Surgical Techniques for Personalized Oncoplastic Surgery in Breast Cancer Patients with Small- to Moderate-Sized Breasts (Part 2): Volume Replacement

Abstract

Oncoplastic breast surgery has become a popular choice of treatment for breast reconstruction after mastectomy. There are two different techniques in oncoplastic surgery depending on the volume of the excised breast tissue. One is the volume displacement procedure, which combines resection with a variety of different breast-reshaping and breast-reduction techniques; the other is the volume replacement procedure in which the volume of excised breast tissue is replaced with autologous tissue. In this study, current authors performed various volume replacement techniques based on the weight of the excised tumor and its margin of resection. We used a latissimus dorsi myocutaneous flap for cases in which the resection mass was greater than 150 g, and for cases in which the resection mass was less than 150 g, we used a regional flap, such as a lateral thoracodorsal flap, a thoracoepigastric flap, or perforator flaps, such as an intercostal artery perforator flap or a thoracodorsal artery perforator flap. In the patients with small to moderate-sized breasts, when a postoperative deformity is expected due to a large-volume tumor resection, the replacement of non-breast tissue is required. Many of whom have small breasts, oncoplastic volume replacement techniques in breast-conserving surgery allow an extensive tumor excision without concern of compromising the cosmetic outcome and can be reliable and useful techniques with satisfactory aesthetic results.

The effectiveness of simultaneous oncoplastic breast surgery in patients with locally advanced breast cancer

“…The esthetic results of surgery can be improved by removing less breast tissue after NACT, and shrinking the tumor and preserving the breast skin simplifies breast reconstruction [7,8]. However, esthetic problems resulting from BCS need to be improved [9]. Removing 20 % of the breast volume decreases breast aesthetics [7,9].…”

“…However, esthetic problems resulting from BCS need to be improved [9]. Removing 20 % of the breast volume decreases breast aesthetics [7,9]. A wide section of the breast may need to be removed in LABC, and the glandular defect that may form can jeopardize the aesthetics.…”

A Comparison Between Oncoplastic Breast Conserving Surgery andStandard Wide Local Excision: A UK Experience

“…An average tumor size of 32 mm in a series of 101 therapeutic mammoplasties was reported by the former study, while the latter reported an average size of 23.9 mm in 37 OPS patients. Similarly, previous studies have reported specimen weights for therapeutic mammoplasty ranging from 222-236 g [1,17]. In relation to the operative times, those patients who underwent a wide local excision (WLE group) spent a shorter time in theatre compared to those who underwent oncoplastic surgery (OPS).…”

The Role of Oncoplastic Breast Surgery in Breast Cancer Treatment

“…The skin defect is also replaced. A similar technique, myosubcutaneous LD flap (mini LD flap) fills in the defect with LD flap, the skin is not transferred in this technique (5,26). Endoscopic LD mini flap applications are being developed with access sites from the breast and axilla (27).…”

“…Despite advances in surgical techniques, positive margin rates in breast cancer following BCS is reported as 20-30% (4,5). The rate of aesthetic problems in conservative surgery that are not amenable for surgical correction have been reported as 30% (6).…”