Annals of surgical oncology
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Oncoplastic mastopexy has been popularized as a method to hide the cosmetic effects of central or large-volume resections associated with breast conservation surgery for breast cancer. ⋯ Oncoplastic mastopexy allows the surgeon to address large tumors or tumors in cosmetically difficult sites adequately for breast conservation. Careful margin marking and re-excision of close or positive margins is still often feasible to achieve adequate negative margin with acceptable cosmesis in spite of the large initial volumes of resection.
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Complete axillary lymph node dissection (ALND) after a positive sentinel lymph node biopsy (SLNB) remains the standard practice. As nodal surgery has long been considered a staging procedure without a clear survival benefit, the need for ALND in all patients is debatable. The purpose of this study was to examine differences in survival for patients undergoing SLNB alone versus SLNB with complete ALND. ⋯ There is an increasing trend toward omitting ALND in patients with micrometastatic nodal disease identified by SLNB. Compared with SLNB alone, completion ALND does not seem to be associated with improved survival for breast cancer patients with micrometastasis in the sentinel lymph nodes.
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Intraoperative radiotherapy (IORT) during breast-conserving surgery as a boost followed by whole-breast radiotherapy is increasingly used. ⋯ After IORT as a tumor bed boost with low-kilovoltage x-rays followed by whole-breast radiotherapy, low local recurrence and chronic toxicity rates were seen after 5-year follow-up.
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Completion axillary lymph node dissection (CALND) is controversial in patients with sentinel lymph node (SLN) metastases ≤ 0.2 mm [N0(i+)]. Our goal was to characterize patients with SLN isolated tumor cells regarding surgical management and axillary recurrence. ⋯ Among breast cancer patients with SLN isolated tumor cells, a small percentage have additional metastasis in other axillary nodes. However, the risk of axillary recurrence appears low in those who do not undergo CALND.
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Several studies have reported an increased rate of contralateral prophylactic mastectomy (CPM) in patients with unilateral breast cancer. This study reports on CPM trends from the American College of Surgeon's National Cancer Data Base (NCDB) diagnosed over a 10-year period. ⋯ Although an increase in the proportion of surgically treated women undergoing CPM was universally observed across a broad range of patient, biological, and provider factors, the increase was more noticeably associated with patient-related factors rather than tumor or biological characteristics. Further studies are needed to determine why patients seem to choose CPM and whether a survival benefit can be associated with this choice of surgical management.