Therapeutic mammaplasty is a safe and effective alternative to mastectomy with or without immediate breast reconstruction
Shelley Potter, Adam Trickey, Tim Rattay, Rachel O’Connell, Rajiv Dave, Elizabeth A. Baker, Lisa Whisker, Joanna Skillman, Matthew Gardiner, R. Douglas Macmillan, Chris Holcombe, Shelley Potter, Adam Trickey, Tim Rattay, Rajiv Dave, Elizabeth A. Baker, Lisa Whisker, Joanna Skillman, Matthew Gardiner, R. Douglas Macmillan, Chris Holcombe, Nicola Barnes, Jane Blazeby, Elizabeth J. Conroy, Rajiv Dave, Matthew Gardiner, Adrian Harnett, Chris Holcombe, Shelley Potter, Tim Rattay, Joanna Skillman, Paula Williamson, Rajgopal Achuthan, Shweta Aggarwal, Elizabeth A. Baker, Naren Basu, Lisa Brock, Patricia Fairbrother, Matthew Gardiner, Chris Holcombe, Charlotte Ives, Abhilash Jain, Baek Kim, R. Douglas Macmillan, John Murphy, Shelley Potter, Tim Rattay, Dionysios-Dennis Remoundos, Richard Sutton, Adam Trickey, Philip Turton, Kathryn Williams, Alain Curnier, Amir Tadros, Ivan Depasquale, Mairi Fuller, Roger Bourne, Steven D. Heys, Ishrak Hamo, Fatima Aloraifi, Laura Fopp, Radhika Bali, Sarah E. Bache, Sarah Benyon, Michael S. Irwin, Amit Agrawal, Charles M. Malata, Claire Murphy, Adam T. Misky, Dennis Wayne Chicken, Nassreen Abdullah, Arnold D. Hill, Carolyn Cullinane, Gareth Irwin, Stuart McIntosh, Sigi Refsum, Samantha Sloan, Peter Mallon, Chiara Sirianni, Ilyas Khattak, Chiara Sirianni, Geerthan Nagachandra, Pasupathy Kiruparan, Debasish Debanth, Simon Davey, Terry‐Ann Curran, Matilda Svenning, Sasirekha Govindarajulu, Zenon Rayter, Rachel Ainsworth, Simon Cawthorn, Ajay Sahu, S.W. Wilson, Elena Prousskaia, Antonello Accurso, Nicola Rocco, Rosa Di Micco, Antonello Accurso, Gennaro Limite, Raffaele Ceccarino
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 < 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.