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Götzl R, Boos AM, Beier JP. [Does it Always have to be the Abdomen? Alternative Flaps in Autologous Breast Reconstruction]. HANDCHIR MIKROCHIR P 2022; 54:339-348. [PMID: 35944537 DOI: 10.1055/a-1880-0927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
[English] Deep inferior epigastric artery perforator (DIEP) or muscle-sparing transverse rectus abdominis muscle (ms-TRAM) flaps remain the gold standard for autologous reconstruction in post-mastectomy patients, although many women may not be candidates for abdominally based free tissue transfer. In this scenario, there are several other donor site options based from the thigh (transverse and diagonal upper gracilis flaps, profunda artery perforator flap, lateral thigh flap), trunk (lumbar artery perforator flap), and buttock (superior and inferior gluteal artery perforator flaps). This article will provide insight into the history, relevant anatomy, surgical technique and novel applications (neurotization) for alternative flaps in autologous breast reconstruction.
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Affiliation(s)
- Rebekka Götzl
- Department of Plastic Surgery, Hand Surgery - Burn Center, University Hospital RWTH Aachen, Aachen, Germany
| | - Anja M Boos
- Department of Plastic Surgery, Hand Surgery - Burn Center, University Hospital RWTH Aachen, Aachen, Germany
| | - Justus P Beier
- Department of Plastic Surgery, Hand Surgery - Burn Center, University Hospital RWTH Aachen, Aachen, Germany
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2
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De La Cruz L, Blankenship SA, Chatterjee A, Geha R, Nocera N, Czerniecki BJ, Tchou J, Fisher CS. Outcomes After Oncoplastic Breast-Conserving Surgery in Breast Cancer Patients: A Systematic Literature Review. Ann Surg Oncol 2016; 23:3247-58. [DOI: 10.1245/s10434-016-5313-1] [Citation(s) in RCA: 159] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Indexed: 11/18/2022]
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Piper ML, Sbitany H. The Optimal Approach to Post-Mastectomy and Post-Lumpectomy Breast Reconstruction. CURRENT BREAST CANCER REPORTS 2016. [DOI: 10.1007/s12609-016-0210-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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4
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Yiannakopoulou E, Mathelin C. Oncoplastic breast conserving surgery and oncological outcome: Systematic review. Eur J Surg Oncol 2016; 42:625-30. [DOI: 10.1016/j.ejso.2016.02.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 01/02/2016] [Accepted: 02/02/2016] [Indexed: 10/22/2022] Open
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Struckmann V, Peek A, Wingenbach O, Harhaus L, Kneser U, Holle G. The free fasciocutaneous infragluteal (FCI) flap: Outcome and patient satisfaction after 142 breast reconstructions. J Plast Reconstr Aesthet Surg 2016; 69:461-9. [DOI: 10.1016/j.bjps.2015.12.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 12/21/2015] [Accepted: 12/22/2015] [Indexed: 02/05/2023]
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6
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Santos G, Urban C, Edelweiss MI, Zucca-Matthes G, de Oliveira VM, Arana GH, Iera M, Rietjens M, de Lima RS, Spautz C, Kuroda F, Anselmi K, Capp E. Long-Term Comparison of Aesthetical Outcomes After Oncoplastic Surgery and Lumpectomy in Breast Cancer Patients. Ann Surg Oncol 2015; 22:2500-2508. [DOI: 10.1245/s10434-014-4301-6] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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7
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Piper M, Peled AW, Sbitany H. Oncoplastic breast surgery: current strategies. Gland Surg 2015; 4:154-63. [PMID: 26005647 DOI: 10.3978/j.issn.2227-684x.2015.03.01] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 03/04/2015] [Indexed: 11/14/2022]
Abstract
The surgical management of breast cancer has dramatically evolved over the past 20 years, with oncoplastic surgery gaining increased popularity. This field of breast surgery allows for complete resection of tumor, preservation of normal parenchyma tissue, and the use of local or regional tissue for immediate breast reconstruction at the time of partial mastectomy. These techniques extend the options for breast conservation surgery, improve aesthetic outcomes, have high patient satisfaction and result in better control of tumor margins. This article will detail the approach to evaluating and treating patients undergoing oncoplastic reconstruction. Different oncoplastic approaches will be described and applied to an oncoplastic reconstructive algorithm. Surgical complications, oncologic outcomes and aesthetic outcomes are reviewed.
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Affiliation(s)
- Merisa Piper
- Division of Plastic & Reconstructive Surgery, Department of Surgery, University of California, San Francisco, CA, USA
| | - Anne Warren Peled
- Division of Plastic & Reconstructive Surgery, Department of Surgery, University of California, San Francisco, CA, USA
| | - Hani Sbitany
- Division of Plastic & Reconstructive Surgery, Department of Surgery, University of California, San Francisco, CA, USA
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Munhoz AM, Montag E, Gemperli R. Oncoplastic breast surgery: indications, techniques and perspectives. Gland Surg 2014; 2:143-57. [PMID: 25083476 DOI: 10.3978/j.issn.2227-684x.2013.08.02] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Accepted: 08/20/2013] [Indexed: 11/14/2022]
Abstract
Breast-conservation surgery (BCS) is established as a safe option for most women with early breast cancer. Recently, advances in oncoplastic techniques have reduced surgical trauma and thus are capable of preserving the breast form and quality of life. In spite of the most BCS defects can be managed with primary closure, the aesthetic outcome may be unpredictable. Oncoplastic reconstruction may begin at the time of BCS (immediate), weeks (delayed-immediate) or months to years afterwards (delayed). With immediate reconstruction, the surgical process is smooth, since both procedures can be associated in one operative setting. Additionally, it permits wider excision of the tumor, with a superior mean volume of the specimen and potentially reducing the incidence of margin involvement. The oncoplastic techniques are related to volume displacement or replacement procedures including local flaps, latissimus dorsi myocutaneous flap and reduction mammaplasty/masthopexy. Regardless of the fact that there is no consensus concerning the best approach, the criteria are determined by the surgeon's experience and the size of the defect in relation to the size of the remaining breast. On the basis of our 15-year experience, it is possible to identify trends in types of breast defects and to develop an algorithm for immediate BCS reconstruction on the basis of the initial breast volume, the extent/location of glandular tissue ressection and the remaining available breast tissue. The main advantages of the technique utilized should include reproducibility, low interference with the oncologic treatment and long-term results. Surgical planning should include the patients's preferences, and chiefly addressing individual reconstructive requirements, enabling each patient to receive an individual "custom-made" reconstruction.
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Affiliation(s)
- Alexandre Mendonça Munhoz
- 1 Plastic Surgery Division, Hospital Sírio-Libanês, São Paulo/ Brazil ; 2 Breast Reconstruction Group, University of São Paulo School of Medicine, Brazil ; 3 Division of Plastic Surgery, University of São Paulo School of Medicine, Brazil
| | - Eduardo Montag
- 1 Plastic Surgery Division, Hospital Sírio-Libanês, São Paulo/ Brazil ; 2 Breast Reconstruction Group, University of São Paulo School of Medicine, Brazil ; 3 Division of Plastic Surgery, University of São Paulo School of Medicine, Brazil
| | - Rolf Gemperli
- 1 Plastic Surgery Division, Hospital Sírio-Libanês, São Paulo/ Brazil ; 2 Breast Reconstruction Group, University of São Paulo School of Medicine, Brazil ; 3 Division of Plastic Surgery, University of São Paulo School of Medicine, Brazil
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9
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Munhoz AM, Montag E, Gemperli R. Current aspects of therapeutic reduction mammaplasty for immediate early breast cancer management: An update. World J Clin Oncol 2014; 5:1-18. [PMID: 24527398 PMCID: PMC3920176 DOI: 10.5306/wjco.v5.i1.1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2013] [Revised: 11/02/2013] [Accepted: 11/16/2013] [Indexed: 02/06/2023] Open
Abstract
Breast-conservation surgery (BCS) is established as a safe surgical treatment for most patients with early breast cancer. Recently, advances in oncoplastic techniques are capable of preserving the breast form and quality of life. Although most BCS defects can be managed with primary closure, the aesthetic outcome may be unpredictable. Among technical options, therapeutic reduction mammaplasty (TRM) remains a useful procedure since the BCS defect can be repaired and the preoperative appearance can be improved, resulting in more proportional breasts. As a consequence of rich breast tissue vascularization, the greater part of reduction techniques have based their planning on preserving the pedicle of the nipple-areola complex after tumor removal. Reliable circulation and improvement of a conical shape to the breast are commonly described in TRM reconstructions. With an immediate approach, the surgical process is smooth since both procedures can be carried out in one operative setting. Additionally, it permits wider excision of the tumor, with a superior mean volume of the specimen and potentially reduces the incidence of margin involvement. Regardless of the fact that there is no consensus concerning the best TRM technique, the criteria is determined by the surgeon’s experience, the extent/location of glandular tissue resection and the size of the defect in relation to the size of the remaining breast. The main advantages of the technique utilized should include reproducibility, low interference with the oncological treatment and long-term results. The success of the procedure depends on patient selection, coordinated planning and careful intra-operative management.
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From radical mastectomy to breast-conserving therapy and oncoplastic breast surgery: a narrative review comparing oncological result, cosmetic outcome, quality of life, and health economy. ISRN ONCOLOGY 2013; 2013:742462. [PMID: 24167743 PMCID: PMC3791839 DOI: 10.1155/2013/742462] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Accepted: 07/30/2013] [Indexed: 11/22/2022]
Abstract
Surgical management of breast cancer has evolved considerably over the last two decades. There has been a major shift toward less-invasive local treatments, from radical mastectomy to breast-conserving therapy (BCT) and oncoplastic breast surgery (OBS). In order to investigate the efficacy of each of the three abovementioned methods, a literature review was conducted for measurable outcomes including local recurrence, survival, cosmetic outcome, quality of life (QOL), and health economy. From the point of view of oncological result, there is no difference between mastectomy and BCT in local recurrence rate and survival. Long-term results for OBS are not available. The items assessed in the QOL sound a better score for OBS in comparison with mastectomy or BCT. OBS is also associated with a better cosmetic outcome. Although having low income seems to be associated with lower BCT and OBS utilization, prognosis of breast cancer is worse in these women as well. Thus, health economy is the matter that should be studied seriously. OBS is an innovative, progressive, and complicated subspeciality that lacks published randomized clinical trials comparing surgical techniques and objective measures of outcome, especially from oncologic and health economy points of view.
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11
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Parmar V, Hawaldar R, Badwe RA. Safety of partial breast reconstruction in extended indications for conservative surgery in breast cancer. Indian J Surg Oncol 2011; 1:256-62. [PMID: 22693374 DOI: 10.1007/s13193-011-0052-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2009] [Accepted: 04/05/2010] [Indexed: 11/24/2022] Open
Abstract
Breast conservation surgery after large volume excisions for women with relatively larger or multicentric operable breast cancer (OBC) and in some locally advanced breast cancers (LABC) post neo-adjuvant chemotherapy (NACT), is known to be a feasible option using a latissimus dorsi flap. However, the oncological safety of such a procedure is not well reported in literature. Two hundred and twenty one women with breast cancer (148-OBC, 73-LABC) underwent BCT plus LD during March 1998 to August 2009. One hundred and forty six women (72-LABC, 66-OBC) received prior NACT for downstaging, followed by completion of adjuvant therapy in all, including postoperative radiotherapy and hormone therapy where indicated. Women aged 20-62 years, with tumors 1.5-15 cm (median 5.0 cm), underwent volume replacement surgery with LD flap. All positive cut margins (total-4.9%, gross positive-1.3%) were re-excised to ensure negative margins. The mean surgical time for excision of primary with axillary clearance followed by volume replacement by LD was 5 h and mean hospital stay 6 days. Donor site morbidity was seen in 11 patients and 3 had minor recipient site infection. At a median follow up of 36 months, ten of 221 patients (4.5%) had failed locally (7-OBC, 3-LABC). The determinants of local recurrence were presence of lymphatic vascular invasion (p = 0.016) and axillary metastasis (p = 0.003). BCT plus LD flap is an oncologically safe, technically quick procedure with minimal morbidity, and should be offered to all eligible women as an extended breast conservation procedure.
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Irani Y, Casanova D, Amar E. [Autologous fat grafting in radiated tissue prior to breast prosthetic reconstruction: is the technique reliable?]. ANN CHIR PLAST ESTH 2010; 57:59-66. [PMID: 21145645 DOI: 10.1016/j.anplas.2010.11.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2010] [Accepted: 11/04/2010] [Indexed: 01/17/2023]
Abstract
BACKGROUND Prosthetic breast reconstruction is critical in the radiated breast. The main purpose of this study was to determine whether fat grafting prior to breast reconstruction could improve thoracic tissue trophicity enough to perform a simple prosthetic reconstruction, avoiding a flap procedure. PATIENTS AND METHODS A total of 25 patients who had undergone a modified radical mastectomy followed by radiotherapy were retrieved. Fat was injected according to Coleman's technique. Prosthetic reconstruction was performed three to six months after the fat grafting procedure. Reconstruction of the nipple-areola complex was performed 3 months after implant positioning. Median follow-up interval was two years. Patient satisfaction was ascertained with a self-assessment questionnaire. Three independent blinded physician observers judged preoperative and postoperative photographs to determine the quality of reconstruction. RESULTS The mean refined fat injected volume was 160ml. In all cases except two, a unique fat grafting procedure was necessary. Prosthetic reconstruction was achieved in 23 cases. The technique failed in two cases and breast reconstruction was achieved by a latissimus dorsi flap with implant. During the follow-up interval, two complications occurred in two patients presenting with fat necrosis and oil cysts. The mean number of total surgical procedures was 2.5 per patient. Quality of reconstruction was judged as good by both physicians and patients. CONCLUSIONS Autologous fat grafting in radiated tissue prior to breast reconstruction is a safe and reliable technique. In selected cases, a simple prosthetic reconstruction can be achieved avoiding a flap procedure.
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Affiliation(s)
- Y Irani
- Service de chirurgie plastique et reconstructrice, hôpital Nord, chemin des Bourrely, 13915 Marseille cedex 20, France.
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Kim S, Lee S, Lee H, Lee J. The Safety and Cosmetic Effect of Immediate Latissimus Dorsi Flap Reconstruction after Breast Conserving Surgery. J Breast Cancer 2009. [DOI: 10.4048/jbc.2009.12.3.186] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Sangwon Kim
- Department of Breast Surgery, Saegyaero Hospital, Busan, Korea
| | - Seokjae Lee
- Department of Breast Surgery, Saegyaero Hospital, Busan, Korea
| | - Hyukjin Lee
- Department of Breast Surgery, Saegyaero Hospital, Busan, Korea
| | - Jinyong Lee
- Department of Breast Surgery, Saegyaero Hospital, Busan, Korea
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Clough K, Nos C, Fitoussi A, Couturaud B, Inguenault C, Sarfati I. Séquelles esthétiques du traitement conservateur des cancers du sein : une classification pour les reconstructions après tumorectomie. ANN CHIR PLAST ESTH 2008; 53:88-101. [DOI: 10.1016/j.anplas.2008.01.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2007] [Accepted: 01/05/2008] [Indexed: 11/15/2022]
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Séquelles thérapeutiques du sein après traitement conservateur du cancer du sein. ANN CHIR PLAST ESTH 2008; 53:135-52. [DOI: 10.1016/j.anplas.2007.10.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2007] [Accepted: 10/02/2007] [Indexed: 11/24/2022]
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Delay E, Gosset J, Toussoun G, Delaporte T, Delbaere M. [Efficacy of lipomodelling for the management of sequelae of breast cancer conservative treatment]. ANN CHIR PLAST ESTH 2007; 53:153-68. [PMID: 18063288 DOI: 10.1016/j.anplas.2007.09.005] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2007] [Accepted: 09/24/2007] [Indexed: 11/27/2022]
Abstract
We report a study of 42 breast cancer patients undergoing lipomodelling, or fat transfer, for sequelae of conservative treatment. Detailed clinical and radiological data of the patients have been collected. These data demonstrate the feasibility of lipomodelling: the technique is simple but requires a learning curve to avoid cytosteatonecrotic lesions; the excellent results obtained in terms of shape and softness of the breast; no surgical implant or flap reconstruction is necessary; the reliability of the procedure: there is normal fat wasting within the first months after treatment, then results stabilize as the patient maintains a healthy weight; the small number of side-effects: only rare, predominantly infectious, rapidly resolving complications are induced. In conclusion, the fat transfer approach presented here represents a considerable advance for the management of moderate sequelae of conservative breast treatment. Using this technique makes it possible to restore the shape and softness of the breast better than any other surgical procedure before, particularly for patients with mild breast deformity.
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Affiliation(s)
- E Delay
- Unité de chirurgie plastique et reconstructrice, centre Léon-Bérard, 28, rue Laënnec, 69373 Lyon cedex 08, France.
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Affiliation(s)
- Jeffrey A Jones
- Division of Plastic Surgery, University of Mississippi, Jackson, MS, USA
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Hudson DA. A modified excision for combined reduction mammoplasty and breast conservation therapy in the treatment of breast cancer. Aesthetic Plast Surg 2007; 31:71-5. [PMID: 17235466 DOI: 10.1007/s00266-005-0063-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Wide local excision combined with postoperative radiotherapy is a useful technique for patients with breast cancer. For patients with macromastia whose tumor is situated in the lower pole of the breast, a breast reduction (keyhole\inverted T pattern) can be used to achieve wide local excision. However, for patients whose tumor is not in the inferior portion of the breast, and in whom this cancer also is situated close to the skin (requiring excision of skin with a 1-cm margin for oncologic safety), the traditional keyhole pattern cannot be used. A modification of the keyhole pattern\inverted T is described. The pedicle used depends on the site of the tumor. Although the breast scars are in different positions, a similar breast shape as well as symmetry still can be achieved. This is a useful technique for a select subgroup of patients. The outcomes for three patients are presented.
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Affiliation(s)
- Donald A Hudson
- Department of Plastic and Reconstructive Surgery, University of Cape Town, Cape Town, South Africa.
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20
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Asgeirsson KS, Rasheed T, McCulley SJ, Macmillan RD. Oncological and cosmetic outcomes of oncoplastic breast conserving surgery. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2005; 31:817-23. [PMID: 16043322 DOI: 10.1016/j.ejso.2005.05.010] [Citation(s) in RCA: 134] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2005] [Revised: 05/12/2005] [Accepted: 05/18/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND Breast-conserving surgery and radiotherapy is firmly established as a good and safe option for most women with early breast cancer. The important outcome measures of breast conservation are survival, local recurrence, cosmesis and patient satisfaction. Partial breast reconstructive techniques may improve cosmesis and patient satisfaction without compromising the oncological outcomes. METHODS A search of the Medline and Pubmed databases of studies on breast conserving surgery where partial breast reconstructive techniques were employed. The keywords used were breast conserving surgery, oncoplastic breast surgery, partial breast reconstruction and reduction mammoplasty. The oncological and cosmetic outcomes of these studies were analysed. RESULTS Studies on partial breast reconstructive techniques often lack oncological outcomes and long-term results are not available. On intermediate follow-up (up to 4.5 years) local recurrence rates vary from 0 to 1.8% per year. Cosmetic failure rates vary from 0 to 18%. To date, detailed studies are small and outcome measures vary. CONCLUSIONS Breast surgeons should be aware of the range of surgical techniques that may enhance the aesthetic results of breast-conserving surgery as well as expand the indications for its use. There is a need for routine assessment of oncological and cosmetic outcomes and long-term results of partial breast reconstructive techniques in relation to these outcomes are awaited.
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Affiliation(s)
- K S Asgeirsson
- Nottingham Breast Institute, Nottingham City Hospital, Hucknall Road, Nottingham NG5 1PB, UK
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21
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Clough KB, Thomas SS, Fitoussi AD, Couturaud B, Reyal F, Falcou MC. Reconstruction after conservative treatment for breast cancer: cosmetic sequelae classification revisited. Plast Reconstr Surg 2005; 114:1743-53. [PMID: 15577344 DOI: 10.1097/01.prs.0000142442.62956.78] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Patients with suboptimal results following breast conservative therapy are presenting more frequently to plastic surgeons as a difficult management problem. A three-type "cosmetic sequelae classification" is proposed to evaluate and manage these patients. From February of 1991 to November of 2001, 85 patients were treated for cosmetic sequelae of breast conservative therapy at the Institut Curie. The patients were followed up prospectively for 6 to 132 months (median, 33 months). They were assessed with regard to age, site and stage of tumor, type of initial breast conservative therapy undertaken, corrective operative procedures performed, complications, and cosmetic results. Forty-eight patients (56.5 percent) had type 1 cosmetic sequelae, 33 patients (38.8 percent) had type 2, and four patients (4.7 percent) had type 3. Type 1 was managed by contralateral symmetrizing procedures. Type 2 was the most difficult to manage by means of various procedures. Type 3 required mastectomy and immediate breast reconstruction. Type 1 had 97.6 percent good results compared with 82.7 percent for type 2. Three of the four type 3 patients had good results. This article reaffirms the validity of the cosmetic sequelae classification as a simple, practical guide for breast reconstructive surgeons. It discusses the various choices of reconstructive procedures available, the importance of preventing these cosmetic sequelae, and the role of the plastic surgeon in the planning of conservative treatment of breast cancers.
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22
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Collins ED. Collaborative surgical treatment of breast cancer. Curr Probl Surg 2004; 41:138-204. [PMID: 14970806 DOI: 10.1016/j.cpsurg.2003.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- E Dale Collins
- Breast Oncology Program, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA
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Affiliation(s)
- Gottfried Wechselberger
- Department of Plastic and Reconstructive Surgery, Leopold-Franzens University Innsbruck, Austria
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Polednak AP. How frequent is postmastectomy breast reconstructive surgery? A study linking two statewide databases. Plast Reconstr Surg 2001; 108:73-7. [PMID: 11420507 DOI: 10.1097/00006534-200107000-00012] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Studies of the frequency of reconstructive surgery among breast cancer patients have involved non-population-based sources, incomplete ascertainment, or both. Postmastectomy breast reconstructive surgery among 4688 breast cancer patients (diagnosed between 1992 and 1996) was estimated by linking a population-based cancer registry with a statewide hospital discharge database in Connecticut. Of these 4688 patients, 585 (12.5 percent) had reconstruction coded in one database or both databases. The reconstruction rates were higher than in a previous study in Connecticut and increased from 9 percent in 1992 to 16 percent in 1996. Reconstruction was not related to the patient's tumor size, marital status, or race (black versus white), but declined with increasing age at diagnosis and with poverty rate (of the census tract of residence). These associations were similar to those reported from previous studies.
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Affiliation(s)
- A P Polednak
- Connecticut Tumor Registry, Connecticut Department of Public Health, 410 Capitol Avenue, Hartford, CT 06134-0308, USA.
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25
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McFadden TC, Gutowski KA. Breast reconstruction after breast conservation therapy: part 2 of the 6-part series on current concepts in breast reconstruction. CURRENT SURGERY 2001; 58:146-155. [PMID: 11275233 DOI: 10.1016/s0149-7944(00)00462-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Affiliation(s)
- T C. McFadden
- Division of Plastic Surgery, Department of Surgery, University of Wisconsin Hospital and Clinics, Madison, Wisconsin, USA
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Abstract
In many cases, breast deformity caused by partial mastectomy can be reduced or corrected by plastic surgery. Partial breast reconstruction is best performed immediately after the partial mastectomy using an approach determined by the size of the breast and the defect. Small defects in large breasts usually need no reconstruction. For larger defects in large breasts, breast reshaping (similar to reduction mammaplasty) combined with a contralateral breast reduction is usually the best option. For medium-sized or smaller breasts with small to moderate-sized defects, local flaps from the subaxillary region are very useful. If the defect is too large for correction with local tissue, a latissimus dorsi myocutaneous flap is usually the best choice. Using these techniques, patients can achieve aesthetically better outcomes from breast-conservation therapy, even when larger tumors are being treated or when wider margins are taken to reduce the risk of tumor recurrence. By working together with an oncologic surgeon and facilitating the removal of larger tumors, the plastic surgeon can widen the indications for both breast-conservation therapy and breast reconstruction at the same time.
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Affiliation(s)
- K B Clough
- Department of Senology at the Institut Curie, Paris, France
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