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Alternative Oncoplastic Techniques for Challenging Breast Conservative Surgeries

  • Régis Resende Paulinelli
Chapter

Abstract

Even in the most favourable cases, a total breast reconstruction does not have the same comfort, ease and sensibility of the original breast, besides having a higher morbidity and a higher risk of complications [1]. In cases in which radiotherapy is mandatory, like locally advanced tumours, the aesthetic results and risks of complications for total breast reconstructions are much worse [2–4]. Therefore, it is important to the patient trying to expand the indications of the conservative treatment through neoadjuvant chemotherapy and oncoplastic surgery [5, 6]. The aim of this chapter is to discuss some less known alternatives and indications for partial breast reconstruction that could allow challenging breast conservative surgeries.

References

  1. 1.
    Potter S, Brigic A, Whiting PF, Cawthorn SJ, Avery KN, Donovan JL et al (2011) Reporting clinical outcomes of breast reconstruction: a systematic review. J Natl Cancer Inst 103(1):31–46PubMedCrossRefGoogle Scholar
  2. 2.
    Pestana IA, Campbell DC, Bharti G, Thompson JT (2013) Factors affecting complications in radiated breast reconstruction. Ann Plast Surg 70(5):542–545PubMedCrossRefGoogle Scholar
  3. 3.
    Albornoz CR, Matros E, McCarthy CM, Klassen A, Cano SJ, Alderman AK et al (2014) Implant breast reconstruction and radiation: a multicenter analysis of long-term health-related quality of life and satisfaction. Ann Surg Oncol 21(7):2159–2164PubMedCrossRefGoogle Scholar
  4. 4.
    Hirsch EM, Seth AK, Dumanian GA, Kim JY, Mustoe TA, Galiano RD et al (2012) Outcomes of tissue expander/implant breast reconstruction in the setting of prereconstruction radiation. Plast Reconstr Surg 129(2):354–361PubMedCrossRefGoogle Scholar
  5. 5.
    Clough KB, Lewis JS, Couturaud B, Fitoussi A, Nos C, Falcou MC (2003) Oncoplastic techniques allow extensive resections for breast-conserving therapy of breast carcinomas. Ann Surg 237(1):26–34PubMedPubMedCentralCrossRefGoogle Scholar
  6. 6.
    Audretsch W, Andree C (2006) Is mastectomy still justified—and if, in which patients? Onkologie 29(6):243–245PubMedGoogle Scholar
  7. 7.
    Fisher B, Anderson S, Bryant J, Margolese RG, Deutsch M, Fisher ER et al (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(16):1233–1241PubMedCrossRefGoogle Scholar
  8. 8.
    Veronesi U, Cascinelli N, Mariani L, Greco M, Saccozzi R, Luini A et al (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(16):1227–1232PubMedCrossRefGoogle Scholar
  9. 9.
    Bleicher RJ, Ruth K, Sigurdson ER, Daly JM, Boraas M, Anderson PR et al (2016) Breast conservation versus mastectomy for patients with T3 primary tumors (>5 cm) a review of 5685 medicare patients. Cancer 122(1):42–49PubMedCrossRefGoogle Scholar
  10. 10.
    Silverman D, Ruth K, Sigurdson ER, Egleston BL, Goldstein LJ, Wong YN et al (2014) Skin involvement and breast cancer: are T4b lesions of all sizes created equal? J Am Coll Surg 219(3):534–544PubMedPubMedCentralCrossRefGoogle Scholar
  11. 11.
    Ataseven B, Lederer B, Blohmer JU, Denkert C, Gerber B, Heil J et al (2015) Impact of multifocal or multicentric disease on surgery and locoregional, distant and overall survival of 6,134 breast cancer patients treated with neoadjuvant chemotherapy. Ann Surg Oncol 22(4):1118–1127PubMedCrossRefGoogle Scholar
  12. 12.
    Pilewskie M, Ho A, Orell E, Stempel M, Chen Y, Eaton A et al (2014) Effect of margin width on local recurrence in triple-negative breast cancer patients treated with breast-conserving therapy. Ann Surg Oncol 21(4):1209–1214PubMedCrossRefGoogle Scholar
  13. 13.
    Lowery AJ, Kell MR, Glynn RW, Kerin MJ, Sweeney KJ (2012) Locoregional recurrence after breast cancer surgery: a systematic review by receptor phenotype. Breast Cancer Res Treat 133(3):831–841PubMedCrossRefGoogle Scholar
  14. 14.
    Losken A, Dugal CS, Styblo TM, Carlson GW (2014) A meta-analysis comparing breast conservation therapy alone to the oncoplastic technique. Ann Plast Surg 72(2):145–149PubMedCrossRefGoogle Scholar
  15. 15.
    Houssami N, Macaskill P, von Minckwitz G, Marinovich ML, Mamounas E (2012) Meta-analysis of the association of breast cancer subtype and pathologic complete response to neoadjuvant chemotherapy. Eur J Cancer 48(18):3342–3354PubMedCrossRefGoogle Scholar
  16. 16.
    Boughey JC, Hunt KK (2015) Spotlight on neoadjuvant therapy for breast cancer. Ann Surg Oncol 22(5):1406–1407PubMedCrossRefGoogle Scholar
  17. 17.
    Houssami N, Macaskill P, Marinovich ML, Morrow M (2014) The association of surgical margins and local recurrence in women with early-stage invasive breast cancer treated with breast-conserving therapy: a meta-analysis. Ann Surg Oncol 21(3):717–730PubMedPubMedCentralCrossRefGoogle Scholar
  18. 18.
    Morrow M, Van Zee KJ, Solin LJ, Houssami N, Chavez-MacGregor M, Harris JR et al (2016) Society of Surgical Oncology-American Society for Radiation Oncology-American Society of Clinical Oncology Consensus Guideline on margins for breast-conserving surgery with whole-breast irradiation in ductal carcinoma in situ. Pract Radiat Oncol 6(5):287–295PubMedPubMedCentralCrossRefGoogle Scholar
  19. 19.
    Rietjens M, Urban CA, Rey PC, Mazzarol G, Maisonneuve P, Garusi C et al (2007) Long-term oncological results of breast conservative treatment with oncoplastic surgery. Breast 16(4):387–395PubMedCrossRefGoogle Scholar
  20. 20.
    De Lorenzi F, Hubner G, Rotmensz N, Bagnardi V, Loschi P, Maisonneuve P et al (2016) Oncological results of oncoplastic breast-conserving surgery: Long term follow-up of a large series at a single institution: a matched-cohort analysis. Eur J Surg Oncol 42(1):71–77PubMedCrossRefGoogle Scholar
  21. 21.
    Spear SL, Clemens MW, Dayan JH (2008) Considerations of previous augmentation in subsequent breast reconstruction. Aesthet Surg J 28(3):285–293PubMedCrossRefGoogle Scholar
  22. 22.
    Kramer S, Darsow M, Kummel S, Kimmig R, Rezai M (2008) Breast-conserving treatment of breast cancer—oncological and reconstructive aspects. Gynakol Geburtshilfliche Rundsch 48(2):56–62PubMedCrossRefGoogle Scholar
  23. 23.
    Rezai M, Knispel S, Kellersmann S, Lax H, Kimmig R, Kern P (2015) Systematization of oncoplastic surgery: selection of surgical techniques and patient-reported outcome in a cohort of 1,035 patients. Ann Surg Oncol 22(11):3730–3737PubMedPubMedCentralCrossRefGoogle Scholar
  24. 24.
    Petit JY, Rietjens M, Lohsiriwat V, Rey P, Garusi C, De Lorenzi F et al (2012) Update on breast reconstruction techniques and indications. World J Surg 36(7):1486–1497PubMedCrossRefGoogle Scholar
  25. 25.
    Santanelli F, Paolini G, Campanale A, Longo B, Amanti C (2009) Modified Wise-pattern reduction mammaplasty, a new tool for upper quadrantectomies: a preliminary report. Ann Surg Oncol 16(5):1122–1127PubMedCrossRefGoogle Scholar
  26. 26.
    Lanitis S, Hadjiminas DJ, Sgourakis G, Al Mufti R, Karaliotas C (2010) Modified Benelli approach for superior segmentectomy: a feasible oncoplastic approach. Plast Reconstr Surg 126(4):195e–197ePubMedCrossRefGoogle Scholar
  27. 27.
    Grisotti A, Calabrese C (2006) Conservative treatment of breast cancer: reconstructive issues. In: Spear SL (ed) Surgery of the breast: principles and Art. 1. Lippincott, Williams & Wilkins, Philadelphia, pp 147–178Google Scholar
  28. 28.
    Fleetwood JR, Barrett SL, Day SV (1987) Skin flaps. The Burow advancement flap for closure of plantar defects. J Am Podiatr Med Assoc 77(5):246–249PubMedCrossRefGoogle Scholar
  29. 29.
    Krishnan R, Garman M, Nunez-Gussman J, Orengo I (2005) Advancement flaps: a basic theme with many variations. Dermatol Surg 31(8 Pt 2):986–994PubMedGoogle Scholar
  30. 30.
    Orlando JC, Guthrie RH (1975) The superomedial dermal pedicle for nipple transposition. Br J Plast Surg 28(1):42–45PubMedCrossRefGoogle Scholar
  31. 31.
    Brown RH, Siy R, Khan K, Izaddoost S (2015) The superomedial pedicle wise-pattern breast reduction: reproducible, reliable, and resilient. Semin Plast Surg 29(2):94–101PubMedPubMedCentralCrossRefGoogle Scholar
  32. 32.
    Garcia ES, Veiga DF, Sabino-Neto M, Beraldo Cardoso FN, Batista IO, Leme RM et al (2015) Sensitivity of the nipple-areola complex and sexual function following reduction mammaplasty. Aesthet Surg J 35(7):NP193–NP202PubMedCrossRefGoogle Scholar
  33. 33.
    Paulinelli RR, Marinho ER (2012) Double independent pedicle oncoplastic mammaplasty: a technique for breast preservation. Rev Bras Mastol 22(1):25–32Google Scholar
  34. 34.
    Daher JC (1993) Breast island flaps. Ann Plast Surg 30(3):217–223PubMedCrossRefGoogle Scholar
  35. 35.
    Paulinelli RR, de Oliveira VM, Bagnoli F, Chade MC, Alves KL, Freitas-Junior R (2014) Oncoplastic mammaplasty with geometric compensation—a technique for breast conservation. J Surg Oncol 110(8):912–918PubMedCrossRefGoogle Scholar
  36. 36.
    Lee JW, Kim MC, Park HY, Yang JD (2014) Oncoplastic volume replacement techniques according to the excised volume and tumor location in small- to moderate-sized breasts. Gland Surg 3(1):14–21PubMedPubMedCentralGoogle Scholar
  37. 37.
    McCulley SJ, Schaverien MV, Tan VK, Macmillan RD (2015) Lateral thoracic artery perforator (LTAP) flap in partial breast reconstruction. J Plast Reconstr Aesthet Surg 68(5):686–691PubMedCrossRefGoogle Scholar
  38. 38.
    Zitelli JA (2008) Design aspect of the bilobed flap. Arch Facial Plast Surg 10(3):186PubMedCrossRefGoogle Scholar
  39. 39.
    Meadows AE, Rhatigan M, Manners RM (2005) Bilobed flap in ophthalmic plastic surgery: simple principles for flap construction. Ophthal Plast Reconstr Surg 21(6):441–444PubMedCrossRefGoogle Scholar
  40. 40.
    Petit JY, Maisonneuve P (2016) Lipofilling of the breast does not increase the risk of recurrence of breast cancer: a matched controlled study. Plast Reconstr Surg 137(2):385–393CrossRefGoogle Scholar
  41. 41.
    Biazus JV, Falcão CC, Parizotto AC, Stumpf CC, Cavalheiro JA, Schuh F et al (2015) Immediate reconstruction with autologous fat transfer following breast-conserving surgery. Breast J 21(3):268–275PubMedCrossRefGoogle Scholar
  42. 42.
    Coleman SR (1995) Long-term survival of fat transplants: controlled demonstrations. Aesthet Plast Surg 19(5):421–425CrossRefGoogle Scholar
  43. 43.
    Clough KB, Kroll SS, Audretsch W (1999) An approach to the repair of partial mastectomy defects. Plast Reconstr Surg 104(2):409–420PubMedCrossRefGoogle Scholar
  44. 44.
    Rainsbury RM (2002) Breast-sparing reconstruction with latissimus dorsi miniflaps. Eur J Surg Oncol 28(8):891–895PubMedCrossRefGoogle Scholar
  45. 45.
    Carlson GW, Page AL, Peters K, Ashinoff R, Schaefer T, Losken A (2008) Effects of radiation therapy on pedicled transverse rectus abdominis myocutaneous flap breast reconstruction. Ann Plast Surg 60(5):568–572PubMedCrossRefGoogle Scholar
  46. 46.
    Cordeiro PG (2012) Discussion: current status of implant-based breast reconstruction in patients receiving postmastectomy radiation therapy. Plast Reconstr Surg 130(4):525e–526eCrossRefGoogle Scholar
  47. 47.
    Parrett BM, Schook C, Morris D (2010) Breast reduction in the irradiated breast: evidence for the role of breast reduction at the time of lumpectomy. Breast J 16(5):498–502PubMedCrossRefGoogle Scholar
  48. 48.
    Rietjens M, De Lorenzi F, Veronesi P, Intra M, Venturino M, Gatti G et al (2006) Breast conservative treatment in association with implant augmentation and intraoperative radiotherapy. J Plast Reconstr Aesthet Surg 59(5):532–535PubMedCrossRefGoogle Scholar
  49. 49.
    Clough KB, Thomas SS, Fitoussi AD, Couturaud B, Reyal F, Falcou MC (2004) Reconstruction after conservative treatment for breast cancer: cosmetic sequelae classification revisited. Plast Reconstr Surg 114(7):1743–1753PubMedCrossRefGoogle Scholar
  50. 50.
    Petit JY, Rietjens M, Botteri E, Rotmensz N, Bertolini F, Curigliano G et al (2013) Evaluation of fat grafting safety in patients with intra epithelial neoplasia: a matched-cohort study. Ann Oncol 24(6):1479–1484PubMedCrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  • Régis Resende Paulinelli
    • 1
  1. 1.Mastology Program, Department of Gynecology and ObstetricsFederal University of Goiás, Service of Gynecology and Breast, Hospital Araújo Jorge, ACCG (Associação de Combate ao Câncer em Goiás)GoiâniaBrazil

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