Skip to main content

Alternative Oncoplastic Techniques for Challenging Breast Conservative Surgeries

  • Chapter
  • First Online:
Book cover Oncoplastic and Reconstructive Breast Surgery
  • 1420 Accesses

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.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 189.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 249.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  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):31–46

    Article  CAS  PubMed  Google Scholar 

  2. Pestana IA, Campbell DC, Bharti G, Thompson JT (2013) Factors affecting complications in radiated breast reconstruction. Ann Plast Surg 70(5):542–545

    Article  CAS  PubMed  Google Scholar 

  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):2159–2164

    Article  PubMed  Google Scholar 

  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):354–361

    Article  CAS  PubMed  Google Scholar 

  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):26–34

    Article  PubMed  PubMed Central  Google Scholar 

  6. Audretsch W, Andree C (2006) Is mastectomy still justified—and if, in which patients? Onkologie 29(6):243–245

    PubMed  Google Scholar 

  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):1233–1241

    Article  PubMed  Google Scholar 

  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):1227–1232

    Article  PubMed  Google Scholar 

  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):42–49

    Article  PubMed  Google Scholar 

  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):534–544

    Article  PubMed  PubMed Central  Google Scholar 

  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):1118–1127

    Article  PubMed  Google Scholar 

  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):1209–1214

    Article  PubMed  Google Scholar 

  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):831–841

    Article  PubMed  Google Scholar 

  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):145–149

    Article  CAS  PubMed  Google Scholar 

  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):3342–3354

    Article  CAS  PubMed  Google Scholar 

  16. Boughey JC, Hunt KK (2015) Spotlight on neoadjuvant therapy for breast cancer. Ann Surg Oncol 22(5):1406–1407

    Article  PubMed  Google Scholar 

  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):717–730

    Article  PubMed  PubMed Central  Google Scholar 

  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):287–295

    Article  PubMed  PubMed Central  Google Scholar 

  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):387–395

    Article  CAS  PubMed  Google Scholar 

  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):71–77

    Article  PubMed  Google Scholar 

  21. Spear SL, Clemens MW, Dayan JH (2008) Considerations of previous augmentation in subsequent breast reconstruction. Aesthet Surg J 28(3):285–293

    Article  PubMed  Google Scholar 

  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):56–62

    Article  PubMed  Google Scholar 

  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):3730–3737

    Article  PubMed  PubMed Central  Google Scholar 

  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):1486–1497

    Article  PubMed  Google Scholar 

  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):1122–1127

    Article  CAS  PubMed  Google Scholar 

  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–197e

    Article  PubMed  CAS  Google Scholar 

  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 147–178

    Google Scholar 

  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):246–249

    Article  CAS  PubMed  Google Scholar 

  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):986–994

    CAS  PubMed  Google Scholar 

  30. Orlando JC, Guthrie RH (1975) The superomedial dermal pedicle for nipple transposition. Br J Plast Surg 28(1):42–45

    Article  CAS  PubMed  Google Scholar 

  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):94–101

    Article  PubMed  PubMed Central  Google Scholar 

  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–NP202

    Article  PubMed  Google Scholar 

  33. Paulinelli RR, Marinho ER (2012) Double independent pedicle oncoplastic mammaplasty: a technique for breast preservation. Rev Bras Mastol 22(1):25–32

    Google Scholar 

  34. Daher JC (1993) Breast island flaps. Ann Plast Surg 30(3):217–223

    Article  CAS  PubMed  Google Scholar 

  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):912–918

    Article  PubMed  Google Scholar 

  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):14–21

    CAS  PubMed  PubMed Central  Google Scholar 

  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):686–691

    Article  PubMed  Google Scholar 

  38. Zitelli JA (2008) Design aspect of the bilobed flap. Arch Facial Plast Surg 10(3):186

    Article  PubMed  Google Scholar 

  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):441–444

    Article  PubMed  Google Scholar 

  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):385–393

    Article  CAS  Google Scholar 

  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):268–275

    Article  PubMed  Google Scholar 

  42. Coleman SR (1995) Long-term survival of fat transplants: controlled demonstrations. Aesthet Plast Surg 19(5):421–425

    Article  CAS  Google Scholar 

  43. Clough KB, Kroll SS, Audretsch W (1999) An approach to the repair of partial mastectomy defects. Plast Reconstr Surg 104(2):409–420

    Article  CAS  PubMed  Google Scholar 

  44. Rainsbury RM (2002) Breast-sparing reconstruction with latissimus dorsi miniflaps. Eur J Surg Oncol 28(8):891–895

    Article  CAS  PubMed  Google Scholar 

  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):568–572

    Article  CAS  PubMed  Google Scholar 

  46. Cordeiro PG (2012) Discussion: current status of implant-based breast reconstruction in patients receiving postmastectomy radiation therapy. Plast Reconstr Surg 130(4):525e–526e

    Article  CAS  Google Scholar 

  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):498–502

    Article  PubMed  Google Scholar 

  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):532–535

    Article  CAS  PubMed  Google Scholar 

  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):1743–1753

    Article  PubMed  Google Scholar 

  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):1479–1484

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer International Publishing AG, part of Springer Nature

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Paulinelli, R.R. (2019). Alternative Oncoplastic Techniques for Challenging Breast Conservative Surgeries. 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_31

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-62927-8_31

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-62925-4

  • Online ISBN: 978-3-319-62927-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics