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Lateral thoracoaxillar dermal-fat flap for breast conserving surgery: the changes of the indication and long-term results

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Abstract

Background

Oncoplastic breast conserving surgery had been challenged to achieve both of local control and the cosmetic appearance of preserved breast. We developed the lateral thoracoaxillar dermal-fat flap (LTDF) as an oncoplastic procedure to fill the defect of breast-conserving surgery in 1999.

Methods

A total of 2338 breast cancer patients underwent surgery from January, 2000 to December, 2017. Mastectomy was performed in 706 patients (30%), and breast conservative surgery (BCS) was performed in 1634 patients (70%). The LTDF was adopted in 487/1634 (30%) of BCS cases to fill the large defect left by partial resection. we divided all patients into 3 groups: breast total mastectomy (BT group), the breast partial resection (BP) with LTDF (LTDF group), and Bp without LTDF (BP group) and compared the clinical characteristics, and recurrence rate.

Results

The Indications for LTDF increased up to 40% in 2010, while they decreased to 20%–30% in the most recent period, in accordance with the frequency of breast reconstruction increased. Patients who underwent BP + LTDF (LTDF group) included significantly higher proportions of stage II diseases and cases treated by neoadjuvant chemotherapy than those in BP or BT groups.. We found no marked difference of local recurrence and distant metastases between the LTDF and Bp groups. However, the rate of distant metastasis was significantly higher in BT group than in the Bp or LTDF group. Concerning the complications of LTDF, we experienced a few complications of Grade 3–4 requiring surgical management, namely one case of dislocation of the LTDF, three cases of bleeding, and five cases each of skin necrosis and fat necrosis.

Conclusions

We reported satisfying long-term outcomes of 487 cases treated by LTDF. LTDF is a suitable oncoplastic technique for BCS.

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Acknowledgements

This study was approved by the institutional review board at Yamanashi Central Hospital.

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Authors and Affiliations

  1. Department of Breast Surgery, Yamanashi Prefectural Central Hospital, Fujimi1-1-1, Kofu, Yamanashi, 400-8506, Japan

    Hiroshi Nakagomi, Masayuki Inoue, Haruka Nakada, Kazushige Furuya, Hideki Watanabe & Kou Ikegame

  2. Department of Plastic Surgery, Yamanashi Prefectural Central Hospital, Fujimi1-1-1, Kofu, Yamanashi, 400-8506, Japan

    Koichi Kobayashi

  3. First Department of Surgery, Yamanashi University, Kofu, Japan

    Masato Ohmori & Yuko Nakayama

Authors
  1. Hiroshi Nakagomi
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  2. Masayuki Inoue
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  3. Haruka Nakada
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  4. Masato Ohmori
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  5. Yuko Nakayama
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  6. Kazushige Furuya
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  7. Hideki Watanabe
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  8. Kou Ikegame
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  9. Koichi Kobayashi
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Correspondence to Hiroshi Nakagomi.

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Nakagomi, H., Inoue, M., Nakada, H. et al. Lateral thoracoaxillar dermal-fat flap for breast conserving surgery: the changes of the indication and long-term results. Breast Cancer 26, 595–601 (2019). https://doi.org/10.1007/s12282-019-00959-2

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  • DOI: https://doi.org/10.1007/s12282-019-00959-2

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