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Oncoplastic resection of breast cancers located in the upper-inner quadrants: a safe and effective surgical technique

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European Journal of Plastic Surgery Aims and scope Submit manuscript

Abstract

Background

The combination of breast conserving surgery (BCS) together with plastic surgery techniques (oncoplastic breast surgery) is a useful surgical tool matching the radical oncological excision while preserving breast cosmesis. Upper-inner quadrant resections represent a challenge for breast surgeons. The aim of this study was to identify a reproducible technique to repair upper-inner quadrant defects with oncoplastic glandular reshaping in order to obtain a satisfactory aesthetic outcome together with a radical excision of the breast cancer.

Methods

During the period from March 2014 to March 2016, 32 patients with an upper-inner quadrant’s breast cancer were treated at our Department. Post-operative complications, negative margins of resection rates and cosmetic outcome (both patient-reported and surgeon-reported) were assessed.

Results

At a mean follow-up of 14 months (range 6–24), the complication rate was 25% (wound dehiscence, seroma formation, hematoma, marginal skin necrosis and partial NAC necrosis). Surgical margins of resection were negative in all procedures, and the overall satisfaction with the cosmetic outcome assessed by the patient was considered excellent in 17 cases (53.1%) and in 19 cases (59.4) when assessed by the surgeon.

Conclusions

The proposed technique represents a valuable and reproducible solution for the challenging reshaping that follows upper-inner quadrantectomies due to its low complication rates, high free margins of resection rates and excellent cosmetic outcomes.

Level of Evidence: Level IV, therapeutic study.

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References

  1. Veronesi U, Cascinelli N, Mariani L, Greco M, Saccozzi R, Luini A, Aguilar M, Marubini E (2002) Twenty-year follow-up of a randomized study comparing breast conserving surgery with radical mastectomy for early breast cancer. N Engl J Med 347:1227–1232

    Article  PubMed  Google Scholar 

  2. Fisher B, Anderson S, Bryant J, Margolese R, Deutsch M, Fisher E, Jeong J, Wolmark N (2002) Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med 347:1233–1241

    Article  PubMed  Google Scholar 

  3. Morrow M, Hamilton AS, Katz SJ (2007) Why do women get mastectomy? Results from a population-based study. J Clin Oncol 25:605

    Google Scholar 

  4. Garcia-Etienne CA, Tomatis M, Heil J et al (2012) Mastectomy trends for early-stage breast cancer: a report from the EUSOMA multi-institutional European database. Eur J Cancer 48:1947–1956

    Article  PubMed  Google Scholar 

  5. Jacobs L (2008) Positive margins: the challenge continues for breast surgeons. Ann Surg Oncol 15:1271–1272

    Article  PubMed  PubMed Central  Google Scholar 

  6. Bajaj AK, Kon PS, Oberg KC et al (2004) Aesthetic outcomes in patients undergoing breast conservation therapy for the treatment of localized breast cancer. Plast Reconstr Surg 114:1442

    Article  PubMed  Google Scholar 

  7. Baildam AD (2002) Oncoplastic surgery of the breast. Br J Surg 89:532–533

    Article  CAS  PubMed  Google Scholar 

  8. Rew DA (2003) Towards a scientific basis for oncoplastic breast surgery. Eur J Surg Oncol 29:105–106

    Article  CAS  PubMed  Google Scholar 

  9. Clough K, Lewis JS, Couturald B, Fitoussi A, Nos C, Falcou MC (2003) Oncoplastic techniques allow extensive resections for breast conserving therapy of breast carcinomas. Ann Surg 237:26–34

    Article  PubMed  PubMed Central  Google Scholar 

  10. Crown A, Wechter DG, Grumley JW (2015) Oncoplastic breast-conserving surgery reduces mastectomy and postoperative re-excision rates. Ann Surg Oncol 22(10):3363–3368

    Article  PubMed  Google Scholar 

  11. Clough K, Kaufman G, Nos C, Buccimazza I, Sarfati IM (2010) Improving breast cancer surgery: a classification and quadrant per quadrant atlas for oncoplastic surgery. Ann Surg Oncol 17:1375–1391

    Article  PubMed  Google Scholar 

  12. Anderson B, Masetti R, Silverstein M (2005) Oncoplastic approaches to partial mastectomy: an overview of volume displacement techniques. Lancet Oncol 6:145–157

    Article  PubMed  Google Scholar 

  13. Kronowitz SJ, Hunt KK, Kuerer HM et al (2007) Practical guidelines for repair of partial mastectomy defects using the breast reduction technique in patients undergoing breast conservation therapy. Plast Reconstr Surg 120(7):1755–1768

    Article  CAS  PubMed  Google Scholar 

  14. Losken A, Styblo TM, Carlson GW et al (2007) Management algorithm and outcome evaluation of partial mastectomy defects treated using reduction or mastopexy techniques. Ann Plast Surg 59(5):235–242

    Article  CAS  PubMed  Google Scholar 

  15. Cochrane RA, Valasiadou P, Wilson AR, Al-Ghazal SK, Macmillan RD (2003) Cosmesis and satisfaction after breast-conserving surgery correlates with the percentage of breast volume excised. Br J Surg 90:1505–1509

    Article  CAS  PubMed  Google Scholar 

  16. Stevenson J, Macmillan RD, Downey S, Renshaw L, Dixon JM (2001) Factors affecting cosmesis after breast conserving surgery. Eur J Cancer 37:S31

    Article  Google Scholar 

  17. Moran MS, Schnitt SJ, Giuliano AE et al (2014) Society of Surgical Oncology and American Society for Radiation Oncology consensus guideline on margins for breast-conserving surgery with whole-breast irradiation in stages I and II invasive breast cancer. J Clin Oncol 32(14):1507–1515

    Article  PubMed  Google Scholar 

  18. Morrow M (2009) Breast conservation and negative margins: how much is enough? Breast 18:84–86

    Article  Google Scholar 

  19. Grisotti A, Calabrese C (2006) Conservative treatment of reconstructive problem. In: Spear SL, Willy SC, Robb GL et al (eds) Surgery of the breast. Principles and art, 2nd edn. Lippincott Williams & Wilkins, Philadelphia, pp 147–178

    Google Scholar 

  20. Cutress RI, Simoes T, Gill J, Hurren JS (2013) Modification of the Wise pattern breast reduction for oncological mammaplasty of upper outer and upper inner quadrant breast tumours: a technical note and case series. J Plast Reconstr Aesthet Surg 66(2):e31–e36

    Article  CAS  PubMed  Google Scholar 

  21. Lee S, Lee J, Jung Y, Bae Y (2015) Oncoplastic surgery for inner quadrant breast cancer: fish-hook incision rotation flap. ANZ J Surg. doi:10.1111/ans.13336

  22. Fitoussi AD, Berry MG, Fama F et al (2010) Oncoplastic breast surgery for cancer: analysis of 540 consecutive cases. Plast Reconstr Surg 125(2):454–462

    Article  CAS  PubMed  Google Scholar 

  23. Kronowitz SJ, Hunt KK, Kuerer HM, Strom EA, Buchholz TA, Ensor JE, Koutz CA, Robb GL (2007) Practical guidelines for repair of partial mastectomy defects using the breast reduction technique in patients undergoing breast conservation therapy. Plast Reconstr Surg 120:1755

    Article  CAS  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Senology, Asur Marche Area Vasta 1, Santa Maria della Misericordia, Viale Comandino 70, 61029, Urbino, Italy

    Daniele Bordoni & Cesare Magalotti

  2. Department of Plastic Surgery, Hand Surgery and Microsurgery, San Gerardo Hospital, Via Pergolesi 33, Monza, Italy

    Pierfrancesco Cadenelli

  3. Department of Clinical Medicine and Surgery, University of Naples “Federico II”, Via Sergio Pansini 5, 80131, Naples, Italy

    Nicola Rocco

  4. Department of Plastic and Reconstructive Surgery, Polytechnic University of Marche, Piazza Roma, 22, 60121, Ancona, Italy

    Matteo Ornelli

  5. Department of Plastic and Reconstructive Surgery, The Talpiot Medical Leadership Program, Sheba Medical Center, Emek HaEla St 1, Ramat Gan, Israel

    Ariel Tessone

  6. Breast Surgery Unit, IRCCS-Arcispedale Santa Maria Nuova, Viale Risorgimento 80, 42123, Reggio Emilia, Italy

    Giuseppe Falco

Authors
  1. Daniele Bordoni
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  2. Pierfrancesco Cadenelli
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  3. Nicola Rocco
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  4. Matteo Ornelli
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  5. Ariel Tessone
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  6. Giuseppe Falco
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  7. Cesare Magalotti
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Corresponding author

Correspondence to Nicola Rocco.

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Conflict of interest

Daniele Bordoni, Pierfrancesco Cadenelli, Nicola Rocco, Matteo Ornelli, Ariel Tessone, Giuseppe Falco, Cesare Magalotti declare that they have no conflict of interest.

Funding

The authors received no funding for this study.

Ethical approval

For this type of study, formal consent is not required.

This article does not contain any studies with animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Financial disclosures

None of the authors has a financial or non-financial interest in any of the products, devices or drugs mentioned in this manuscript.

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Bordoni, D., Cadenelli, P., Rocco, N. et al. Oncoplastic resection of breast cancers located in the upper-inner quadrants: a safe and effective surgical technique. Eur J Plast Surg 41, 157–164 (2018). https://doi.org/10.1007/s00238-017-1340-9

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  • DOI: https://doi.org/10.1007/s00238-017-1340-9

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