?. Plast Reconstr Surg 2008; 121 (05) 1527-1531
    CrossrefPubMedGoogle Scholar
  • 47 Rao SS, Parikh PM, Goldstein JA. et al. Unilateral failures in bilateral microvascular breast reconstruction. Plast Reconstr Surg 2010; 126 (01) 17-25 DOI: 10.1097/PRS.0b013e3181da8812. (PMID: 20595829)
    CrossrefPubMedGoogle Scholar
  • 48 Casey 3rd WJ, Chew RT, Rebecca AM. et al. Advantages of preoperative computed tomography in deep inferior epigastric artery perforator flap breast reconstruction. Plast Reconstr Surg 2009; 123 (04) 1148-1155 DOI: 10.1097/PRS.0b013e31819e23e1. (PMID: 19337083)
    CrossrefPubMedGoogle Scholar
  • 49 Cheng M, Janzekovic J, Finze R. et al. Conceptualizing Scaffold Guided Breast Tissue Regeneration in a Preclinical Large Animal Model. Bioengineering (Basel) 2024; 11 (06) 593 DOI: 10.3390/bioengineering11060593... (PMID: 38927829)
    CrossrefPubMedGoogle Scholar
  • 50 Cheng M, Janzekovic J, Mohseni M. et al. A Preclinical Animal Model for the Study of Scaffold-Guided Breast Tissue Engineering. Tissue Eng Part C Methods 2021; 27 (06) 366-377 DOI: 10.1089/ten.TEC.2020.0387. (PMID: 33906394)
    CrossrefPubMedGoogle Scholar
  • 51 Ding J, Wei C, Xu Y. et al. 3D printing of Ceffe-infused scaffolds for tailored nipple-like cartilage development. BMC Biotechnol 2024; 24 (01) 25 DOI: 10.1186/s12896-024-00848-3. (PMID: 38689309)
    CrossrefPubMedGoogle Scholar