Therapeutic mammaplasty is a safe and effective alternative to mastectomy with or without immediate breast reconstruction
Authors: Potter S , Trickey A , Rattay T , O'Connell R L , Dave R , Baker E , Whisker L , Skillman J , Gardiner M D , Macmillan R D , Holcombe C , Potter S , Trickey A , Rattay T , Dave R , Baker E , Whisker L , Skillman J , Gardiner M D , Macmillan R D , Holcombe C , Barnes Nicola L P , Blazeby Jane , Conroy Elizabeth , Dave Rajiv V , Gardiner Matthew D , Harnett Adrian , Holcombe Chris , Potter Shelley , Rattay Tim , Skillman Joanna , Williamson Paula , Achuthan Rajgopal , Aggarwal Shweta , Baker Elizabeth , Basu Naren , Brock Lisa , Fairbrother Patricia , Gardiner Matthew D , Holcombe Chris , Ives Charlotte , Jain Abhilash , Kim Baek , Macmillan R Douglas , Murphy John , Potter Shelley , Rattay Tim , Remoundos Dennis , Sutton Richard , Trickey Adam , Turton Philip , Williams Kathryn , Curnier Alain , Tadros Amir , Depasquale Ivan , Fuller Mairi , Bourne Roger , Heys Steven , Hamo Ishrak , Aloraifi Fatima , Fopp Laura , Bali Radhika , Bache Sarah , Benyon Sarah L , Irwin Michael S , Agrawal Amit , Malata Charles M , Murphy Claire , Misky Adam , Chicken Dennis Wayne , Abdullah Nassreen , Hill Arnold D K , Cullinane Carolyn , Irwin Gareth , McIntosh Stuart A , Refsum Sigi , Sloan Samantha , Mallon Peter , Sirianni Chiara , Khattak Ilyas , Sirianni Chiara , Nagachandra Geerthan , Kiruparan Pasupathy , Debanth Debasish , Davey Simon , Curran Terry-Ann , Svenning Matilda , Govindarajulu Sasirekha , Rayter Zenon , Ainsworth Rachel , Cawthorn Simon , Sahu Ajay , Wilson Sherif , Prousskaia Elena , Accurso Antonello , Rocco Nicola , Di Micco Rosa , Accurso Antonello , Limite Gennaro , Ceccarino Raffaele , Liccardo Raffaele , Coco Guido , Nizamoglu Metin , Morgan Mary , Ramakrishnan Venkat , Catanuto Giuseppe , Wilkins Alex , McManus Penelope , Kneeshaw Peter , Grover Kartikae , Mahapatra Tapan , Wooler Brendan , Elahi Bilal , Ihsan Naila , Bucknor Alexandra , Reissis Dimitris , Hunter Judith , Wood Simon , Jallali Navid , Henry Francis P , Verjee Liaquat S , Lee Jason , Khan Shazia M , Azmy Iman , Massey Julia , Hollywood Ciaran , Oluwajana Michael , Bathla Sonia , Seward Joanna , Harding-MacKean Claudia , Lane Risha , Murali Kothandaraman , Biswas Bashishta , Trapszo Pawel , Seetharam Seema , Kennedy Katy , Alder Louise , Graja Tomasz , Amin Khalid , Kokan Jalal , Roshanlall Chandeena , Gill Emma , Kulkarni Dhananjay , Dixon J M , Young Oliver , Saleem Talha , Biddle M , Kearns Marie , Weiler-Mithoff Eva , Chew Ben , Malyon Andy , Scott John , McGill David , Mackay Iain , Bains Salena , Barrows Sara , Rattay Tim , Pilgrim Simon , Shokuhi Sheila , Lambert Kelly , Kenny Frances , Valassiadou Kalliope , Kaushik Monika , Krupa Jaroslaw , Dragoumis Dimitris , Lampropoulos Pavlos , Moss Sarah , Khalil Haitham , Haq Anwar , Balasubramanian Balapathiran , Charalampoudis Petros , Hamed Hisham , Kothari Ashutosh , Kovacs Tibor , Douek Michael , Mehmood Iftikhar , Ray Biswajit , Adelekan Matthew , Humphreys Laura , Tayeh Salim , Choy Christina , Parvanta Laila , Michieletto Silvia , Saibene Tania , O'Brien James , Down Sue , Downey Sarah , Pereira Jerome , Sami A S , Gvaramadze Anzors , Jibril Jibril A , Thekkinkattil Dinesh , Udayasankar S , Khawaja Saira , Shariaha Yousef , Holt Simon , James Ruth , Rizki Hirah , Kirkpatrick Katharine , Ravichandran Duraisamy , Shrestha Deepak , Barua Ellora , Akolekar Deepika , Hamad Ahmed , Kleidi Eleftheria , Hignett Susan , Pope Vanessa , Naseem Salma , Isherwood Jennifer , Soulsby Rachel , Taylor Amanda , Chin Kian , Nguyen Dai , Guest Francesca , Thorne Amanda , Lefemine Valentina , Kirchhoff Chris , Murphy Declan C , Lo Michelle , Harcourt Ruth , Pain Simon J , Hussien Maged I , Zechmeister Katalin , Sassoon E M , Figus Andrea , Haywood Richard M , Ali Rozina , Alexander Susanna , Harnett Adrian , Geropantas Konstantinos , Epurescu Daniel , Lewis Rebecca , Fafemi Oladapo , Gahir Jasdeep , Gandamihardja Tasha , Kelsall Jennett , Muhibullah Nazli , Otieno Charlene , Mazari Fayyaz , Dauria Marta , Whisker Lisa , Macmillan Douglas , Gutteridge Eleanor , Rasheed Tuabin , Khout Hazem , Asgeirsson Kristjan , McCulley Stephen , Mariniello Maria Donatella , Roncella Manuela , Ghilli Matteo , Colizzi Livio , Rossetti Elena , Marzia Lo Russo , Fustaino Loredana , Li Alessandro Quattrini , Harvey Kate L , Windle Rebecca , Remoundos Dionysios Dennis , Roy Pankaj , MacLean Gael , Adwani Asha , Popa Elena , Goh Steven , Shetty Geeta , Clark Sarah , Bernaudo Lorenzo , Agrawal Avi , Mansfield Lucy , Tebbal Sally , Patel Ashraf , Grassi Veronica , Pujji Ojas , Hamnett Kathryn , Basu Naren , Granger Emily , Durbar Michael , Pikoulas Panagiotis , Garnsey Clare , Walker Philip , Vollermere Angela J , Michalakis Ioannis , Jones Robin , Youssef Mina , Ives Charlotte , Masood Mohammad , Dunn Julie , Olsen Sisse , Ferguson Douglas , Tillett Rachel , Allan Anna , Woollard Alex , Canny Rebecca , Woollard Alexander , Mosahebi Afshin , Hamilton Stephen , Chana Jagdeep , Sojitra Nilesh , Younis Ibby , Rainsbury Dick , Chand Natalie , Kalles Vasileios , Stebbing Anne , Harris Kevin , Laws Siobhan , Holcombe Chris , Tansley Anne , Mitchell Geraldine , de Sousa Emma , Henderson Julia , Chandrashekar Mysore , Pereira Bernadette , Constantinou Chloe , Elfadl Dalia , Irakleidis Foivos , Hernan Izaro , Byrne Miriam , O'Connell Rachel , Rusby Jennifer , Barry Peter , Krupa Katerine , Allum William , MacNeill Fiona , Roche Nicola , Gui Gerald , Ramsey Kelvin , Harris Paul , James Stuart , Potter Shelley , Sutton Richard , McIntosh Jamie , Laurence Nicola , MacLennan Louise , Milligan Robert , Cain Henry , Critchley Adam , O'Donoghue Joe , Kalra Loraine , Collis Nick , Weston-Petrides Gina , Fiddes Roanne , Brown Victoria , Aertssen Anna , Slade-Sharman Diana , Khan Mansoor , McGuiness Caroline , Amorosi Vittoria , di Pompeo Fabio Santanelli , Exarchos Georgios , Jiwa Natasha , Hu Jennifer , Ledwidge Serena , Johnson Laura , Peel Anthony , Dhooma Naseem , Farrell Eric , Devane Liam , Tevlin Ruth , McDermott Enda , Prichard Ruth , Evoy Denis , Rothwell Jane , Geraghty James , Morrison Colin , Lawlor Catriona , Langlands Fiona , Taylor Lauren , Turton Philip , Achuthan Raj , Horgan Kieran , Mckenzie Shireen , Hogan Brian , Lansdown Mark , Navin Channegowda , Sherwin Liz , Mortimer Caroline , Garg Neeraj , Adam Rahma , Arif Tahera , Kryjak Zbigniew , Ali Deedar , Sowdi Ravi , Fage Elena , Mylvaganam Senthurun , Matey Pilar , Vidya Raghavan , Sircar Tapan , Asaad Oubida , Bhaskar Pud , Dordea Matei , Chrysafi Ada , McCartan Damian , Dave Rajiv , Foster Rachel , Wilson Rebecca , Okwemba Sylvia , Majeed Yousef , O'Brien Ciara , Mathen Vinod , Murphy John , Barnes Nicola , Gandhi Ashu , Harvey James , Kirwan Cliona C , Johnson Richard , Patel Krupali , Ribas Maria Dalmau , Vigneswaran Natali , Challoner Tom , Skillman Joanna , Park Alan , Rizkalla Maged , Tomlins Abigail , McEvoy Kat , Jafferbhoy Sadaf , Soumian Soni , Narayanan Sankaran , Kirby Robert , Bajrusevic Sladana , Maalo Joseph , Charalambous Michalis , Lai Lee Min , Chong Kelvin , Thomson Simon , Monib Sherif , Chagla Leena , Audisio Riccardo , Taghizadeh Rieka , Iqbal Azhar , James Karen , Callaghan Maria , Poonawala Shabbir , Lund Jonathan , Vinayagam Raman , Jafferbhoy Sadaf , Thrush Steven , Thomas Rachel Bright , Mullan Michelle , Taylor Jevan , Yoshimura Ryo , Mathew Tom , Jones Ben Mancey , Munot Kailas , Nasr Rana , Piper Jenny , El-Sharief Deena , Mustafa Mohammed , MacLeod Caitlin , Smyth Elizabeth , Depasquale Ivan , Fuller Mairi , Saeed Nina , Masannat Yazan , Mohd-Amin Amir Tan , Agrawal Amit , Irwin Gareth , Sloan Sam , Refsum Sigi , McIntosh Stuart , Ibrahim Abdulla , Sahu Ajay , Govindarajulu Sasirekha , Cawthorn Simon , Accurso Antonello , Rathinaezhil Rathi , Wilkins Alex , Khalifa Eiman , Grover Kartikae , McManus Penny , Kneeshaw Peter , Mahapatra Tapan , Azmy Iman , Massey Julia , Trapszo Pawel , Lane Risha , Seetharam Seema , Rocco Nicola , Roshanlall Chandeena , Kokan Jalal , Amin Khalid , Leeper Alexander , Kulkarni Dhananjay , Dixon J M , Young Oliver , Saleem Talha , McIlhenny Jennifer , Malyon Andy , Mansell James , Ogsto Keith , Romics Laszlo , Dragoumis Dimitris , Krupa Jaroslaw , Valassiadou Kalliope , Lambert Kelly , Kaushik Monika , Shokuhi Shelia , Pilgrim Simon , Lee Xiang Wei Jonathan , Al-Allak Asmaa , Fowler Clare , Massey Eleanore , Court Fiona , Hunt Richard , Vestey Sarah , Khalil Haitham , Elgammal Mohsen , Parvanta Laila , Sami A S , Gvaramadze Anzors , Thekkinkattil Dinesh , Kirkpatrick Katharine , James Ruth , Noshirwani Arish , Arif Tehera , Kryjak Zbigniew , Taylor Amanda , Syed Farah H , Safdar Gazalla , Chin Kian , Soulsby Rachel , Thorne Amanda , Guest Francesca , El-Abbar Mohammed , Hogg Fiona , McGee Pauline , Pitsinis Vassilis , Smith Jenny , Makkiyah Sundus , Mustafa Syed , Otieno Charlene , Photiou Dana , Macmillan Douglas , Gutteridge Ellie , Mazari Fayyaz , Oni Georgette , Khout Hazem , Kelsall Jennett , Hallam Kelly , Asgeirron Kristjan , Whisker Lisa , D'Auria Marta , Al-zubaidi Samim , McCulley Stephen , Rasheed Tuabin , Bailey James , Brock Lisa , Muhibullah Nazli , Tenovici Alexandra , Remoundos Dionysios-Dennis , Chaidos Nikos , Predescu Oana , Roy Pankaj , Windle Rebecca , Popa Elena , Shetty Geeta , Rezulski Jan , Goh Steven , Abdullah Tholkifl , Thekkinkattil Dinesh , Khawaja Saira , Udayasankar Sujatha , Tebbal Sally , Grassi Veronica , Talbot Adam , Basu Naren , Singh Jagdeep , Smith Amy , Volleamere Angela , Garnsey Clare , Pikoulas Panagiotis , Ives Charlotte , Ferguson Douglas , Tillett Rachel , Dean Sarah , Olsen Sisse , Rainsbury Dick , Peiris Lashan , Sjokvist Olivia , Laws Siobhan , Tansley Anne , De Sousa Emma , Mitchell Geraldine , Henderson Julia , Chandrashekar Mysore , Potter Shelley , Micha Aikaterini , Godden Amy , Pereira Bernadette , Constantinou Chloe , Rusby Jennifer , Krupa Katherine , Barry Peter , Critchley Adam , Kim Baek , Cain Henry , O'Donoghue Joe , Henton John , Kalra Loraine , MacLennan Louise , Bennett Ruth , Nicholson Stewart , Paolini Guido , Renzi Luca Francesco , Di Pompeo Santanelli , Ria Vitto , Hu Jennifer , Johnson Laura , Lewis Rebecca S , Hadad Sirwan , Sharma Anup , Toomey Delia , Banerjee Dibyesh , Tang Sarah Shuk Kay , Taylor Lauren , Turton Philip , Achuthan Raj , McKenzie Shireen , Ahmad Tanvir , Williams Kate , Absar Mohammed , Nasir Nabila , Rychlik Igor Jerzy , Darragh Lynn , Johnston Ruth , Kirk Stephen , Rees-Lee Jacqueline , Green Michael , Sharma Abhishek , Chong Kelvin , Lai Lee Min , Choong Jia , Aggarwal Shweta , Ullah Zaker , Chagla Leena , Koshy Ommen , Bathla Sonia , Kiernan Tamara , Bhojwani Ajay Ashok , Lund Jonathan , Callaghan Maria , Vinayagam Raman , Poonawala Shabbir , Taylor Jevan , Mullan Michelle , Bright-Thomas Rachel , Gandhi Ashu , Byrne Ged , Ibrahim Ibrahim , Harvey James , Murphy John , Highton Lyndsey , Chrysafi Ada , Morris Owen , Chatterjee Sumohan , Mathen Vinod , Majeed Yousef , Kirwan Cliona , Mancey-Jones Ben , El Sharief Denna , Munot Kailas , Nasr Rana , Frame Richard 
Published: February 2020

Abstract

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 &lt; 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.