Oncoplastic Techniques for Early Upper Inner Quadrant Breast Cancer; A Comparative Study Between Inferior Pedicle Mammaplasty and Doughnut Mastopexy

Abstract

Background: Breast conserving treatment (BCT) has become the standard treatment in early breast cancer; its goal is to provide a treatment as effective as mastectomy with the added benefit of a preserved breast. However, it is sometimes difficult to achieve good cosmetic results, particularly in patients with breast cancer located in the upper inner quadrant, for which the traditional conservative surgery results in a deformed breast. Aim of the work: To compare prospectively the oncoplastic results of inferior pedicle mammaplasty and doughnut mastopexy as techniques for early breast cancers located at the upper inner quadrant. Patients and Methods: This is a prospective randomized study on twenty female patients who were diagnosed to have early breast cancer located in the upper inner quadrant and are candidates for oncoplastic breast surgery. The study was conducted at Ain Shams University Hospitals. Approval of the Ethical Committee and written informed consent from all participants were obtained. Patient selection was achieved through a number of inclusion and exclusion criteria. Results: There is significant difference between the two groups as regards the operative time, intraoperative blood loss, hospital stay, total drainage volume, drainage days, postoperative complications, cosmetic outcome and the need for contralateral symmetrization. Inferior pedicle mammaplasty needs longer operative time and postoperative hospital stay and drainagy days with more intraoperative blood loss in comparison to Doughnut mastopexy. As regards the postoperative complications, we found that there are more complications in Inferior pedicle mammaplasty than Doughnut mastopexy as wound wound infection and dehiscence. Conclusion: Patients with early breast cancer located in the upper inner quadrant are candidate for either Inferior pedicle mammaplasty or Doughnut mastopexy. Doughnut mastopexy is better for them as there is less morbidity, better cosmesis, no need for contralateral symmetrization and fewer complications, so no delay in radiotherapy and Inferior pedicle mammaplasty needs more surgeon experience.

Round Block Technique in the Management of Breast Cancer, Meta-Analysis Study

“…This check list included: the overall shape of the breast, the symmetry of both breasts, the site and direction of the nipple, the volume of the breast and the skin incision shape. 80% of patients had excellent cosmetic while 20% had good cosmetic outcome [19] .…”

“…On reviewing the hospital stays, it was nearly 2 days except in the work of Mohsen et al, [10] who showed increase in the stay for about 3.5 days because patients with chronic illness or morbid obesity were admitted 1 or 2 days before surgery. While operation duration was reported to be about 120 minutes in average, except El Atrash et al 19 and Abdl Rahman et al, [22] who showed an increase in the operative time up to 170 minutes and 165 minutes respectively. This is may be attributed to the early surgeon's learning curve for the procedure.…”

“…The overall percentage from pooled data is 82.5% (95% CI: 75.6% -87.8%). El Atrash et al, [19] achieved 100% satisfaction with cosmetic results for patients. Patients who were satisfied had an either an excellent or a good cosmetic result on the scales used in that studies.…”

“…Patients who were satisfied had an either an excellent or a good cosmetic result on the scales used in that studies. The aesthetic outcome score in El Atrash et al, [19] was by a score based on multiple items that made up a check list to be evaluated by the team and the Multi-Disciplinary Team (MDT) of the breast for every single case. This check list included: the overall shape of the breast, the symmetry of both breasts, the site and direction of the nipple, the volume of the breast and the skin incision shape.…”

“…Unquestionably, achieving tumor-free resection margins is the most important in any cancer surgery. Four studies of El Atrash et al [19] , Abdl rahman et al [22] , Ahmed et al [23] and Kyung In et al [14] mentioned that there were no positive margins after excision of the tumor in their studies. The highest percentage for positive margin was mentioned by Bramhall et al, with 34.3%.…”