The American Journal of Surgery (2015) 210, 199-200
Letters to the Editor
Oncoplastic surgery: fashion or necessity? With interest we read the article by Tenofski et al.1 This article compares the immediate and long-term complications and consequences of oncoplastic and nononcoplastic breast-conserving surgeries (BCS). It is a retrospective study of 142 procedures in 140 patients, of which 84 were traditional and 58 oncoplastic BCS. Among the oncoplastic group, the majority had simple level 1 oncoplastic procedures and the rest either reduction therapeutic or donut mammoplasty. The 2 groups had statistically not different size of tumors removed or number of cases needing re-excision. However, oncoplastic surgery caused delayed healing, fat necrosis, and pain 6 to 12 months after surgery more often. Finally, oncoplastic techniques did not seem to improve the cosmetic outcome even many months into the postoperative period. The aim of oncoplastic BCS is to achieve conservation in cases of large tumors. It also ‘‘hides’’ scars, reduces the contralateral breast to achieve symmetry, reconstructs the nipple, and so forth. And it does all thisdwith no compromise of the oncologic resultdwith the aim to improve the final cosmetic result. However, it is not a cheap exercise as it takes up significant time and resources in today’s cost-conscious environment. The latter should not be deterrent if oncoplastic BCS actually delivers on its promises. Being provocative, one can support that this publication does not seem to justify the application of oncoplastic BCS in this case. This type of procedure treated cancers of the same size, did not affect the rates of re-excision, increased the complications and complaints, and had similar cosmetic results as the more traditional method. Therefore, it is reasonable to question its necessity. Surely, one has to acknowledge that attention to cosmesis has become more ‘‘fashionable’’ among breast cancer patients, and this increases patients’ expectations from their procedure.
The younger age of the oncoplastic group may mean that these patients had higher cosmetic expectations and were stricter with the judgment of the esthetic result. Besides, radiotherapy may also affect cosmesis, and it seems that there was a difference between the groups. Finally, one cannot avoid noticing that the oncoplastic group was heterogeneous from the technical point of view, with about two thirds of it being adjacent tissue transfer. As different oncoplastic techniques have different indications and complications (rates and types), it would be methodologically more accurate not to put all the oncoplastic procedures in the same pot. Besides, we feel that the oncoplastic techniques ‘‘not’’ studied here are the ones that actually deliver on the promise and are able to remove large cancers with breast conservation. Being strong supporters of oncoplastic surgery but having become devil’s advocates for the purposes of this article, we are looking forward to the authors’ comments. Demetrios Moris, M.D. Michael Kontos, M.D., Ph.D. First Department of Surgery, ‘‘Laikon’’ General Hospital, University of Athens, Athens 11474, Greece http://dx.doi.org/10.1016/j.amjsurg.2014.09.042
Reference 1. Tenofsky P, Dowell P, Topalovski T, et al. Surgical, oncologic, and cosmetic differences between oncoplastic and nononcoplastic breast conserving surgery in breast cancer patients. Am J Surg 2014;207:398–402.
Regarding: Long-term patient outcomes after surgical stabilization of rib fractures To the Editor: This letter is in regards to our recently published manuscript, ‘‘Long-term patient outcomes after surgical
0002-9610/$ - see front matter Ó 2015 Elsevier Inc. All rights reserved.
stabilization of rib fractures.’’1 In this descriptive study, we identified 101 patients who had surgical stabilization of severe rib fractures over a 31-month period between 2010 and 2012, and invited them to participate in a
©2015 Elsevier
Letters to the Editor
Oncoplastic surgery: fashion or necessity? With interest we read the article by Tenofski et al.1 This article compares the immediate and long-term complications and consequences of oncoplastic and nononcoplastic breast-conserving surgeries (BCS). It is a retrospective study of 142 procedures in 140 patients, of which 84 were traditional and 58 oncoplastic BCS. Among the oncoplastic group, the majority had simple level 1 oncoplastic procedures and the rest either reduction therapeutic or donut mammoplasty. The 2 groups had statistically not different size of tumors removed or number of cases needing re-excision. However, oncoplastic surgery caused delayed healing, fat necrosis, and pain 6 to 12 months after surgery more often. Finally, oncoplastic techniques did not seem to improve the cosmetic outcome even many months into the postoperative period. The aim of oncoplastic BCS is to achieve conservation in cases of large tumors. It also ‘‘hides’’ scars, reduces the contralateral breast to achieve symmetry, reconstructs the nipple, and so forth. And it does all thisdwith no compromise of the oncologic resultdwith the aim to improve the final cosmetic result. However, it is not a cheap exercise as it takes up significant time and resources in today’s cost-conscious environment. The latter should not be deterrent if oncoplastic BCS actually delivers on its promises. Being provocative, one can support that this publication does not seem to justify the application of oncoplastic BCS in this case. This type of procedure treated cancers of the same size, did not affect the rates of re-excision, increased the complications and complaints, and had similar cosmetic results as the more traditional method. Therefore, it is reasonable to question its necessity. Surely, one has to acknowledge that attention to cosmesis has become more ‘‘fashionable’’ among breast cancer patients, and this increases patients’ expectations from their procedure.
The younger age of the oncoplastic group may mean that these patients had higher cosmetic expectations and were stricter with the judgment of the esthetic result. Besides, radiotherapy may also affect cosmesis, and it seems that there was a difference between the groups. Finally, one cannot avoid noticing that the oncoplastic group was heterogeneous from the technical point of view, with about two thirds of it being adjacent tissue transfer. As different oncoplastic techniques have different indications and complications (rates and types), it would be methodologically more accurate not to put all the oncoplastic procedures in the same pot. Besides, we feel that the oncoplastic techniques ‘‘not’’ studied here are the ones that actually deliver on the promise and are able to remove large cancers with breast conservation. Being strong supporters of oncoplastic surgery but having become devil’s advocates for the purposes of this article, we are looking forward to the authors’ comments. Demetrios Moris, M.D. Michael Kontos, M.D., Ph.D. First Department of Surgery, ‘‘Laikon’’ General Hospital, University of Athens, Athens 11474, Greece http://dx.doi.org/10.1016/j.amjsurg.2014.09.042
Reference 1. Tenofsky P, Dowell P, Topalovski T, et al. Surgical, oncologic, and cosmetic differences between oncoplastic and nononcoplastic breast conserving surgery in breast cancer patients. Am J Surg 2014;207:398–402.
Regarding: Long-term patient outcomes after surgical stabilization of rib fractures To the Editor: This letter is in regards to our recently published manuscript, ‘‘Long-term patient outcomes after surgical
0002-9610/$ - see front matter Ó 2015 Elsevier Inc. All rights reserved.
stabilization of rib fractures.’’1 In this descriptive study, we identified 101 patients who had surgical stabilization of severe rib fractures over a 31-month period between 2010 and 2012, and invited them to participate in a
©2015 Elsevier
