Seroma is an expected consequence and not a complication of MammoSite brachytherapy

Seroma has long been listed as a complication of MammoSite brachytherapy. Palpable abnormalities are clinically apparent months after treatment and a vast majority of patients demonstrate seroma formation in radiologic studies. We embarked on this study to evaluate the actual sonographic incidence and eventual sonographic resolution, possible contributing factors, cosmesis, pain, and local control associated with seroma formation after MammoSite partial breast irradiation (PBI). We investigated 160 patients who underwent MammoSite PBI from 2002 to 2006 of whom 100 patients had serial sonographic information. Clinical and tumor variables, infection, pain, and cosmesis were investigated. Dosimetric data including volume of balloon, dose at balloon surface, and at skin were analyzed. After a median follow-up of 36 months, the incidence of sonographically confirmed post-radiation seroma was 78% within the first 1 year following radiation and steadily decreased with time. The average size of a seroma cavity was 2.3 cm (range 0.6-6 cm) with a decline to an average of 1.4 cm after 1 year, with complete resolution in 65% of patients at 2 years. No statistically significant correlation was found between patient characteristics, tumor variables, and volumetric or dosimetric data for seroma formation. Excellent/good cosmetic scores were achieved in 94% of women with and 92% without seroma. Local control was equivalent between patients with and without seroma. Consecutive sonographic imaging reveals a high rate of seroma formation after MammoSite PBI, with resolution in 65% of patients by 2 years without intervention. Seroma formation does not prevent an excellent cosmetic result or alter local control.     

Psychological impact and cosmetic outcome of surgical breast cancer strategies

BACKGROUND: Current surgical treatment modalities for breast cancer include breast conserving surgery, mastectomy alone and mastectomy with breast reconstruction. There are recognized benefits of breast conservation and breast reconstruction over mastectomy but there are few studies assessing this area in Australia. The aim of the present study was to compare the various surgical strategies for breast cancer treatment in terms of quality of life, cosmesis and patient satisfaction. METHODS: A chart analysis was conducted of all patients who underwent Breast Cancer Reconstruction at the Royal Adelaide Hospital Breast Unit between 1990 and 2002. Patients were then traced and asked to take part in an interview. Mastectomy and breast conservation patients who attended outpatient clinic for follow up were also approached. All three groups were interviewed and self-assessment quality of life questionnaires (Functional Assessment of Cancer Therapy-Breast, body image) were administered. The breast conservation and reconstruction groups also underwent assessment of satisfaction and cosmesis. RESULTS: A total of 78 mastectomy, 109 breast conservation and 123 breast reconstruction patients were interviewed. Quality of life assessment was similar between the three groups but the breast conservation and reconstruction patients' body image scores were superior to the mastectomy group. Patient satisfaction was higher in the reconstruction group than the breast conservation group of patients, while cosmesis was similar. CONCLUSION: While little difference was seen on quality of life assessment, body image is improved with the use of breast conservation and reconstruction. The high satisfaction and cosmesis scores in the breast reconstruction group are an indication of the superior results that can be achieved with breast reconstruction.     

Influence of surgical technique on axillary seroma formation: a randomized study

The aim of this study was to evaluate the influence of surgical technique in the form of electrocautery and suction drains on seroma formation following surgery for breast cancer. A prospective randomized study was carried out. One hundred and sixty patients with breast cancer who underwent surgery were allocated to four arms using a 2 x 2 factorial design. This method enabled us to evaluate the independent effect of two different causative factors on the incidence of postoperative seroma formation using a single dataset with limited numbers. The main outcome measure was postoperative seroma formation defined as a postoperative axillary collection requiring more than one aspiration after removal of the drain. The incidence of seroma in our institution is 90%. Incidence of postoperative seroma was 88.3% if electrocautery was used, which reduced to 82.2% if surgery was carried out using scissors for dissection and ligatures for haemostasis (P = 0.358). There was no influence on the incidence of seroma formation whether suction drain (84.6%) or corrugated drains (86.1%) were used (P = 0.822). The use of electrocautery in axillary dissection does not adversely affect postoperative seroma formation after surgery for breast cancer. The use of different drainage techniques has no bearing on the postoperative seroma formation. The surgical technique has no influence on the rate of seroma formation after surgery for breast cancer.     

Predictors of mastectomy in a certified breast center - the surgeon is an independent risk factor

Abstract:  The current study examined predictors of mastectomy in a certified breast center with the main impact on the factor surgeon. A total of 663 patients were analyzed for their mastectomy rates. Included were patients with T1 and T2 tumors, who had their surgery performed by one of three specialized breast surgeons with a workload of at least 50 new breast cancer cases per year. On multivariate analysis central tumor localization, positive lymph node status, nonunifocality, large tumor size, and the surgeon were independent predictors of mastectomy. Surgeon A had a mastectomy rate of 30.5% (50/164), surgeon B 26.9% (43/160) respectively, and surgeon C had a mastectomy rate of 15.8% (27/171), p = 0.005. Patients, who had surgery performed by surgeon A or surgeon B were 2.34 [95% confidence interval (CI): 1.38–3.97, p < 0.005] respectively 1.96 (95% CI: 1.14–3.36, p = 0.01) times as likely to have a mastectomy than patients who had surgery performed by surgeon C. Even in a certified breast center with specialized breast surgeons the surgeon is an independent risk factor of mastectomy, as the tumor criteria are given at the time of diagnosis.     

Six‐year Outcome of a Prospective Study Evaluating Tumor Bed Boost with Intra‐operative Electron Irradiation Followed by whole‐Breast Irradiation for Early‐Stage Breast Cancer

A prospective study was performed for patients with early‐stage breast cancer in which a single fraction of intraoperative electron irradiation (IOERT) was given to the tumor bed, followed by conventional fractionated whole‐breast irradiation (WBRT). Patients with T1/T2N0 breast cancer underwent lumpectomy and sentinel lymph node biopsy. A tumor bed boost of 10 Gy of IOERT using 6–12 MeV electrons was administered by a dedicated mobile linear accelerator in the operating room. After adequate wound healing, 48 Gy WBRT was given to the whole breast in 24 fractions. Fifty‐two patients were enrolled between February 2003 and January 2005. At a median follow‐up of 79 months, there were two local relapses. The 6‐year actuarial overall survival and distant control rates were 89% and 96%, respectively. At last follow‐up, cosmesis was graded as excellent or good in 45 (87%), fair in five (10%), and poor in two patients (4%), respectively. Difficulty in wound healing occurred in two patients who had additional surgery later. One patient developed significant fibrosis after aspiration of a symptomatic seroma. The result of this pilot study shows the feasibility of using IOERT as the tumor bed boost in lieu of 6–8 days of standard electron beam treatment with good local control and cosmetic results. However, late surgical intervention of the lumpectomy bed may result in more pronounced tissue fibrosis and wound healing difficulty.     

Contrast-enhanced breast magnetic resonance imaging: the surgical perspective

BACKGROUND: Contrast-enhanced breast magnetic resonance imaging (MRI) has shown excellent sensitivity (93%) for breast malignancies. The clinical role and value of MRI for the breast surgeon remains unresolved and controversial. METHODS: A retrospective review of clinical and imaging records was undertaken for 79 surgical patients evaluated by MRI as part of their initial assessment. RESULTS: Of 79 patients, 71 (90%) had dense mammograms, 64 (81%) had known primary breast cancer (BrCA), 42 (53%) had a family history of BrCA, and 8 (10%) had known breast atypia. MRI identified a larger than clinically suspected BrCA size in 10 (16%) patients and greater BrCA extent in 26 (41%) patients. Of 15 non-BrCA patients, 10 (67%) had a biopsy after the MRI with identification of BrCA in 6 (40%) patients. Overall, there were 20 MRI-initiated core biopsies, of which 14 (70%) identified BrCA. Of 70 BrCA patients, 13 (19%) had neoadjuvant chemotherapy, 35 (50%) had breast-conserving surgery, 36 (51%) had total mastectomy, and 14 (22%) had bilateral total mastectomy. MRI had good pathology correlation in 56 of 62 (90%) patients. In patients with known BrCA (by core biopsy), none of the 29 breast-conserving surgery resections undertaken after MRI had a positive margin or required re-excision. CONCLUSIONS: MRI is very accurate for BrCA evaluation, both for lesion size and extent. With good collaboration between the radiologist and surgeon, MRI is a powerful 3-dimensional and communication tool for the breast surgeon and the patient.     

Evolving concepts in breast reconstruction with latissimus dorsi flaps: results and follow-up of 121 consecutive patients

Breast reconstruction using autologous tissue is increasingly gaining in interest. A review of results obtained from a series of consecutive patients undergoing breast reconstruction with the latissimus dorsi flap (LDF) was carried out to evaluate the effects of the authors' refinements to the procedure. Data collected during the perioperative course and a minimum follow-up of 12 months in 121 patients (mean age, 47 years; 50% with previous radiotherapy) who underwent treatment from 1994 to 1998 were analyzed retrospectively. In addition, a structured interview was conducted to evaluate patient satisfaction. Eighteen different surgeons in one teaching hospital were involved in the operative procedures. No patient was referred to the intensive care unit. An additional implant was used in 25% of patients. With the exception of the occurrence of seroma, the complication rate was low (seroma, 60%; bleeding, 4%; hematoma, 5%; minor wound dehiscence, 3%; wound infection, 2%). No flap was lost. Donor site morbidity was extremely low; 90% of patients had no complaints. The result of surgery was rated as excellent or good by 59% of patients, 89% would undergo this type of breast reconstruction again, and 91% would recommend it to other women. Refinements that improved the technique substantially included incision lines exclusively in the bra line, improved flap volume resulting from the harvest of an extended fat pad, and quilting sutures to reduce the formation of seroma. In the current study, endoscopic muscle harvest did not represent an improvement in procedure. The technique of breast reconstruction with the LDF has been improved substantially during the past few years, and provides the plastic surgeon with an excellent, safe, and consistently successful method for breast reconstruction.     

Breast reduction in the irradiated breast: evidence for the role of breast reduction at the time of lumpectomy

Given the high incidence of breast cancer in our society, it is common to encounter patients with macromastia who desire breast reduction after breast-conserving therapy by lumpectomy and radiation. We hypothesize that radiation leads to a significant increase in postoperative complications after breast reduction. All patients with a history of unilateral breast lumpectomy and radiation who subsequently underwent bilateral breast reduction by a single surgeon from 2004 to 2008 were retrospectively reviewed. Outcomes including cellulitis, wound breakdown, seroma, and need for repeat operations were compared between the radiated and nonradiated breast. The Fisher's exact test was used for statistical analysis. Twelve patients (mean age, 57 years) underwent bilateral breast reduction a mean of 86 months after unilateral lumpectomy and radiation. The nonradiated breasts had no complications postoperatively. The radiated breasts had a significant increase in complications with a total of five breasts (42%, p<0.04) having postoperative complications including cellulitis in two breasts, seroma requiring drainage in five breasts, two cases of fat necrosis, and one case of wound dehiscence. This resulted in two admissions for intravenous antibiotics and two repeat operative procedures. Additionally, three patients had significant breast asymmetry or contour deformities after reduction requiring operative revisions. Breast reduction after radiation leads to a significant increase in complications. Given this data, patients with macromastia undergoing breast conservation therapy for cancer should be considered for reduction at the time of lumpectomy and prior to radiation.     

Factors associated with postsurgical wound infections among breast cancer patients: A retrospective case‐control record review

Women with non‐metastatic breast cancer will be offered surgery as their first option. Unfortunately, studies have shown that the most common postoperative complication is surgical wound infection (SWI). We investigated the prevalence of SWI in breast cancer patients and identified the factors predictive of its development. The study was conducted at the breast cancer centre in Singapore. A retrospective case‐control review of medical records was used. During the 2013 to 2016 study period, there were 657 postsurgical breast cancer patients with only 105 records eligible for the study. The sample consisted of one to four case:control (21:84), matched according to their age at the time of their surgery. Patients presenting with SWI were grouped into cases, while those without SWI were grouped into the controls. Chi‐square test and Mann‐Whitney U test were used to identify risk factors associated with SWI. Regression analysis of predictive variables from the univariate analyses was included. These variables were type of breast surgery, implants, comorbidities, previous surgery, previous chemotherapy, surgical drains, seroma, blood transfusion, surgeon department, and length of stay. The prevalence of SWI was 9%. Demographic, clinical, and comorbidities were not associated with SWI. However, multivariate analysis found that “surgeon department,” “discharged with surgical drains,” and “postoperative seroma” were predictive of SWI. Monitoring SWI is indispensable to minimise burdens on individuals and institutions. Health care professionals should identify high‐risk patients based on the identified predictive variables. A cross‐institutional record review of SWI in postoperative breast cancer patients should be conducted.     

Reduction Mammoplasty Approach to Oncoplasty—Zone-Wise Planning in Indian Patients

Introduction This article is an attempt to formulate certain guidelines for planning of zone-wise reconstruction after breast conservation surgery. The planning involves applying reduction mammoplasty principles with certain modifications to address the defect. Patients and Methods This is a retrospective study of 61 patients with breast cancer who underwent breast conservation surgery and reconstruction of partial breast defects with oncoplastic techniques between January 2014 to March 2019. Patients having low tumor to breast ratio and thus good candidates for volume displacement techniques were included in the study. Results A total of 61 breast cancer cases were included; 22 cases were located in zone 1, nine in zone 2, seven in zone 3, three in zone 4, four in zone 5, one in zone 6, 12 in zone 7, two in zone 8, and three in zone 9. The most common pedicle design used was superomedial in 38 cases, followed by inferior in 19 and medial in 6 cases. Vertical short scar technique was used in 33 cases and Wise pattern skin incision in 30 cases. Follow-up period ranged from 4 months to 65 months, with a mean of 31 months. Four patients had partial skin necrosis, three had suture line dehiscence, two had wound infection, one had seroma, and eight patients had fat necrosis. All patients were satisfied with the cosmetic outcome. Conclusion Breast oncoplastic techniques are effective, reliable, oncologically safe, and conducted with minimal complications in patients with moderately large ptotic breasts, thereby making planning easier and more reproducible by following the reconstruction procedures described in the article. We believe that these techniques should be incorporated in the armamentarium of every plastic surgeon to manage the defects created after breast conservation surgery, in order to achieve the best cosmetic outcomes.     

Superior Pedicle Mammaplasty without Parenchymal Incisions after Massive Weight Loss

Background: After considerable weight loss, the breast suffers significant deformation. The ptotic breast is characterized by a lack of superior pole, tissue excess in the inferior pole, down-migration of nipple-areola complex (NAC) with redundancy of skin tissue. The authors describe a mastopexy technique based on a modulated and progressive reshaping, back rotation, and suspension of mammary gland parenchyma without parenchymal incisions. Methods: Forty-five patients with bilateral moderate or severe breast ptosis underwent mastopexy from January 2011 to January 2014 with complete detachment of breast from the pectoralis major muscle and the plication of parenchyma without any parenchymal incision. Patients were followed up for one year, reporting any complication, and measuring the jugulum–NAC distance. The outcomes were assessed by the patients as well as the surgical team. Results: The aesthetic outcomes were good or excellent in all patients. The new mammary contour and the distance between the jugular fossa and the nipple were stable during this time with a good filling of upper pole. No major complications were reported. Conclusions: This technique gave good breast shape, long-term projection, and upper pole fullness, without parenchymal incisions. It restores breast shape and projection, especially in post-bariatric patients. A similar technique has not been described yet.     

Seroma formation following breast cancer surgery

A seroma is the most frequent complication of breast cancer surgery, the etiology of which remains obscure. We reviewed our data to determine the factors related to the incidence of seroma formation in our patients. A retrospective analysis of the records of 359 consecutive patients (334 Hispanic; 93%) who underwent primary surgical therapy from January 1, 1996 to December 31, 2000, with either modified radical mastectomy (MRM) or wide local excision (WLE) and axillary lymph node dissection (ALND) was performed. In all cases, removal of the breast was performed using electrocoagulation, and sharp dissection was used in the axilla. One-eighth inch closed suction round drains were used. Early arm motion was encouraged. The seroma rate was compared to the age of the patient, the presence and number of positive axillary lymph nodes, the total number of axillary lymph nodes removed, tumor size, weight of the patient, the use of neoadjuvant chemotherapy, and the type of surgery performed. The overall seroma rate was 15.8%. Seromas occurred in 19.9% of patients undergoing MRM and in 9.2% of patients undergoing breast-conserving surgery (p=0.01). The seroma rate was not influenced by any other tested variables. All seromas were easily managed with aspiration and pressure; this technical maneuver allowed seroma resolution in all patients except one following one to six aspirations. A seroma did not delay initiation of chemotherapy. No patient developed a capsule requiring excision. In our experience, a seroma is a "necessary evil;" it will occur unpredictably in a predictable number of patients.     

背阔肌皮瓣联合假体在乳腺癌患者Ⅰ期乳房重建中的临床应用

目的介绍背阔肌皮瓣联合假体应用于乳腺癌患者Ⅰ期乳房重建的临床经验。方法回顾性分析14例应用背阔肌皮瓣联合假体行乳腺癌术后Ⅰ期乳房重建病例的临床资料,其中患者平均年龄44.2(20~54)岁,Ⅰ期乳腺癌4例,Ⅱa期8例,Ⅱb期2例。经背部和腋部切口分别为6例和8例。结果手术后无皮瓣坏死;无伤口感染;供区血清肿5例(35.7%),均经穿刺抽液治愈。平均随访32.6(4~58)月,2例患者接受了放射治疗未发现不良后果,患者对再造乳房形态非常满意8例,满意5例,一般1例,无不满意患者,乳房美学评价按照Ueda标准均6分,优良率为100%。结论对于选择性的乳腺癌患者,乳房切除后背阔肌皮瓣联合假体Ⅰ期乳房重建是一种并发症少、手术效果良好的乳房重建方法 。     

Feasibility of Breast Preserving Therapy with Single Fraction In Situ Radiotherapy Delivered Intraoperatively

Background Accelerated partial breast irradiation (APBI) has gained widespread interest as a means of improving the convenience and availability of breast conserving radiotherapy. Intraoperative radiation therapy (IORT) is an APBI technique that delivers breast radiotherapy as a single dose at the time of partial mastectomy. We adapted the technique of Veronesi to deliver IORT prior to tumor excision to improve delivery to the region at risk and reduce the volume of normal tissue irradiated. Methods Patients age ≥55 with ultrasonographically defined tumors ≤3 cm and invasive ductal carcinoma confirmed by core biopsy were eligible. Pre-operative ultrasound was performed at the time of needle localization and radiocolloid injection. IORT treatment planning was performed prior to surgery using ultrasound tumor definition, selecting cone size and electron energy to optimize dose distribution. In the operating room, the surgeon retracted the skin over the tumor, cone was placed and radiotherapy delivered. Standard partial mastectomy was then performed. Results Twenty-three patients were enrolled in the study. Eighteen patients completed IORT with 10 patients having successful IORT no additional local therapy necessary. In five patients, the intraoperative radiation therapy served as the boost and in three patients unsuspected larger tumors or multicentric disease necessitated a mastectomy. The majority of patients had a good to excellent cosmetic result. Conclusions Single fraction in situ IORT prior to partial mastectomy is feasible for patients with small breast cancers in achieving a good to excellent cosmetic result. Based on this early preliminary data, we plan to expand our feasibility trial.     

Endoscopic axillary surgery in breast cancer

BACKGROUND: The aim was to provide an assessment of the current status of endoscopic axillary surgery in patients with breast cancer. METHODS: Fifty-three patients underwent endoscopic lymphadenectomy. The surgical efficiency (operating time, number of resected nodes, intraoperative and postoperative complications), short-term morbidity (duration of drainage, total lymph flow, seroma rate) and long-term outcome (pain, numbness, mobility, strength, oedema) were assessed. The incidence and severity of different arm symptoms were compared with the results of 396 patients treated with a conventional axillary procedure. Finally, all available data relating to endoscopic axillary surgery were reviewed. RESULTS: The operating time ranged from 60 to 150 min. A mean 17 (range 10-28) lymph nodes was resected. The extent of postoperative lymphorrhoea (mean 372 ml) and the seroma rate (eight of 34 patients) were not significantly reduced in comparison with conventional surgery. The assessment of long-term morbidity revealed fewer disturbances of sensitivity and a decreased rate of severe symptom intensity for pain, oedema and complaints related to mobility. CONCLUSION: Despite excellent visualization of anatomical landmarks and improved long-term morbidity, endoscopic lymph node dissection cannot be regarded as a suitable technique for routine axillary management in breast cancer because of long operating times.     

Cosmetic results of early breast carcinoma treated with wide local excision, external beam radiotherapy and iridium-192 boost

Cosmetic results of 80 patients with axillary lymph node negative or unknown T1 and T2 carcinoma of the breast who were treated with wide local excision, external beam radiotherapy and iridium-192 boost, were evaluated by the patient and the radiotherapist at 18-36 months. Their overall cosmetic results were assessed as good, very good or excellent by 80% of the patients. The radiotherapist's assessment was similar but in general the patients score was more favourable. After a follow-up of 24-72 months recurrence was found in only one patient at 40 months. This approach offers good cosmesis with low local recurrence rates in early breast carcinoma patients with negative axillary lymph nodes.     

Patient-based outcomes after Ilizarov surgery in resistant clubfeet

We present the results of clinical evaluation and patient-based outcomes after Ilizarov surgery in resistant clubfeet (grade D clubfeet, Dimeglio-Bensahel system). This is a retrospective study of 26 resistant clubfeet in 23 children who were managed by the Ilizarov technique. The average age of the patients at the time of the operation was 9 years and the average follow-up period was 47 months. A calcaneal or mid-foot osteotomy followed by bony distraction was undertaken in nine feet and a soft-tissue distraction, with or without soft-tissue release, was undertaken in 17 feet. Clinical evaluation of the degree of correction of the deformity and functional evaluation, using patient-based questionnaires, were used in assessing the outcome in these patients. Patient-based outcomes give useful information about the functional status following surgery, complementing the objective assessment by the surgeon. Clinical evaluation revealed stiff, plantigrade feet in nine patients and a recurrent deformity after initial correction in the remaining 14 patients. The patient-based outcomes were good to excellent in 52% for satisfaction, 57% for cosmesis, 48% for walking and 73% for teasing (made fun of because of the shape of foot), showing that the functional results were better in these patients in spite of a poor surgical outcome.     

Oncoplastic Breast-Conserving Surgery: Analysis of Quadrantectomy and Immediate Reconstruction with Latissimus Dorsi Flap

Background Oncoplastic breast-conserving surgery satisfies oncologic principles and improves cosmetic outcomes, even when an important breast volume excision is required. Methods We reviewed 28 patients suffering from breast cancer treated with quadrantectomy and immediate myocutaneous latissimus dorsi flap reconstruction. We evaluated the status of the surgical margins, early complications, and cosmetic outcome. Cosmetic assessment was carried out by a panel made up of three women and one man: a female member of an association against breast cancer, a female general practitioner, a female gynecologic resident, and a male breast-specialized surgeon. Results Free margins were obtained in all cases. There were 11 postoperative complications: 9 seromas at the donor site, 1 dehiscence of the back wound, and 1 minor partial flap skin necrosis. Chemotherapy and radiotherapy adjuvant treatment was not compromised. The cosmesis outcome was deemed to be good in 43.75% of the cases and satisfactory in 56.25%. The score for overall cosmesis outcome was 6.92 out of 10. Symmetry and the scar of the reconstructed breast were the most influential criteria in the quantitative assessment of overall cosmetic results. Conclusion Partial mastectomy (quadrantectomy) and immediate reconstruction with a myocutaneous latissimus dorsi flap allows extensive resection, which fits oncologic requirements, without serious morbidity and a good cosmetic outcome.     

The use of a breast symmetry index for objective evaluation of breast cosmesis

The cosmetic result after breast surgery is an important marker in clinical studies. Most authors used subjective scales to judge breast cosmesis. However, inter-observer discrepancies are very high and the use of such subjective scales for prospective trials is highly disputed. In this study we present for the first time a new invented breast symmetry index (BSI). This BSI is calculated by subtracting the size and the shape between both breasts (frontal view and side view). The BSI is measured with a software system called breast analysing tool (BAT) from digital photographs. The photographs of 27 patients have been analysed with this software by different physicians to evolve inter-observer reproducibility. The Harris scale for subjective cosmetic analyses has been correlated with the BSI. In our study the inter-observer reproducibility was excellent (Pearson correlation r=0.9; p<0.05) and the BSI was able to significantly differentiate between good and bad cosmesis (BSI values from 0%d to 30%d is good, BSI>30%d is bad cosmesis). Thus the BSI may be used for clinical studies.     

Four-year clinical update from the American Society of Breast Surgeons MammoSite brachytherapy trial

Background

We present a 4-year update on the efficacy, cosmetic results, and complications of MammoSite breast brachytherapy in patients enrolled in the American Society of Breast Surgeons registry trial.

Methods

A total of 1,449 breasts in 1,440 patients with early stage breast cancer undergoing breast-conserving therapy were treated with adjuvant, accelerated partial breast irradiation (APBI) (34 Gy in 3.4-Gy fractions) delivered with the MammoSite device. The median follow-up period for the entire group was 36.1 months.

Results

The 3-year actuarial rate of ipsilateral breast tumor recurrence was 2.15%. The 3-year actuarial rate of axillary recurrence was .36%. Complication rates were as follows: infection, 9.5%; seroma, 26.8% (symptomatic seroma, 12.7%); and fat necrosis, 2.0%. The percentages of breasts with good or excellent cosmetic results were as follows: 12 months, 95%; 24 months, 94%; 36 months, 94%; and 48 months, 91%.

Conclusions

Locoregional control, complications, and cosmetic outcomes from MammoSite APBI at the 4-year update are acceptable and similar to results seen with other forms of APBI.