Oncoplastic breast surgery:current strategies and outcome

Abd El Baky, Mahmoud M.; Aldardeer, Ahmed Abdelkahaar; Ali, Ayman M.; Redwan, Alaa A.

doi:10.21608/smj.2018.42037

Oncoplastic breast surgery:current strategies and outcome

Document Type : Original Article

Authors

¹ Department of surgery, Faculty of medicine, Sohag university.

² Department, of Surgery Faculty of, Medicine University of, Sohag.

³ Department, Faculty, of Medicine General Surgery, Sohag University.

10.21608/smj.2018.42037

Abstract

Oncoplastic surgery has emerged as a new approach to allow wide excision for breast conserving surgery without compromising the natural shape of the breast. It is based on integration of plastic surgery techniques for immediate breast reshaping after wide excision for breast cancer.
Objective:To study the different methods of oncoplastic surgery for breast reconstruction to achieve better aesthetic outcome and improve quality of life.
Patients and Methods: Thirty patients with breast cancer, treated at Sohag University Hospital between July 2016 to May 2017 were included in this study. The oncoplastic techniques performed were Local glandular tissue displacement in (60%), latissimus dorsi flap (LD) in (16.6%), superior pedicle flap in(10%), implant insertion in (6.6%) and Transverse rectus abdominus myocutanous flap (TRAM) in (6.6%). The choice of the oncoplastic techniques depends on the achievement of free safety margins, the breast volume, and its ptotic degree.
Results: The number of patients included in the study were thirty. The median age was 43 years (range; 20–60 ys). There were three major complications that require repeating the oncoplastic techniques. Recorded complications included wound infection (5/30, 16.6 %) donor site seroma (10/30, 33.3 %), postoperative haematoma (1/30, 3.3%), flap ischemia and necrosis (1/30, 3.3%). The 12-months subjective patient satisfaction was excellent in 27 (90%) patients, and bad in 3 (10 %) patients. There were two local recurrence, no systemic metastasis after an average follow-up duration of 12 months.
Conclusion:Restoring the defect after resection of the breast cancer can be safely achieved using oncoplastic procedures including the previous techniques with immediate breast reconstruction. In our patients, these procedures yield a satisfactory aesthetic outcome with lower morbidity.

Keywords

References

1-Fisher B, Jeong JH, Anderson S, et al., (2002). Twenty-five year follow-up of a randomized trial comparing radical mastectomy, total mastectomy, and total mastectomy followed by irradiation. N Engl J Med; 347:567-75.

2-Clough KB, Ihrai T, Oden S, et al., (2012). Oncoplastic surgery for breast cancer based on tumour location and a quadrant per- quadrant atlas. Br J Surg; 99:1389-95.

3- Losken A, Pinell-White X, Hart AM, et al., (2014). The oncoplastic reduction approach to breast conservation therapy: benefits for margin control. Aesthet Surg J;34:1185-91.

4- Barnea Y, Inbal A, Barsuk D, et al., (2014). Oncoplastic reduction using the vertical scar superior-medial pedicle pattern technique for immediate partial breast reconstruction. Can J Surg 2014; 57:E134-40.

5- Chan SW, Cheung PS, Lam SH, (2010). Cosmetic outcome and percentage of breast volume excision in oncoplastic breast conserving surgery. World J Surg; 34:1447-52.

6- Clough KB, Lewis JS, Couturaud B, et al., (2003). Oncoplastic techniques allow extensive resection for breast-conserving therapy of breast carcinomas. Ann Surg; 237:26–34.

7- Jamal K. Almasad, and Bareqa Salah, (2008). Breast Reconstruction by Local flaps after Conserving Surgery for Breast Cancer: An Added Asset to Oncoplastic Techniques, The Breast Journal, Volume 14 Number 4, 340–344.

8- Omar Farouk, Essam Attia1, Sameh Roshdy1, et al., (2015). The outcome of oncoplastic techniques in defect reconstruction after resection of central breast tumors, World Journal of Surgical Oncology P: 13–285.

9- Pezzi CM, Kukora JS, Audet IM, et al, (2004). Breast conservation surgery using nipple-areolar resection for central breast cancers. Arch Surg; 139:32-7.

10- Stavrou D, Weissman O, Polyniki A, (2009). Quality of life after breast cancer surgery with or without reconstruction. Eplasty; 9:e18.

11- Saira Khawaja, Abrar Saiyed, Darmiga Thayabaran et al, (2015). A Comparison Between Oncoplastic Breast Conserving Surgery and Standard Wide Local Excision: A UK Experience. Breast Can Curr Res 1:1.

12- Lee AH, (2005). Why is carcinoma of the breast more frequent in the upper outer quadrant? A case series based on needle core biopsy diagnoses. Breast. Apr; 14(2):151-2.

13- Rainsbury R. M, (2007). “Surgery Insight: oncoplastic breast conserving reconstruction—indications, benefits, choices and outcomes” Nature Clinical Practice Oncology, vol. 4, no. 11, pp. 657–664.

14- Tuomo, Masetti R, and Silverstein M. J. (2009). “Oncoplastic approaches to partial mastectomy: an overview of volume displacement techniques,” The Lancet Oncology, vol. 6, no. 3, pp. 145–157.

15- Clough KB, Ihrai T, Oden S, et al, (2012). Oncoplastic surgery for breast cancer based on tumour location and a quadrant per- quadrant atlas. Br J Surg;99:1389-95.

16- MG Berry, AD Fitoussi, A Curnier, et al, (2010). J Plast Reconstr Aesthet Surg 2010; 63:1233–1243.

17- Clough KB, Kroll SS, Audretsch W, (1999). An approach to the repair of partial mastectomy defects.Plast Reconstr Surg;104:409-20.

18- Anderson BO, Masetti R, Silverstein MJ, (2005). Oncoplastic approaches to partial mastectomy: an overview of volume displacement techniques. Lancet Oncol;6:145-57.

19- McCulley SJ, Macmillan RD, (2005). Planning and use of therapeutic mammoplasty Nottingham approach. Br J Plast Surg;58:889-901.