CONSIDERATIONS IN BREAST SURGERY AFTER CHEMOTHERAPY CLIP PLACEMENT - PowerPoint PPT Presentation

CONSIDERATIONS IN BREAST SURGERY AFTER CHEMOTHERAPY

CLIP PLACEMENT • I s impo rta nt in a ll b re a st b io psie s b ut is ma nda to ry in ne o a djuva nt pa tie nts

SAME PATIENT AFTER CHEMO, CLIPS ARE ALL THAT REMAIN

WHAT IF THE PATIENT HAS A CCR? • Ma uri e t a l in 2005, me ta -a na lysis o f ne o vs a djuva nt c he mo • Sho we d no diffe re nc e in OS, DF S, a nd DDF S • Sho we d a sig nific a nt inc re a se in L RR in the ne o -a djuva nt a rms • 22% inc re a se • Drive n b y 4 studie s whe re surg e ry wa s re pla c e d b y ra dia tio n in c CR • Whe n the se studie s we re pulle d o ut L RR is the sa me • I ma g ing is ina c c ura te a t a sse ssing re sidua l dise a se o a nnidis JP. Ne o a djuva nt ve rsus a djuva nt syste mic tre a tme nt in b re a st c a nc e r: a me ta -a na lysis. J NatlCanc e r I nst. F Ma uri D, Pa vlidis N, I e b 2 2005;97(3):188-194 Dia la ni V, Cha da shvili T , Sla ne tz PJ. Ro le o f ima g ing in ne o a djuva nt the ra py fo r b re a st c a nc e r. Ann S urg Onc o l. Ma y 2015;22(5):1416-1424

WHILE THE PATIENT IS GETTING CHEMOTHERAPY • Ge ne tic te sting if indic a te d • Visit the pla stic surg e o n if indic a te d • Midpo int visit with surg e o n to re a sse ss tumo r/ g o a ls • Re -ima g e b re a st/ a xilla if it will c ha ng e thing s

SURGERY DECISION MAKING • OS is the sa me b e twe e n pa rtia l a nd c o mple te ma ste c to my • L RR is hig he r in pa rtia l e ve n with ra dia tio n b ut no t e no ug h to impa c t surviva l • Surg e ry de c isio n ma king drive n b y: • Da ta • Co sme sis • Po st Ma ste c to my Ra dia tio n • F e a r

SIMPLE SURGERY OPTIONS • L umpe c to my • Quic k re c o ve ry • Po ssib ility o f ma rg in po sitivity • Ca n b e do ne with a b re a st re duc tio n “o nc o pla stic ” • Simple Ma ste c to my • Quic k re c o ve ry • F itte d fo r pro sthe sis in 8 we e ks

MORE COMPLEX OPTIONS • Skin Spa ring Ma ste c to my • Nipple c a n b e re c o nstruc te d a t a la te r da te • Nipple Spa ring Ma ste c to my • Nic e st c o sme tic o utc o me b ut le a ve s mo re b re a st tissue

RECONSTRUCTION • I mpla nt • Simple r surg e ry • Usua lly a t le a st two surg e rie s • Will ne e d a n e xc ha ng e a t so me po int in the future • Auto lo g o us • DI E P, T RAM a nd L a tissimus F la ps • Muc h b ig g e r surg e ry b ut ma y b e a “o ne a nd do ne ” • Ag e s with the pa tie nt • F e e ls mo re na tura l

SENTINEL LYMPH NODE IN N1 PATIENTS • Sta nda rd ha s b e e n a c o mple tio n AL NDx in pa tie nts with N1-2 dise a se pre ne o -a djuva nt c he mo • Re c e ntly ACOSOG Z1071 lo o ke d a t fa lse ne g a tive ra te in SL NBx a fte r c he mo • Sho we d a n a xilla ry pCR in 40% o f pa tie nts • Sho we d a fa lse ne g a tive ra te o f 12.6% • F NR we nt do wn with • Co mb o o f b lue dye / ra dio tra c e r • 3 o r mo re lymph no de s re mo ve d Bo ug he y JC, Suma n VJ, Mitte ndo rf E A, e t a l. Se ntine l lymph no de surg e ry a fte r ne o a djuva nt c he mo the ra py in pa tie nts with no de -po sitive b re a st c a nc e r: the ACOSOG Z1071 (Allia nc e ) c linic a l tria l. JAMA. Oc t 9 2013;310(14):1455-1461

ALLIANCE A11202