the Effect of Therapeutic Mammoplasty on the Start of Adjuvant Chemotherapy
Condition: Effect of Therapeutic Mammoplasty on Adjuvant Chemotherapy
Study type: Observational

Summary: 
      the purpose of this study was to examine the impact of therapeutic mammoplasty on the
      delivery of adjuvant chemotherapy
    

Detailed description: 
      One out of every eight women will be diagnosed with breast cancer in her lifetime, making it
      the most common cancer in women. Over the last decades the survival rate has increased
      slowly, which is currently estimated to be 85 % in developed countries. However, with an
      estimated annual number of breast cancer deaths of 537,000 worldwide, breast cancer still is
      the most important cause of death by cancer among women. Despite advances in different
      treatment modalities, about 45 % of all breast cancer patients still undergoes a mastectomy
      for adequate local control. The resulting loss of a breast may have a negative effect on body
      image, sexuality, and sense of femininity. (8) Oncoplastic breast techniques are being
      increasingly employed to allow breast conservation whilst maintaining a quality aesthetic
      outcome. Therapeutic mammoplasty (TM) describes multiple breast-conserving techniques1 which
      remove the breast tumour in combination with adjuvant radiotherapy (1). TM is available to
      women with early stage breast cancer with larger or ptotic breasts who would benefit from a
      reduction mammoplasty technique in addition to tumour removal. The use of TM is increasing
      worldwide, with the potential to deliver benefits both oncologically, in terms of increased
      tumour free margin width, and with an associated superior long-term aesthetic outcome.
      Despite increasing enthusiasm for the techniques there is limited data on long-term
      oncological safety or effects upon delivery of adjuvant treatments.TM techniques can enable a
      larger volume of tissue to be resected with the tumour6 enabling patients to have
      breast-conserving surgery for larger tumours. Just as the role of TM is expanding, adjuvant
      chemotherapy is increasingly being used in women with early stage breast cancer and if
      delivered in a timely fashion after the primary resection, decreases recurrence and improves
      overall survival (3). However, TM is associated with higher complication rates than
      traditional breast-conserving methods and one barrier to TM is the concern that
      post-operative complications may lead to a delay in initiation of chemotherapy or even
      omission. There is increasing evidence that immediate breast reconstruction has an effect on
      adjuvant chemotherapy delivery. Three recent series involving over 4000 patients suggest that
      immediate breast reconstruction does lead to a significant delay in the delivery of adjuvant
      chemotherapy (2). However, the clinical significance of this delay has not been established.
      On the contrary, a recent study performed by Doughty et al. compared 95 patients undergoing
      immediate breast reconstruction following mastectomy with cohorts having breast-conserving
      surgery and simple mastectomy with no reconstruction, in which no delay to commencement of
      adjuvant chemotherapy was noted. The majority of case series on TM do not comment on the
      timing of adjuvant treatments. When they are reported, studies vary between no delays to
      adjuvant treatment through to five studies reporting delays in between 1.9%9 and 6% of
      patients (8).
    

Intervention name(s): therapeutic mammoplasty
Intervention type(s): Procedure
Intervention description(s): therapeutic oncoplastic surgeries in cases of breast cancer
Observational model: Other
Time perspective: Retrospective
Sampling method: Probability Sample
Study population: 
        female patients between the age of 25 to 65 who underwent therapeutic ammoplasty and will
        recieve adjuvant chemotherapy