An oncoplastic procedure for central and medio-cranial breast cancer
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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Cited by (33)
The iTOP trial: Comparing immediate techniques of oncoplastic surgery with conventional breast surgery in women with breast cancer - A prospective, controlled, single-center study
2022, International Journal of SurgeryCitation Excerpt :OBC Level I procedures (resection of <25% of breast volume): included Doughnut mastopexy or batwing technique [27,28]. OBC Level II procedures (resection of >25% of breast volume): the techniques of choice were the Lejour/inverted-T technique for superior pedicles [29], and the modified Hall-Findlay technique for medial or lateral pedicles [30,31] or inferior pedicle variants [32]. All oncoplastic procedures were performed by one senior surgeon (FF) and the majority of patients in this group was recruited within the first three year.
Oncoplastic reconstruction of central lumpectomy defects using the medial pillar island flap
2021, Journal of Plastic, Reconstructive and Aesthetic SurgeryCitation Excerpt :In patients who present with breast ptosis, lower pole redundancy is typically employed as a donor site to create a flap, along with a mammaplasty design, for the reconstruction of the areolar defect.4-14 Several approaches have been reported mostly with Wise pattern reduction and inferior pedicle skin advancement.5-14 In this study, we present the oncoplastic reconstruction of central lumpectomy defects using medial pillar island flap along with vertical mammaplasty.
Oncological results of oncoplastic breast-conserving surgery: Long term follow-up of a large series at a single institution A matched-cohort analysis
2016, European Journal of Surgical OncologyOncoplastic surgery in breast conservation: A prospective evaluation of the patients, techniques, and oncologic outcomes
2014, American Journal of Surgery