Oncoplastic central quadrantectomies

Centrally located breast carcinomas treated with central quadrantectomy and immediate nipple-areola reconstruction: a cohort study

BACKGROUND

Mastectomy has often been cited as the favoured option for centrally located breast tumours because lumpectomies or quadrantectomies that remove the nipple-areola complex often result in poor cosmesis. Currently, breast-conserving treatment is a preferred treatment for centrally located breast tumours, but this approach requires oncoplastic breast technique to avoid aesthetic sequels. This article describes the use of breast reduction techniques with immediate nipple-areola complex reconstruction (utilised to treat breast cancer) for centrally sited breast tumours PATIENTS: Ten patients suffering from a centrally located breast carcinoma were treated at our breast unit over a period of 16 years (2006-2022). Oncologic and patient-reported outcomes were updated revising electronic reports and surveying with BREAST-Q module Breast conserving therapy (version 2, Spanish) postoperative scales.

RESULTS

Excision margins were complete in all cases. There have been no postoperative complications, all patients are alive and no cases of recurrence after 84.8 months of mean follow-up. Patients score the domain satisfaction with breast: mean 61.7 (Standard deviation 12.5) out of 100.

CONCLUSIONS

Breast reduction mammaplasty with immediate nipple-areola complex reconstruction allows surgeons to carry out a central quadrantectomy to treat centrally located breast carcinoma with good oncologic and cosmetic outcome.

Oncoplastic surgery for Paget's disease of the breast

Introduction

Paget's disease of the breast (PDB) is a rare nipple entity associated with multifocality. Due to its location, resection of the entire nipple-areolar complex is necessary. Historically central quadrantectomy and mastectomy have the surgical treatments of choice. The feasibility of oncoplastic breast surgery (OBS) for PDB is unknown.

Methods

This was a retrospective study performed in a Brazilian oncological hospital. We evaluated the factors related to the performance of OBS in PDB. In addition, the impact of OBS on local recurrence and survival was analysed. Comparisons were made between groups using the chi-square test, Mann-Whitney U test, and Kaplan-Meier method. To assess the impact factor of the variables on the performance of OBS, logistic regression was performed.

Results

Eighty-five patients were evaluated. OBS was performed in 69.4% (n=59), and of these, 16 (27.2%) were symmetrized with contralateral surgery. Mastectomy without reconstruction was performed in 28.3% of the patients. The primary procedure performed was mastectomy with reconstruction (n=38; 44.7%), and the preferential technique for immediate reconstruction was skin-sparing mastectomy with prosthesis; for late reconstruction, the preferred technique was using the latissimus dorsi. Breast conserving-surgery was performed in 27.0% (n=23), primarily using the plug-flap technique (OBS). Age was associated with the use of OBS; as patients aged 40-49 exhibited a higher rate of OBS (p = 0.002; odds ratio 3.22). OBS did not influence local recurrence (p=1.000), overall survival (p=0.185), or cancer-specific survival (p=0.418).

Conclusion

OBS improves options related to surgical treatment in PDB without affecting local recurrence or survival rates.

A new oncoplastic technique for removal of centrally located malignant tumors and reconstruction by a local dermo-glandular flap in conservative breast surgery

AIM

To evaluate the local dermo-glandular flap as a new reconstructive oncoplastic technique after removal of central malignant tumors of the breast, in terms of patient satisfaction and local recurrence.

PATIENTS AND METHODS

This study included 60 females with centrally located breast cancer who underwent central quadrantectomy and local dermo-glandular flap with either sentinel lymph node biopsy or axillary clearance.

RESULTS

The mean age of the patients was 49.68 ± 8.52 years. The duration of the operation ranged from 68-105 minutes, with a mean of 79.77 ± 9.41 minutes. Local recurrence was observed in three patients (5.00%) with no distant metastasis. Forty-seven patients (78.33%) reported satisfaction after the operation. Ugly scarring and the existence of tissue defects were the main factors affecting patient satisfaction. Correction of these complications increased overall satisfaction to 88.33%.

CONCLUSIONS

For small- and medium-sized breasts, the use of a local dermo-glandular flap for the management of centrally located malignant tumors seems to be a simple and easy technique with good oncological outcomes and acceptable few minor complications. This technique offers an immediate reconstruction of a new areola with fewer scars that will be hidden later after areola tattooing. Most of the patients reported satisfaction three months after areola reconstruction.

Update on oncoplastic techniques in breast conserving surgery: algorithms for predictable results and custom-made reconstructions

Breast cancer surgery is going to be a relevant specialty involved in the multidisciplinary disease management, finalized to guarantee high performances on mortality reduction together with a quality of life improvement. The intellectual architecture of this field is characterized by its inclination to respect, sharing, empathy and scientific knowledge that can make it a high model of medical culture. In this context, oncoplastic breast conserving surgery is identified by special aesthetic sensitivities, as well as creativity and innovation. Knowing how to reshape the gland and fill the gaps, planning the targeted exeresis design, while anticipating the final outcome, respecting symmetries and ensuring first of all oncological safety, are the new skills that are required to the breast surgeon. Several tecniques could provide a refined surgical treatment but always challenging according to anatomical findings and patient expectations, as a systematic process of self-critical reflection, with the purpose to optimize criteria for improving therapeutic results.

Evolution and time trends of nipple-sparing mastectomy: a single-center experience

Nipple Sparing Mastectomy (NSM) requires the entire breast tissue to be removed, maintaining the nipple-areola complex, and represents nowadays the gold standard of the demolitive breast surgery. Although it represents the evolution of conservative breast surgery, NSM presents some limitations in the selection of women candidates for treatment, and still there are no real guidelines regarding its indications, but simply objective data to address the choice. How the breast surgery approach to demolitive and conservative surgery has changed over time? We evaluated throughout the years (from 2009 up to 2018) the time trend of NSM at our institution and analysed the main differences between patients undergone NSM and other mastectomies and/or breast conserving surgery in terms of cancer size, multicentricity and biological profile. We found 781 NSMs, 1261 other mastectomies and 5621 breast conservative surgeries. Among NSMs, 39.6% were reconstructed with tissue expander and 58.1% with definitive prosthesis. From 2009 to 2018 we found a general increase of NSM rate (from 21.3% of all mastectomies in 2009 to 67.3% in 2018) and a decrease of total mastectomies (from 78.7% of all mastectomies in 2009 to 32.7% in 2018). In line with the literature data, our data confirm that in the recent years NSM represents the gold standard for radical breast surgery. Undisputed in prophylaxis, NSM is continuously acquiring more support in being used as first line treatment for locally advanced disease.

Oncoplastic Breast Conserving Surgery: Aesthetic Satisfaction and Oncological Outcomes

Objective

Oncoplastic breast conserving surgery (BCS) involves radical excision of tumors while maintaining the natural breast contours. In this study, we present the results of the oncoplastic BCS surgeries performed in our clinic.

Material and Methods

13 breast cancer patients who had undergone oncoplastic BCS were included in this retrospective study. Postoperative photographs and retrospective chart reviews were used to evaluate the results. Aesthetic satisfaction level was verbally obtained from the patients.

Results

Oncoplastic BCS was performed using superomedial, superolateral, superior and inferior pedicles. All the patients were highly satisfied with the final aesthetic results and tumor free at the postoperative 12 months.

Conclusion

Oncoplastic BCS can achieve favorable results regarding the final aesthetic appearance and tumor control.