TeaM

Overview

Therapeutic mammaplasty (TM) extends the boundaries of breast-conserving surgery by combining breast reduction and mastopexy techniques with tumour excision, preserving a natural breast shape and avoiding the need for mastectomy in some patients. In recent years the technique has rapidly grown in popularity in the UK however its current prevalence and success rate are unknown. Furthermore there is a lack of robust evidence in the literature to support the technique. The TeaM study is a multicentre prospective audit that aims to describe the practice and outcomes of TM, measuring against ABS and BAPRAS standards where applicable.  The study uses a research collaborative model involving both breast and plastic surgeons. Anonymised data is collected using REDCap and includes patient demographics, tumour characteristics, operative details, pathology, post-operative outcomes and 30 day complications. Projected recruitment is 500 patients, data collection started in September 2016 and will end on 30th June 2017. It is anticipated to be the largest study of TM worldwide to date.

Objectives

• To identify the number of units performing TM across the UK and the volumes of procedures performed
• To describe the current practice of therapeutic mammaplasty (TM) including the indications and techniques used
• To evaluate the clinical outcomes of TM using different techniques and explore predictors of adverse outcome
• To determine the impact of TM on the delivery of adjuvant therapy
• To determine best practice with regards to TM with a view to generating national guidelines
• To establish a network of units performing TM willing and able to participate in future research studies
• To inform the feasibility, design and conduct of a prospective multi-centre cohort study exploring the clinical, patient-reported and oncological outcomes of TM

Inclusion criteria

• All female patients over the age of 16 undergoing a therapeutic mammaplasty defined as the application of breast reduction or mastopexy techniques including removal of skin to reduce the skin envelope to treat invasive or pre-invasive (DCIS) breast cancer using BCS will be eligible for inclusion in the study. 
• This will include any of the following techniques, performed using appropriate glandular or dermoglandular pedicles at the time of tumour removal including the removal of skin to simultaneously reduce the skin envelope: 

• Wise pattern, ‘inverted T’ or inverted anchor reduction patterns
  Single vertical scar or LeJour reduction mammaplasty techniques
• Benelli mastopexy
• Round block or donut techniques with excision of skin (see figure)
• Grisotti flaps for central cancers removing the nipple
• Melon-slice or horizontal wedge excision with or without nipple preservation