TeaM
TeaM results accepted for publication
The TeaM results paper has been published in the British Journal of Surgery.26-08-2018
UPDATE: 19/07/2017
Recruitment closed on 30th June 2017. Final data entry is underway. There are currently 729 records in the system. Well done to everyone involved!
Certificates will be issue to collaborators once the final data have been verified during autumn 2017.
UPDATE: 21/11/2016
Elizabeth Baker presented an update at the iBRA3 Study Day.
46 centres are participating. To date 37 patients have been entered into REDCap.
Recruitment will continue to the end of February. Units can still join the study.
Background
Breast conserving surgery (BCS) and adjuvant radiotherapy is an established treatment for early breast cancer. While many women may prefer breast conservation to mastectomy, in many cases, standard BCS may result in unacceptable cosmetic outcomes which may adversely impact on patient satisfaction and quality of life. Therapeutic mammaplasty (TM) describes ‘the oncoplastic application of breast reduction and mastopexy techniques to treat selected breast cancers by breast conserving surgery (BCS)’. These techniques effectively extend the boundaries of traditional BCS by allowing adequate resection of larger tumours in women with medium to large breasts without compromising cosmetic outcome; provide an alternative to mastectomy +/- reconstruction in those with ptotic breasts and may improve outcomes for women with large breasts in whom standard BCS followed by radiotherapy may be associated with lymphoedoema, fibrosis and chronic pain.
Despite the widespread adoption of these techniques into routine practice, there is limited high-quality evidence to support benefits of this approach. TM procedures are more complex than standard BCS with significant associated resource implications and concerns have been raised regarding both complication rates and oncological safety when TM is performed. Although these concerns are not supported by the literature, the majority of published studies are small, retrospective single centre, often single surgeon case series with limited follow-up that are poorly designed and reported with inconsistent end-points that limit cross-study comparison such that the findings cannot be relied upon. Two recent systematic reviews have highlighted the paucity of high-quality clinical, oncological and cosmetic outcome data and emphasised the urgent need for well-designed prospective studies to establish the indications and outcomes of therapeutic mammaplasty to determine best practice. Uncertainties relating to the current indications for TM including the practice and outcomes of TM in large tumours (>4cm) not traditional managed by BCS; rates and management of margin positivity; predictors of adverse outcomes; the impact of TM on delivery of adjuvant therapy and appropriate assessment of key patient reported outcomes including, but not limited to, aesthetic end-points, as well as long term data on recurrence rates in particular need to be addressed if the procedure is to be offered and bench-marked appropriately.
Although RCTs provide the best evidence for the effectiveness of an intervention, trials are largely inappropriate in this context. A high-quality prospective multicentre cohort study exploring the practice and outcomes of these techniques is therefore essential to support the safe practice of TM, generate guidelines, guide decision-making and inform health policy.
Aims and objectives
i. To identify the number of units performing TM across the UK and the volumes of procedures performed
ii. To describe the current practice of therapeutic mammaplasty (TM) including the indications and techniques used
iii. To evaluate the clinical outcomes of TM using different techniques and explore predictors of adverse outcome.
iv. To determine the impact of TM on the delivery of adjuvant therapy
v. To determine best practice with regards to TM with a view to generating national guidelines
vi. To establish a network of units performing TM willing and able to participate in future research studies
vii. To inform the feasibility, design and conduct of a prospective multicentre cohort study exploring the clinical, patient-reported and oncological outcomes of TM.
ST8 Breast Surgery
Miss Lisa Brock
Research Co-ordinator
Nottingham Breast Institute
Ms Patricia Fairbrother
Independent Cancer Patients’ Voice
Patient Representative
Mr Matthew D. Gardiner
Specialist registrar, Plastic Surgery
Miss Charlotte Ives
ST8, Breast Surgery
Penninsula Deanery
Professor Chris Holcombe
Professor of Breast Surgery
Royal Liverpool Hospital
ABS Academic and Research Committee Representative
Mr Abhilash Jain
RCS SSL in Plastic and Hand Surgery
Mr Baek Kim
ST6 Breast trainee
Yorkshire and the Humber Deanery
Mr R Douglas Macmillan
Consultant Oncoplastic Breast Surgeon
Nottingham Breast Institute
Mr John Murphy
Consultant Oncoplastic Breast Surgeon
University Hospital South Manchester
Miss Shelley Potter
Academic Clinical Lecturer
University of Bristol
Mr Tim Rattay
NIHR Doctoral Fellow
University of Leicester
Mr Dennis Remoundos
Consultant Oncoplastic Breast Surgeon
Oxford
Mr Richard Sutton
Consultant Oncoplastic Breast Surgeon
Royal United Hospital Bath
Mr Adam Trickey
Research Associate
School of Social and Community Medicine, University of Bristol
Statistician and methodology
Miss Kate Williams
National Oncoplastic Fellow
President, Mammary Fold
University Hospitals South Manchester
The TeaM Steering Group (in alphabetical order): R. Achuthan, S. Aggar- wal, E. Baker, N. Basu, L. Brock, P. Fairbrother, M. D. Gardiner, C. Hol- combe, C. Ives, A. Jain, B. Kim, R. D. Macmillan, J. Murphy, S. Potter, T. Rattay, D. Remoundos, R. Sutton, A. Trickey, P. Turton, K. Williams.
Local investigators (alphabetically by centre) and members of the Mammary Fold Academic and Research Collaborative:
C. MacLeod, E. Smyth, I. Depasquale, M. Fuller, N. Saeed, Y. Masannat (Aberdeen Royal Infir- mary, NHS Grampian); A. Tan Mohd-Amin, A. Agrawal (Addenbrooke’s Hospital, Cambridge Universities NHS Foundation Trust); G. Irwin, S. Sloan, S. Refsum, S. McIntosh (Belfast City Hospital, Belfast Health and Social Care Trust); A. Ibrahim, A. Sahu, S. Govindarajulu, S. Cawthorn (Breast Care Centre, Southmead Hospital, North Bristol NHS Trust, Bris- tol); A. Accurso (Breast Unit, University of Naples ‘Federico II’, Naples, Italy); R. Rathinaezhil (Brighton and Sussex University Hospitals NHS Trust); A. Wilkins, E. Khalifa, K. Grover, P. McManus, P. Kneeshaw, T. Mahapatra (Castle Hill Hospital, Hull and East Yorkshire Hospitals NHS Trust); I. Azmy, J. Massey (Chesterfield Royal Hospital NHS Foundation Trust); P. Trapszo, R. lane, S. Seetharam (Darent Valley Hospital, Dartford and Gravesham NHS Trust); N. Rocco (Department of Clinical Medicine and Surgery, University of Naples ‘Federico II’, Naples, Italy); C. Roshan- lall, J. Kokan, K. Amin (East Cheshire NHS Trust); A. Leeper, D. Kulkarni, J. M. Dixon, O. Young, T. Saleem (Edinburgh Breast Unit, Western Gen- eral Hospital, NHS Lothian); J. McIlhenny (Forth Valley Royal Hospital, NHS Forth Valley); A. Malyon, J. Mansell, K. Ogsto, L. Romics (Gartnavel General Hospital, NHS Greater Glasgow and Clyde); D. Dragoumis, J. Krupa, K. Valassiadou, K. Lambert, M. Kaushik, S. Shokuhi, S. Pilgrim, X. Wei, J. Lee (Glenfield Hospital, University Hospitals of Leicester); A. Al-Allak, C. Fowler, E. Massey, F. Court, R. Hunt, S. Vestey (Gloucester- shire Hospital NHS Foundation Trust); H. Khalil (Good Hope Hospital, Heart of England NHS Foundation Trust); M. Elgammal (Heatherwood and Wexham Park Hospital, Frimley Health NHS Foundation Trust); L. Parvanta (Homerton University Hospital NHS Foundation Trust); A. S. Sami, A. Gvaramadze, D. Thekkinkattil (Lincoln County Hospital, United Lincolnshire Hospitals NHS Trust); K. Kirkpatrick, R. James (Luton and Dunstable University Hospital); A. Noshirwani, T. Arif, Z. Kryjak (Mid Yorkshire Hospitals NHS Trust); A. Taylor, F. H. Syed, G. Safdar, K. Chin, R. Soulsby (Milton Keynes University Hospital NHS Foundation Trust); A. Thorne, F. Guest, M. El-Abbar (Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust); D. A. Munnoch, E. J. Macaskill, F. Hogg, P. McGee, V. Pitsinis (Ninewells Hopsital, NHS Tayside); J. Smith, S. Makkiyah, S. Mustafa (Northern Lincolnshire and Goole NHS Foun- dation Trust); C. Otieno, D. Photiou, D. Macmillan, E. Gutteridge, F. Mazari, G. Oni, H. Khout, J. Kelsall, K. Hallam, K. Asgeirron, L. Whisker, M. D’Auria, S. Al-zubaidi, S. McCulley, T. Rasheed, J. Bailey, L. Brock, N. Muhibullah (Nottingham Breast Institute, Nottingham University Hospi- tals NHS Trust); A. Tenovici, D.-D. Remoundos, N. Chaidos, O. Predescu, P. Roy, R. Windle (Oxford University Hospitals NHS Foundation Trust); E. Popa, G. Shetty, J. Rezulski, S. Goh, T. Abdullah (Peterborough City Hospital, North West Anglia NHS Foundation Trust); D. Thekkinkat- til (Pilgrim Hospital Boston, United Lincolnshire Hospitals NHS Trust); S. Khawaja, S. Udayasankar (Prince Philip Hospital, Hywel Dda Uni- versity Health Board); S. Tebbal, V. Grassi (Princess Alexandra Hospi- tal NHS Trust); A. Talbot, N. Basu, J. Singh (Queen Elizabeth Hospital). Birmingham, University Hospitals Birmingham NHS Foundation Trust); A. Smith, A. Volleamere, C. Garnsey, P. Pikoulas (Royal Bolton Hospi- tal, Bolton NHS Foundation Trust); C. Ives, D. Ferguson, R. Tillett, S. Dean, S. Olsen (Royal Devon and Exeter NHS Foundation Trust); R. M. Rainsbury, L. Peiris, O. Sjokvist, S. Laws (Royal Hampshire County Hos- pital, Hampshire Hospitals NHS Foundation Trust); A. Tansley, E. De Sousa, G. Mitchell, J. Henderson, M. Chandrashekar, S. Potter (Royal Liverpool and Broadgreen University Hospitals NHS Trust); A. Micha, A. Godden, B. Pereira, C. Constantinou, J. Rusby, K. Krupa, N. To, P. Barry (Royal Marsden NHS Foundation Trust); A. Critchley, B. Kim, H. Cain, J. O’Donoghue, J. Henton, L. Kalra, L. MacLennan, R. Bennett, S. Nicholson (Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust); G. Paolini, L. Francesco Renzi, S. Di Pompeo, V. Ria (Sant’Andrea Hospital of Rome); J. Hu, L. Johnson, R. S. Lewis, S. Hadad, S. Sundaramoorthy (St Bartholomew’s Hospital, Barts Health NHS Trust); A. Sharma, D. Toomey, D. Banerjee, S. Shuk Kay Tang (St George’s University Hospitals NHS Foundation Trust); L. Taylor, P. Tur- ton, R. Achuthan, S. McKenzie, T. Ahmad (St James’s University Hospital, The Leeds Teaching Hospitals NHS Trust); K. Williams, M. Absar, N. Nasir (The Pennine Acute Hospitals NHS Trust); I. Jerzy Rychlik, L. Dar- ragh, R. Johnston, S. Kirk (The Ulster Hospital, South Eastern Health and Social Care Trust); J. Rees-Lee, M. Green (Torbay and South Devon NHS Foundation Trust); A. Sharma, K. Chong, L. M. Lai (West Hert- fordshire Hospitals NHS Trust); J. Choong, S. Aggarwal, Z. Ullah (Whipps Cross University Hospital, Barts Health NHS Trust); L. Chagla, O. Koshy, S. Bathla, T. Kiernan, A. Ashok Bhojwani (Whiston Hospital, St Helens and Knowsley Teaching Hospitals NHS Trust); J. Lund, K. James, M. Callaghan, R. Vinayagam, S. Poonawala (Wirral University Teaching Hos- pital NHS Foundation Trust); J. Taylor, M. Mullan, R. Bright-Thomas (Worcestershire Acute Hospitals NHS Trust); A. Gandhi, G. Byrne, I. Ibrahim, J. Harvey, J. Murphy, L. Highton, A. Chrysafi, R. Hawley-Jones, N. Barnes, O. Morris, S. Chatterjee, V. Mathen, Y. Majeed, C. Kirwan (Wythenshawe Hospital, Manchester University NHS Foundation Trust); B. Mancey-Jones, D. El Sharief, K. Munot, R. Nasr, R. Frame (York Teach- ing Hospital NHS Foundation Trust).
Acknowledgements
R.D.M. and S.P. are joint senior authors of this article. The TeaM Steering Group acknowledges the con- tribution of the following individuals: E. Cowling, G. Lazaraviciute, R. Innes, S. Jamshidifard, T. Gardner (Aberdeen Royal Infirmary, NHS Grampian); I. Carty, S. Khan (Chesterfield Royal Hospital NHS Foundation Trust); P. Lampropoulos (Good Hope Hospital, Heart of England NHS Foundation Trust); S. Kaptanis (Homerton University Hospital NHS Foundation Trust); M. Youssef, M. Masood (Royal Devon and Exeter NHS Foundation Trust); L. MacLennan (Royal Victoria Infirmary, New- castle upon Tyne Hospitals NHS Foundation Trust); V.
Amorosi (Sant’Andrea Hospital of Rome).
Surgery Research Grant.
Publications
Study documents