Subaxillary Replacement Flap Compared with the Round Block Displacement Technique in Oncoplastic Breast Conserving Surgery: Functional Outcomes of a Feasible One Stage Reconstruction

Paolo Orsaria, Antonella Grasso, Georgeta Soponaru, Francesca Carnevale, Virginia Scorsone, Edy Ippolito, Francesco Pantano, Matteo Sammarra, Claudia Piccolo, Michele Altomare, Giuseppe Perrone, Vittorio Altomare, Paolo Orsaria, Antonella Grasso, Georgeta Soponaru, Francesca Carnevale, Virginia Scorsone, Edy Ippolito, Francesco Pantano, Matteo Sammarra, Claudia Piccolo, Michele Altomare, Giuseppe Perrone, Vittorio Altomare

Abstract

Background: For selected women diagnosed with breast cancer (BC), partial reconstructive techniques involve displacement or replacement procedures to improve cosmesis without compromising oncological safety. This study aims to evaluate the surgical outcomes of the round block (RB) compared with the subaxillary flap (SF) technique for patients with upper outer tumor.

Patients and methods: Thirty-three patients treated with oncoplastic conserving surgery (15 RB and 18 SF) were enrolled in this retrospective study. After carrying out a comparison of baseline characteristics, all cases were recruited for postoperative evaluation of oncological and cosmetic parameters. Moreover, we investigated several scoring combinations to check whether they could discriminate surgeon and patient satisfaction according to different functional results.

Results: Median age (p < 0.05), average tumor size (p > 0.05), estimated resection volume (p > 0.05), and nodal involvement (p > 0.05) were slightly higher in the SF group. A greater frequency of DCIS (p < 0.05) in the RB series correlated with reintervention for positive margins (p > 0.001). At a mean follow-up of 19 months, no locoregional recurrences were recorded and early and late complications were comparable (p > 0.05). The overall satisfaction with cosmesis was characterized by similar proportions of good results (p > 0.05), with some details more related to each procedure.

Conclusion: The proposed techniques represent effective solutions for reshaping that follows upper outer wide excision, achieving comparable complication rates, low reinterventions, and good aesthetic results in relation to technical and social functioning evaluations. However, it is crucial to establish a careful patient selection in order to manage correct surgical planning while predicting any potential sequelae or complication.

Keywords: breast cancer; cosmetic outcomes; displacement; oncoplastic surgery; replacement.

Conflict of interest statement

The authors have no conflict of interest to declare in relation to this study.

Figures

Figure 1
Figure 1
A 46-year-old woman with left multifocal invasive ductal carcinoma (pT1N1, luminal A G1). (a–c) Preoperative markings are shown. (c,d) Segmental resection of the upper outer on the left using the round block technique. (e,f) On table results after closing defects. (g–i) One month after surgery, frontal and side view.
Figure 2
Figure 2
A 45-year-old woman with right invasive ductal carcinoma (yT0N0, Triple Negative G3). (a–c) Preoperative markings are shown. (c–e) Segment resection of the upper outer part on the right using the subaxillary replacement flap technique after neoadiuvant chemotherapy. (e,f) On table results after closing defect. (g–i) One month after surgery, frontal and side view.

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