Ten-year trend analysis of breast cancer, oncoplastic, and reconstructive breast surgery in a single institution (2010-2019), what has not changed?

A Morad; K Johnson; S Bate; I Birkby; S Schofield; J Harvey

doi:10.1007/s10549-024-07294-x

Ten-year trend analysis of breast cancer, oncoplastic, and reconstructive breast surgery in a single institution (2010-2019), what has not changed?

Breast Cancer Res Treat. 2024 Apr 30. doi: 10.1007/s10549-024-07294-x. Online ahead of print.

Authors

A Morad^{1

2}, K Johnson³, S Bate⁴, I Birkby³, S Schofield³, J Harvey³

Affiliations

¹ Nightingale Breast Cancer Centre, Manchester University, NHS Foundation Trust, Manchester, UK. dr.ammorad@gmail.com.
² Nottingham Breast Institute, Nottingham University Hospitals NHS Trust, Hucknall Rd, Nottingham, NG5 1PB, UK. dr.ammorad@gmail.com.
³ Nightingale Breast Cancer Centre, Manchester University, NHS Foundation Trust, Manchester, UK.
⁴ Centre for Biostatistics, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK.

PMID: 38689173
DOI: 10.1007/s10549-024-07294-x

Abstract

Purpose: There has been a UK national directive to ensure that patients are offered reconstructive surgical options. We aimed to assess any change in oncoplastic practice over a 10-year period.

Methods: The surgical management of 7019 breast cancers was retrospectively assessed at Nightingale Breast Centre, Manchester University UK, from 2010 to 2019. The procedures were categorised into breast conservative surgery (BCS) and mastectomy ± immediate reconstruction. The data were analysed using inclusion and exclusion criteria.

Results: The overall rates of BCS and mastectomy were 60.1% and 39.9% respectively. No statistically significant change in the overall rates of BCS or mastectomy was observed over the last decade (p = 0.08). The rate of simple wide local excision (WLE) decreased from 98.7% to 89.3% (p < 0.001), whilst the rate of therapeutic mammoplasty (TM) increased from 1.3% to 8% (p < 0.01). The rate of chest wall perforator flaps (CWPF) changed from zero to account for 2.7% of all BCS by 2019. The overall rate of immediate breast reconstruction (IBR) did not significantly change over the study period, but it consistently remained above the national average of 27%. The rate of implant-based IBR increased from 61.3% to 76.5% (p = 0.012), whilst the rate of Latissimus Dorsi (LD) reconstruction decreased from 26.7% to 5.1% (p < 0.05). Additionally, the rate of nipple-sparing mastectomy significantly increased from 5.2% to 24%.

Conclusion: No significant changes in the overall rates of BCS was observed, the rates of advanced breast conservation techniques, nipple-sparing mastectomy, and implant-based IBR all have increased, whilst the use of LD reconstruction decreased.

Keywords: Breast conservative surgery; Chest wall perforator flaps; Immediate autologous breast reconstruction; Immediate breast reconstruction; Immediate implant-based breast reconstruction; Oncoplastic breast surgery.