Surgical strategy, methods of reconstruction, surgical margins and postoperative complications in oncoplastic breast surgery

Abstract

Background: Oncoplastic breast surgery is an evolving discipline in the surgical treatment of breast cancer aimed to improve the outcome.

Methods: Oncoplastic breast surgery was performed between January 2008 and December 2010 on 72 women with 74 breast cancers selected from a population of 1,018 primary breast cancer patients. Careful preoperative planning revealed the possibility of partial breast reconstruction with volume reduction, volume displacement or volume replacement depending on breast size as well as tumour size and location. Data were registered consecutively.

Results: The surgical plan was successful in all but one case, where a mastectomy had to be performed during the primary surgery. In 53 cases, a contralateral mammoplasty was performed during the operation to achieve symmetry. During the follow-up period until November 2011, only one patient needed corrective surgery. Final histopathological examination indicated that seven cases required extended resection and three cases required a mastectomy. Five patients experienced delayed wound healing, although complications requiring further surgery occurred for the reconstructed breast in four cases, the contralateral breast in three cases and the axilla after exaeresis in two cases because of haematoma. Such complications led to slight delay in adjuvant therapy for four patients.

Conclusions: This study demonstrates that it is feasible to implement oncoplastic breast surgery into daily clinical practice as a supplement to conventional breast cancer surgery. As such, oncoplastic breast surgery may provide a markedly better outcome than breast-conserving surgery in terms of shape and symmetry without compromising the surgical margins. Level of Evidence: Level IV, prognostic/risk study.

Keywords: Breast cancer; Methods of reconstruction; Oncoplastic surgery; Partial breast reconstruction; Postoperative complications; Surgical margins.

Figures

Fig. 1

Illustration of the distribution of zones in the breast described by McCulley and MacMillan [14]

Fig. 2

Patient with medium to large breasts from group I. A 42-year-old woman with a 15-mm invasive ductal carcinoma located in the lower central region of the left breast (zone III). Weight of lumpectomy at 80 g, reconstruction with volume reduction technique and contralateral reduction mammoplasty. Preoperative photos (a, b) and results after radiotherapy 2 years post-surgery (c, d)

Fig. 3

Patient with medium to large breasts from group II. A 59-year-old woman with a 17-mm invasive ductal carcinoma in the upper region (zone VII) of the left breast. Weight of lumpectomy at 41 g, reconstruction with volume displacement technique with inferior-based extended flap with skin island and contralateral reduction mammoplasty. Photos preoperative (a, b), peroperative (c) and 3 months postoperative (d, e)

Fig. 4

Patient with medium to large breasts from group III. A 63-year-old woman with a 19-mm invasive ductal carcinoma located in the central region of the right breast (zone I). Weight of lumpectomy at 124 g, which included the nipple-areola complex, reconstruction with volume displacement technique with inferior-based flap and immediate nipple reconstruction and contralateral reduction mammoplasty. Photos taken preoperative (a, b), peroperative (c) and 2 years postoperative (d, e)

Fig. 5

Patient with small breasts from group IV. A 46-year-old woman with a 25-mm invasive ductal carcinoma in the lateral region (zone VI) of the left breast. Weight of lumpectomy at 40 g, reconstruction with volume replacement technique with tunnelled thoracodorsal flap with skin island and no contralateral surgery. Pre- (a, b) and postoperative photos after 3 months (c, d)