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IntroductionTherapeutic mammoplasty (TM) is a type of oncoplastic breast surgery (OBS) well suited to breast cancers in medium-large sized breasts with ptosis, and in some cases of large or multifocal/Multicentric (MF/MC) tumors. It includes contralateral symmetrisation. This report describes our experiences and outcomes of TM in breast cancer patients in a single institutional cohort in India.MethodsWe present data for 207 cases (194 breast cancer, 13 benign disease) who underwent TM as part of their primary treatment. All patients underwent surgery after careful analysis of feasibility by a multidisciplanary tumor board and patient counselling. We report the clinicopathological profiles, surgical and oncological outcomes, and patient related outcome measures (PROMs) with different TM surgical procedures.ResultsPatients were relatively young at a median age of 49 years with moderate-large breasts and grade II-III ptosis. Patients underwent simple (n=96), complex (n=79) or extreme TM (n=46). Low post-operative complication rates and good-excellent cosmetic scores were observed. With median follow-up of 26 months, 148 patients completed more than 1 year follow-up. The 1-year BREAST-Q PROMs revealed good-to-excellent scores for all types of therapeutic mammoplasty.ConclusionWe conclude that in a country where women present with large and locally advanced tumours, TM safely expands the indications for breast conservation surgery. PROMs scores show that this surgery is perceived to be physically and mentally satisfactory. With the popularization of this procedure, it is possible that more Indian patients with breast cancer will receive the benefits of breast conservation while maintaining their quality of life.

Immediate breast reconstruction surgery (IBRS) with a sub-pectoral placement of implant improves quality of life of patients undergoing a mastectomy. Implant-based IBRS with autologous lower dermal sling (ALDS) procedure provides an effective surgical alternative to acellular dermal matrices. However, the influence of this procedure on radiation therapy (RT) outcomes remains unclear. This study aims at investigating post-surgery complications after 1 year in patients who have undergone IBRS-ALDS and RT. In this single-institution retrospective study, 78 implant-based IBRS patients with data available for a minimum of 1-year follow-up were stratified into group A (n = 40; IBRS) and group B (n = 38; IBRS + RT). Based on the use of ALDS procedure, group A patients were further stratified into sub-groups A1 (conventional IBRS; n = 21) and A2 (ALDS-IBRS; n = 19). Similarly, group B patients were sub-stratified into sub-groups B1 (conventional IBRS + RT; n = 18) and B2 (ALDS-IBRS + RT; n = 20). Clinical assessment and patient-reported outcome measures (PROMs) after 1-year post-surgery were conducted using Baker classification and BREAST-Q questionnaire, respectively. Patients in sub-group B1 exhibited higher percentages of overall major complications (41.6%) when compared to sub-group B2 (8.2%). Capsular contracture (12.5%) and reconstruction failure (20.8%) rates were higher for sub-group B1 vis-a-vis sub-group B2. Superior breast reconstruction outcomes with psycho-social well-being were observed in group B patients in comparison to group A (p

Purpose Breast cancer is the most common cancer in India, affecting all socio-economic strata. Despite its growing global acceptance, Breast Oncoplasty Surgery (BOS) remains nascent in India, necessitating local context-specific innovative delivery models for clinicians and the general public. Here, we present experiences from Orchids Breast Health Clinic (OBHC; Pune, India) with the implementation of BOS clinical services, training, and research and community outreach. Methods OBHC, a dedicated breast unit, has established the first dedicated BOS clinic in India, conducted hands-on training workshops for trainee surgeons, developed an MCh degree program in breast oncoplasty with the University of East Anglia (Norwich, United Kingdom), undertaken BOS research in Indian patients, and created outreach programs to popularize BOS. Results A cost-effective one surgeon–dual role concept wherein the same surgeon performs onco- and plastic surgery and one-stage implant-based breast reconstruction has been adopted. Since 2013, BOS cases included BCS (n = 440), breast reconstruction (n = 210), and therapeutic mammoplasty (n = 135). The unavailability of acellular dermal matrices has prompted the innovation of a surgical technique, termed Advanced Autologous Dermal Sling, which uses vascularized local tissue as implant cover. Significant improvement in postsurgery outcomes and protection against radiation complications has been observed. BOS hospitalization costs have been reduced by 50% thereby, which has led to high rates of acceptance (80%) of BOS in patients at OBHC. Young breast surgeons from across India and South Asian Association for Regional Cooperation countries have enrolled in the MCh degree program, which involves an embedded curriculum with online didactic modules and hands-on training workshops in Pune, India. Longitudinal follow-up after 1, 3, and 5 years postsurgery in the study cohorts is undertaken for post-BOS outcomes using clinical assessment (Bakers scale) and patient-reported outcomes measures (BREAST-Q questionnaire). Multiple research projects are undergoing peer-review before publication. To increase awareness of BOS among Indian women, community awareness campaigns with the theme of Losing Is Not an Option are underway via public talks, symposia, marathon, and op-eds in electronic and print media. Conclusion The OBHC model of Affordable Excellence in BOS, developed in the Indian context, can be extrapolated to benefit patients with breast cancer from other low- and middle-income countries. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/jco/site/ifc . No COIs from the authors.

Breast Cancer (BC) treatment leads to mutilation and destruction of breast shape with negative effects on body image and self-esteem.One of the main goals of reconstructive and oncoplastic breast surgery is to satisfy patients and improve their quality of life (QoL).Therefore, it is important to assess the patient experience post-surgery by means of patient-reported outcome measures (PROMs) that focus on the patient’s perception of the surgery and surgical care, as well as psychosocial well-being and physical functioning. The objective of the current study was to identify predictors of patient satisfaction such as breast appearance including implant type in a selective sample of women who underwent breast reconstruction surgery using implants. Participants in this prospective study were women, (age 26–75 years) that were newly diagnosed with breast carcinoma. All consecutive patients who underwent breast reconstruction between January 2013 and October 2014 were asked to complete the BREAST-Q questionnaire 1 year after surgery. 120 patients underwent unilateral breast reconstruction using implant. While 38 patients underwent reconstruction with opposite breast reduction symmertization, 27 patients underwent therapeutic mammoplasty. The response rate for BREAST-Q questionnaire completion was 98 % with 147 out of 150 study participants completed the questionnaire. From the data collected from 147 patients, the responses could be distributed into 4 distinct groups based on the reconstruction outcomes namely “very much satisfied” (93 %) or “definitely and mostly satisfied” (94 %) or “satisfied” with the outcome (88 %) or “definitely agree on having reconstruction rather than the alternative of having no breast “(91 %).The results showed significant improvement in all four areas that were evaluated after surgery namely satisfaction with the appearance of the breasts, psychosocial, sexual and physical well-being. While the reconstruction surgery had an overall positive impact on quality of life it was observed that in patients that did not undergo breast reconstruction psychological issues related to sexuality were observed. Many newly diagnosed BC patients do not opt for these new surgical procedures due to psychological trauma or lack of information. Based on these observations, we propose that Breast Cancer Management protocols should also include additional counselling support for the newly diagnosed BC patients on the option of breast reconstruction along with conventional medical treatment counselling by the Oncosurgeon.