Current practice and short-term outcomes of therapeutic mammaplasty in the international TeaM multicentre prospective cohort study

Journal article

Background

Therapeutic mammaplasty (TM) which combines breast reduction and mastopexy techniques with tumour excision, may extend the boundaries of breast-conserving surgery (BCS) and improve outcomes for patients, but current practice is unknown and high-quality outcome data is lacking. This prospective multicentre cohort study aimed to explore the practice and short-term outcomes of the technique.

Methods

Consecutive patients undergoing TM at participating centres between 1st September,2016 and 30th June,2017 were recruited to the study. Demographic, pre-operative, operative, oncological and complication data were collected. The primary outcome was unplanned re-operation for complications within 30 days of surgery. Secondary outcomes included re-excision rates and time to adjuvant therapy.

Results

Overall 880 patients underwent 899 TM procedures at 50 centres. The most common indications for TM were avoidance of poor cosmetic outcomes associated with standard BCS (n=702, 78.1%) or avoidance of mastectomy (n=379, 42.2%). Wise-pattern skin incisions were the most common (n=429, 47.7%) but a range of incisions and nipple/areola pedicles were used. Immediate contralateral symmetrisation was performed in one-third of cases (n=284, 32.2%). In total, 205 (23.3%) patients experienced a complication but <3%(n=25) required re-operation. Median lesion size was 24.5mm (interquartile range (IQR) 16-38mm). Incomplete excision was seen in 132 cases (14.7%) but only 51 (5.8%) patients ultimately required mastectomy. Median time to adjuvant therapy was 54 days (IQR 42-66).

Conclusions

Therapeutic mammaplasty is a safe and effective alternative to mastectomy or standard BCS. Further work is now required to explore the impact of the technique on quality of life and establish cost-effectiveness.

Authors: O'Connell, R; Baker, E; Trickey, A; Rattay, T; Whisker, L

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: Wiley
• Journal: British Journal of Surgery
• Volume: 105
• Issue: 13
• Pages: 1778-1792
• Publication date: 2018-08-22
• Acceptance date: 2018-06-21
• DOI: 10.1002/bjs.10959
• EISSN: 1365-2168
• ISSN: 0007-1323