Abstract
Breast-conserving therapy offers both effective treatment and the psychological benefit of retention of the breast. For breast conservation to be effective, the primary tumor must be resected with adequate surgical margins while simultaneously maintaining the breast’s shape and appearance. Declivity of the skin and/or displacement of the nipple-areolar complex (NAC) can occur when the target lesion is sizable and can create especially troubling defects for centrally located lesions. Some type of central closure of the breast is commonly required when larger areas of breast tissue are removed. The use of “volume-displacement” techniques for advancing fibroglandular tissue sections along the chest wall to close large resection cavities has become a fundamental tool for cosmetically optimized breast conservation surgery. The techniques described in this chapter include those used for central segmental resections that utilize volume-displacement techniques in which local parenchymal tissue flaps are advanced for glandular remodeling and include the central lumpectomy, batwing mastopexy lumpectomy, donut mastopexy lumpectomy, and variations on the reduction mastopexy lumpectomy which utilize a pedicle flap to restore the nipple-areolar complex.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Veronesi U, Cascinelli N, Mariani L 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 347:1227–1232
Fisher B, Anderson S, Bryant J 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 347:1233–1241
Anderson BO, Masetti R, Silverstein MJ (2005) Oncoplastic approaches to partial mastectomy: an overview of volume-displacement techniques. Lancet Oncol 6:145–157
Audretsch WP (2006) Reconstruction of the partial mastectomy defect: classification and method. In: Spear SL (ed) Surgery of the breast: principle and art, 2nd edn. Lippincott Williams & Wilkins, Philadelphia, PA, pp 179–216
Maguire PD, Adams A, Nichols MA (2015) Oncoplastic surgery and radiation therapy for breast conservation: early outcomes. Am J Clin Oncol 38:353–357
Chen CY, Calhoun KE, Masetti R, Anderson BO (2006) Oncoplastic breast conserving surgery: a renaissance of anatomically-based surgical technique. Minerva Chir 61:421–434
Love SM, Barsky SH (2004) Anatomy of the nipple and breast ducts revisited. Cancer 101:1947–1957
Rezai M, Knispel S, Kellersmann S et al (2015) Systematization of oncoplastic surgery: selection of surgical techniques and patient-reported outcome in a cohort of 1,035 patients. Ann Surg Oncol 22:3730–3737
Santos G, Urban C, Edelweiss MI et al (2015) Long-term comparison of aesthetical outcomes after oncoplastic surgery and lumpectomy in breast cancer patients. Ann Surg Oncol 22:2500–2508
Nizet JL, Maweja S, Lakosi F et al (2015) Oncological and surgical outcome after oncoplastic breast surgery. Acta Chir Belg 115:33–41
Vos EL, Koning AH, Obdeijn IM et al (2015) Preoperative prediction of cosmetic results in breast conserving surgery. J Surg Oncol 111:178–184
Silverstein MJ, Savalia N, Khan S, Ryan J (2015) Extreme oncoplasty: breast conservation for patients who need mastectomy. Breast J 21:52–59
Grubnik A, Benn C, Edwards G (2013) Therapeutic mammaplasty for breast cancer: oncological and aesthetic outcomes. World J Surg 37:72–83
Valenzuela M, Julian TB (2007) Ductal carcinoma in situ: biology, diagnosis, and new therapies. Clin Breast Cancer 7:676–681
Boetes C, Veltman J, van Die L et al (2004) The role of MRI in invasive lobular carcinoma. Breast Cancer Res Treat 86:31–37
Bluemke DA, Gatsonis CA, Chen MH et al (2004) Magnetic resonance imaging of the breast prior to biopsy. JAMA 292:2735–2742
Silverstein MJ, Lagios MD, Recht A et al (2005) Image-detected breast cancer: state of the art diagnosis and treatment. J Am Coll Surg 201:586–597
Silverstein MJ, Gamagami P, Rosser RJ et al (1987) Hooked-wire-directed breast biopsy and overpenetrated mammography. Cancer 59:715–722
Liberman L, Kaplan J, Van Zee KJ et al (2001) Bracketing wires for preoperative breast needle localization. Am J Roentgenol 177:565–572
Jakub JW, Gray RJ, Degnim AC et al (2010) Current status of radioactive seed for localization of non palpable breast lesions. Am J Surg 199:522–528
Cox CE, Russell S, Prowler V et al (2016) A prospective, single arm, multi-site, clinical evaluation of a nonradioactive surgical guidance Technology for the Location of nonpalpable breast lesions during excision. Ann Surg Oncol 23:3168–3174
Huemer GM, Schrenk P, Moser F et al (2007) Oncoplastic techniques allow breast-conserving treatment in centrally located breast cancers. Plast Reconstr Surg 120:390–398
Grisotti A (1998) Conservation treatment of breast cancer: reconstructive problems. In: Spear SL (ed) Surgery of the breast: principles and art. Lippincott-Raven Publishers, Philadelphia, PA, pp 137–153
Schoeller T, Huemer GM (2006) Immediate reconstruction of the nipple/areola complex in oncoplastic surgery after central quadrantectomy. Ann Plast Surg 57:611–615
Iwuagwu OC (2005) Additional considerations in the application of oncoplastic approaches. Lancet Oncol 6:356
Meretoja TJ, Svarvar C, Jahkola TA (2010) Outcome of oncoplastic breast surgery in 90 prospective patients. Am J Surg 200:224–228
Roughton MC, Shenaq D, Jaskowiak N et al (2012) Optimizing delivery of breast conservation therapy: a multidisciplinary approach to oncoplastic surgery. Ann Plast Surg 69:250–255
Kronowitz SJ, Feledy JA, Hunt KK et al (2006) Determining the optimal approach to breast reconstruction after partial mastectomy. Plast Reconstr Surg 117:1–11; discussion 12–14
Moran MS, Schnitt SJ, Giuliano AE et al (2014) Society of Surgical Oncology—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 32:1507–1515
Morrow M, Van Zee KJ, Solin LJ 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. J Clin Oncol 34(33):4040–4046
Clough KB, Gouveia PF, Benyahi D et al (2015) Positive margins after oncoplastic surgery for breast cancer. Ann Surg Oncol 22:4247–4253
Silverstein MJ, Larson L, Soni R et al (2002) Breast biopsy and oncoplastic surgery for the patient with ductal carcinoma in situ: surgical, pathologic, and radiologic issues. In: Silverstein MJ, Recht A, Lagios M (eds) Ductal carcinoma in situ of the breast. Lippincott Williams & Wilkins, Philadelphia, PA, pp 185–204
Bong J, Parker J, Clapper R, Dooley W (2010) Clinical series of oncoplastic mastopexy to optimize cosmesis of large-volume resections for breast conservation. Ann Surg Oncol 17:3247–3251
Caruso F, Catanuto G, De Meo L et al (2008) Outcomes of bilateral mammoplasty for early stage breast cancer. Eur J Surg Oncol 34:1143–1147
Rietjens M, Urban CA, Rey PC et al (2007) Long-term oncological results of breast conservative treatment with oncoplastic surgery. Breast 16:387–395
Losken A, Dugal CS, Styblo TM, Carlson GW (2014) A meta-analysis comparing breast conservation therapy alone to the oncoplastic technique. Ann Plast Surg 72:145–149
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
1 Electronic Supplementary Material
(MOV 2134500 kb)
Rights and permissions
Copyright information
© 2019 Springer International Publishing AG, part of Springer Nature
About this chapter
Cite this chapter
Calhoun, K.E., Anderson, B.O. (2019). Oncoplastic Surgery: Central Quadrant Techniques. In: Urban, C., Rietjens, M., El-Tamer, M., Sacchini, V.S. (eds) Oncoplastic and Reconstructive Breast Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-62927-8_26
Download citation
DOI: https://doi.org/10.1007/978-3-319-62927-8_26
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-62925-4
Online ISBN: 978-3-319-62927-8
eBook Packages: MedicineMedicine (R0)