An oncoplastic procedure for central and medio-cranial breast cancer

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Abstract

Breast conserving therapy shows remarkable oncologic results and is eligible for up to 73% of patients with breast cancer. Cosmetic results are good, however, in patients with central or medio-cranial (“no-man's land”) located breast cancer, the cosmetic result may be unsatisfying. The use of different breast reduction techniques have been shown to increase resection free margins and improve cosmetic results. We report here about the use of the Hall Findlay breast reduction technique for oncoplastic surgery to improve the cosmetic result in 11 patients. The Hall Findlay technique shows good postoperative breast symmetry, all patients had resection free margins above 5 mm and are free of disease at a mean follow-up of 12 months. The technique may be used for breast cancer at various locations and reduces scar visibility and morbidity.

Introduction

The debate about the oncologic safety of breast conserving therapy (BCT) in patients with stage I and II breast cancer is over after Veronesi and Fisher published the results of their prospective randomised trials.1, 2 In about 15% of patients the quadrantectomy may lead to a significant lack in cosmetic outcome, which may be improved by the lumpectomy technique.3, 4, 5 However, 23% are still dissatisfied with their appearance.6 This may be due to the use of BCT in patients with unfavourable cancer locations. In the last 10 years our institution operated on 2090 breast cancer patients using the lumpectomy technique. The BCT-rate in this cohort was 78%. Patients undergoing BCT were very much satisfied with their results except singular patients with central, medio-cranial or caudal cancer locations.

Several oncoplastic techniques have already been described to improve the cosmetic outcome after BCT,7, 8, 9 such as concomitant breast reduction and local parenchyma flaps. Moreover these techniques have been shown to increase the size of the resection free margins and improve the cosmetic outcome.10, 11 We report here about the use of the Hall Findlay vertical breast reduction technique12 to improve cosmetic outcome in patients with “central breast cancer” or breast cancer located in the upper inner quadrant called the “no-man's land”.

Section snippets

Inclusion criteria and eligibility

Patients with histologically verified stage I or II breast cancer were eligible for combining BCT with the Hall Findlay breast reduction. Oncologic exclusion criteria for this modified BCT were the same as for all BCT: no microscopic resection free margin (R0 resection) after reasonable attempts, multicentric carcinoma, inflammatory breast cancer, progressive disease after neoadjuvant chemotherapy, contraindication for radiotherapy and the patient's own preference. Non-oncologic exclusion

Operative procedures

From September 2005 to September 2006, 11 women were operated with this technique due to central (n = 7) or medio-cranial (n = 4) breast cancer. Five patients were operated by a single surgeon (F.F.); the other 6 patients were operated by 2 surgeons (G.N. and S.G.). Four women had to undergo secondary mastectomy 2 weeks after the first operation. In these 4 women, 3 had multicentric intraductal breast cancer not seen in the mammogram or during intraoperative frozen sectioning, 1 woman had a

General considerations

Oncoplastic surgery defines the combination of reconstructive techniques with oncologic surgery.15 Recently, Clough et al. presented excellent cosmetic and oncologic results of 300 women after oncoplastic surgery.11, 16 Main advantages are the increased distance of the resection margins10 and the improved cosmetic outcome.17, 18

Not all patients with breast cancer may need oncoplastic surgery.16 Eligible patients usually have an unfavourable relation in size between breast and tumor, medium or

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