Determining the Optimal Approach to Breast Reconstruction after Partial Mastectomy

Kronowitz, Steven J.; Feledy, Jules A.; Hunt, Kelly K.; Kuerer, Henry Mark; Youssef, Adel; Koutz, Cindy A.; Robb, Geoffrey L.

doi:10.1097/00006534-200609010-00051

Cited by 102 publications

(37 citation statements)

References 6 publications

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“…The choice of oncoplastic technique was based on the location of the tumor. 1,2 For tumor in the upper outer or upper central quadrant, a reverse fish-hook-shaped skin incision was designed to facilitate an inferiorbased dermoglandular rotation flap ( Figure 1A). For tumor in the upper inner or lower quadrant, a fish-hook-shaped skin incision was designed to facilitate a superior-based dermoglandular rotation flap ( Figure 2A).…”

Section: Surgical Techniquementioning

confidence: 99%

Dermoglandular rotation flap with subaxillary advancement flap as an oncoplastic technique for breast cancer

2020

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We propose a novel oncoplastic surgical technique, dermoglandular rotation flap with subaxillary advancement flap, as a feasible one‐stage operation. Breast conserving surgery, incorporating the dermoglandular rotation flap with subaxillary advancement flap, was performed in 49 female patients with breast cancer, between January and December 2015. After a full‐thickness fibroglandular resection including the tumor, an inferior‐ or a superior‐based rotation flap was performed according to the location of the defect. The subaxillary flap consisted of skin, dermis, and subcutaneous fat tissue and was mobilized from the chest wall musculature. Since subaxillary skin has greater redundancy, it can be easily moved to reach the lateral aspect of the breast. Approximation of the subaxillary flap to the lateral side of rotated dermoglandular flap served to relieve skin tension and avoid displacement of the nipple‐areola complex (NAC). Consequently, there was wider dermoglandular tissue rotation and efficient filling of defect without any significant postoperative deformity. The mean follow‐up period was 46.5 ± 3.1 months (range, 42.4‐52.1 months). Mean tumor size, on pathology, was 2.1 cm (range, 0.4‐6.0). Mean excised breast tissue weight was 78.4 g (range, 28.6‐195.0). More than half of the patients (51%) studied had excised breast tissue weighing more than 80 g. None of the included patients had positive surgical margins in final pathologic reports. Most patients answered excellent or good for self‐estimated cosmetic outcomes including symmetry of the breast and NAC, breast shape, scarring, and overall satisfaction. A modified dermoglandular rotation flap technique along with subaxillary advancement flap is a feasible and effective oncoplastic technique for breast cancers.

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Section: Surgical Techniquementioning

confidence: 99%

Dermoglandular rotation flap with subaxillary advancement flap as an oncoplastic technique for breast cancer

2020

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“…3,4 These targets are easy to obtain when lesions to be treated are under 2 cm, in medium-large breasts or if the rate of gland to be removed does not exceed 20% of the whole breast. 5,6 Nevertheless, in routine clinical practice, these conditions do not always occur and up to 85% of BCS patients are reported to suffer from physical imperfections that frequently result in considerable psychological repercussions. 5,[7][8][9] In order to broaden the possibilities of conservative surgery and reduce these risks, our group was among the first to introduce and develop techniques that were named "Oncoplastic Surgery" (OPS) 10,11 masterfully codified by Dr. Clough and the Paris Breast Center.…”

mentioning

confidence: 99%

Results obtained with level II oncoplastic surgery spanning 20 years of breast cancer treatment: Do we really need further demonstration of reliability?

et al. 2019

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Oncoplastic surgery (OPS) has demonstrated its superiority above traditional breast conserving surgery, but is still struggling to consolidate its role in breast cancer therapeutic protocols mainly because of contrasting scientific evidences and reduced follow‐up results available. The objective of our contribution is to analyze results obtained with 381 patients consecutively treated in our Multidisciplinary Breast Center by means of level II OPS between January 1998 and January 2018 for unilateral, primary breast cancer. Surgical endpoints were mean specimen weight and volume, mean diameter of main lesion (MLD), rates of positive margins (PMR), re‐excision (RR), conversion to mastectomy (CMR), complications (CR) and oncological endpoints as overall survival (OS), disease‐free survival (DFS), and local recurrence rate (LR). About 29.1% were treated for multifocal/multicentric disease, and 29.1% previously underwent neo‐adjuvant chemotherapy (NACT). Regarding surgical techniques, 53.0% of patients received “inverted T” and 30.1% “J” mammoplasties, whereas 13.6% underwent “round block,” 2.3% “Grisotti,” and 1% “batwing” techniques. Regarding surgical outcomes, mean specimen weight was 215 g (50‐2157) and volume 345 mm3 (21‐7980). MLD 23 mm, PMR 7.6%, RR 3.6%, CMR 1.6%, and CR 5.8%. With a mean follow‐up of 118 months, oncological outcomes were: OS 93.7%, DFS 82.3%, LR 4.4%. In conclusion, our analysis confirmed level II OPS reliability even for longer follow‐up timing and in difficult situations as multifocal disease or after NACT.

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“…25,26 The former approach may violate guidelines, 20 while the latter are reported to have higher complication rates than techniques with direct parenchymal closure. 14,27 The surgical approach used in this study differs in essentials from double lumpectomy and conventional oncoplastic techniques. All patients who underwent BCT had en bloc multiple tumour excisions through a single incision, followed by local tissue arrangement procedures.…”

Section: Discussionmentioning

confidence: 99%

“…[9][10][11][12] Chinese women have been shown to have smaller breast volume (SVB) tissue, 13 posing challenges for good cosmetic outcomes with BCT. 14 The presence of ipsilateral multifocal and multicentric breast cancers (MFMCBC) compounds these challenges. The lower initial parenchymal volume serves as a barrier for the provision of adequate retained tissue to achieve a reasonable postsurgical cosmetic outcome following multiple tumour excisions.…”

Section: Introductionmentioning

confidence: 99%

Breast conservation treatment for multifocal and multicentric breast cancers in women with small‐volume breast tissue

Tan¹,

Sitoh

Sim³

2014

ANZ Journal of Surgery

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Determining the Optimal Approach to Breast Reconstruction after Partial Mastectomy

Cited by 102 publications

References 6 publications

Dermoglandular rotation flap with subaxillary advancement flap as an oncoplastic technique for breast cancer

Dermoglandular rotation flap with subaxillary advancement flap as an oncoplastic technique for breast cancer

Results obtained with level II oncoplastic surgery spanning 20 years of breast cancer treatment: Do we really need further demonstration of reliability?

Breast conservation treatment for multifocal and multicentric breast cancers in women with small‐volume breast tissue

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