Retrospective review of 108 breast reconstructions using the round block technique after breast-conserving surgery: Indications, complications, and outcomes

Abstract

Background Several oncoplastic approaches have been implemented in recent years to enhance cosmetic results and to reduce complications. The round block technique is a volume displacement technique for breast reconstruction after breast-conserving surgery (BCS). However, its indications are currently limited according to tumor location, and its cosmetic results and complications have not been clearly established. We hypothesized that the round block technique could produce favorable cosmetic results without major complications regardless of tumor location or nipple-tumor distance, below a certain resected tumor volume and tumor-breast volume ratio.Methods All breast reconstructions using the round block technique after BCS were included in this analysis. Patients’ data were reviewed retrospectively to investigate complications during follow-up, and clinical photos were used to evaluate cosmetic results. The relationships of tumor location, nipple-tumor distance, tumor volume, and the tumor-breast volume ratio with cosmetic results were investigated.Results In total, 108 breasts were reconstructed. The mean resected tumor volume was 30.2±15.0 mL. The cosmetic score was 4.5±0.6 out of 5. Tumor location, nipple-tumor distance, tumor volume, tumor-breast volume ratio, radiotherapy, and chemotherapy had no significant effects on cosmetic results or complications. There were no major complications requiring reoperation.Conclusions Breast reconstruction using the round block technique after BCS can lead to good cosmetic results without major complications regardless of the tumor location, nipple-tumor distance, radiotherapy, or chemotherapy. Below the maximum tumor volume (79.2 mL) and the maximum tumor-breast volume ratio (14%), favorable results were consistently obtained.

Review of 107 Oncoplastic Surgeries Using an Acellular Dermal Matrix with the Round Block Technique

“…During the study period, 158 reconstructions were performed after BCS; 68% of the patients used the ADM, and RBT reconstruction without the ADM was performed for the rest. In a previous study, there was no significant difference in the incidence of complications (present study, 13.0%, vs. the previous study, 11.1%), and cosmetic complications were much lower (5.6% vs. 15.7%) [ 18 ]. Additionally, although it was difficult to solve depression deformity during breast lower pole reconstruction with RBT alone, much better cosmetic results were obtained by performing an additional ADM graft ( Figure 6 ).…”

“…All seroma complications were resolved with 2–3 aspirations without reoperation; only one patient required aspiration once a week for a month. It was found that seroma occurred in 6.5% of RBT reconstruction without the ADM in another study; therefore, it was confirmed that a large number of seromas occurred when the ADM was used [ 18 ]. When two ADMs were used, the incidence of seroma was significantly higher than that when one ADM was used.…”

“…In western women with excised volume measuring less than 20%, satisfactory cosmetic results can be achieved with glandular reshaping, and in the case of small to moderate breast sized Asian women, the patient who underwent glandular tissue reshaping with the ratio of the tumor specimen weight to breast volume of 0.12 g/mL (mean excise breast weight; 40.46 g) showed cosmetically satisfactory results [ 16 , 17 ]. In particular, the RBT is generally used when the tumor is close to the nipple, located on the upper or outer side, or when the resection volume is <100 g; however, a recent study reported good cosmetic results regardless of tumor location [ 3 , 4 , 18 ]. Our method can also be performed in all locations, and an ADM graft is performed when the breast volume is small or when it is difficult to maintain the contour with only local tissue rearrangement in intraoperative findings (e.g., IMF retraction, depression deformity).…”

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

“…It was noticed that, in most of the studies, the round block technique was done and more suitable to tumors located in the upper quadrants. After reviewing, Ogawa [15] and Kyung In et al, [24] both didn't prefer the Round Block or the Modified Round Block for the lower quadrants, especially if the tumor-breast ratio is high, as it affects the cosmetic result negatively. Also, if the excised volume is more than 25%, it's better to combine the RBT or the MRBT with other techniques to achieve a better cosmetic outcome.…”

Correlation between Collagen Type I/III Ratio and Scar Formation in Patients Undergoing Immediate Reconstruction with the Round Block Technique after Breast-Conserving Surgery

“…All patients included in the study underwent immediate RBT breast reconstruction after breast-conserving surgery using the areola circumference incision method as described by Kim et al in 2020 [ 19 ]. After drawing two concentric circles centered on the nipple, breast-conserving surgery was performed by making a semicircular incision along the arc where the breast cancer was located, and the breast was reconstructed through a glandular advancement flap around the site of the removed tumor.…”