A Modified Quadrantectomy Through Circumareolar Incision for Patients with Breast Cancer

Lee, Min Hyuk; Lim, Hoon; Baek, Moo Jun; Hur, Kyung Yul; Park, Kyung Kye; Jang, Yong Seog; Choi, Doo Ho; Moon, Chu; Kim, IK Soo

Abstract

Bast conservation therapy has become an accepted method of primary treatment for the early stage breast cancer. The extent of local excision and skin incision has been in controversy, owing to the risk of local recurrence and cosmesis. To improve breast cometic apperance following quadrantectomy for breast cancer, authors propose a novel surgical technique that is carried out local excision through circumareolar skin incision, remodeling of breast ot replace the volum loss. Level I&II axillary dissection were performed and radiotherapy were followed. Twenty-one patients underwent the novel method for breast conserving surgery from September 1995 to October 1998 in the department of surgery at Soonchunhyang University Hospital. Cosmetic outcome was evaluated by means of panel assessment and breast retraction assessment (BRA). The mean age of patient was 43.3 years(30 to 67 years). The distribution of the 22 tumors were located in the right of 11, left of 9 and both breast of 1. The mean fumor size was 1.7 cm(0.5 to 2.8cm). The type of histology was 5 of ductal carcinoma in situ, 13 infiltrating ductal carcinoma, 2 of tubular carcinoma and 1 medullary carcinoma. Five of 22 patients had metastases in the axillary nodes. The cosmetic evaluation was performed by the 3 panelist who scored it a 5-panel scale (E0 to E4). Eighteen cases were scored as E0 (excellent, 81.8%), 1 case as E1 (good), 1 case as E2 (moderate) and 2 cases as E3 (bad) cosmetic results. BRA values were calculated by simple vector geometry employing the Pythagorean theorem, BRA values for the patients ranged 0.5 to 4.4 cm with a mean of 1.6 cm and for a group of 30 control women values ranged from 0.4 to 1.8 cm with mean value of 0.9 cm. When panel scores and BRA values were compared, 18 cases of excellent (E0) scoring had under the 3.5 cm of BRA value. One of two cases with bed (E3) score had over 3.5 cm of BRA vale. Eighteen cases who were less than 60 years old had satisfactory cosmetic results by panel scoring and BRA value. Twenty one cases who underwent a novel method for breast conserving therapy were considered as excellent and fair cosmetic results. It is concluded that the remodeling of breast following modified quadrantectomy through circumareolar skin incision is useful for preventing breast deformity.