J Korean Med Assoc.  2009 Oct;52(10):981-995. 10.5124/jkma.2009.52.10.981.

Oncoplastic Breast Surgery

• Bae YT

• KMID: 2188080
• DOI: http://doi.org/10.5124/jkma.2009.52.10.981

Abstract

For the majority of patients with breast cancer, a surgery that minimizes breast loss combined with radiotherapy has become a popular treatment of choice. The wider clearance margins are necessary for the lower risk of local recurrences, although the greater amount of breast tissue should be removed and the risk of deformation of the breast is higher. Satisfactory cosmetic results can be achieved by oncoplastic breast surgery. The aims of this paper are to review articles of oncoplastic surgery for breast cancer and to summarize the full range of immediate reconstructions from local flaps to sophisticated perforator flaps. It is important for a surgeon to minimize breast loss while the operation and maintain the patient's feeling that her breasts are still a part of her own body after the operation. The oncoplastic breast surgery will become an integral element of the surgical treatment of breast cancer in the future.

Keyword

Breast cancer; Breast conserving surgery; Breast reconstruction; Immediate breast reconstruction

MeSH Terms

Breast
Breast Neoplasms
Cosmetics
Female
Humans
Mammaplasty
Mastectomy, Segmental
Perforator Flap
Recurrence
Cosmetics

Figure

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  Figure 1A Preoperative view of a 51-year-old patient suffering symptomatic macromastia with invasive carcinoma in the upper outer quadrnat of the right breast and the ductal carcinoma in situ in the upper outer quadrant of left breast.

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  Figure 1B Intraoperative view showing the completion of bilateral breast reduction with a Wise-pattern inferior pedicle technique.

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  Figure 1C The aesthetic outcome of bilateral breast reduction with a Wise-pattern inferior pedicle technique.

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  Figure 2A Preoperative view of the left breast with a tumor located at lower pole of left breast (Lt.) and close-up view (Rt.).

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  Figure 2B A partial mastectomy and thoracoeipigasric flap was designed.

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  Figure 2C Intraoperative view showing rotation of thoracoepigastric flap into the defect of lower pole of left breast after partial mastectomy.

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  Figure 2D View of showing skin closure and a complete reconstruction by rotation of thoracoepigastric flap.

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  Figure 2E Postoperative front and oblique views of thoracoepigastric flap after three months.

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  Figure 3A Preoperative view of rotational flap designed to perform a wide excision and transfer subaxillary skin and subcutaneous fat into the upper outer quadrant.

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  Figure 3B Intraoperative view showing a partial mastectomy and incision of rotational flap.

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  Figure 3C Immediate postoperative view showing skin closure and completion of rotational flap.

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  Figure 3D Postoperative view shows aesthetic outcome after six months.

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  Figure 4A Preoperative view showing a patient with a mass located in the upper outer quadrant of right breast and planned for partial mastectomy and repairing of the defect with a superiorly based local flap.

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  Figure 4B Intraoperative view showing a partial mastectomy and incision of superiorly based local flap.

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  Figure 4C Immediate postoperative view showing skin closure and completion of superiorly based local flap.

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  Figure 4D Postoperative view showing aesthetic outcome after six months.

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  Figure 5A Preoperative view of a 44-year-old patient with invasive ductal carcinoma in the mid-upper quadrant of right breast.

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  Figure 5B A view showing a mass located in the mid-upper quadrant of right breast and the planned for partial mastectomy and repairing of the defect with a inferiorly based local flap.

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  Figure 5C Intraoperative view showing a partial mastectomy defect and incision of inferiorly based local flap.

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  Figure 5D Immediate postoperative view showing skin closure and completion of inferiorly based local flap.

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  Figure 5E Postoperative view showing aesthetic outcome of front and oblique views after six months.

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  Figure 6A A patient with a mass located in transition zone of the upper and lower outer quadrants of the left breast. A partial mastectomy and lateral thoracodorsal fasciocutaneous flap was designed.

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  Figure 6B A intraoperative view of the lateral thoracodorsal fasciocutaneous flap dissected and rotated into the lateral breast defect.

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  Figure 6C Immediate postoperative view showing skin closure and completed reconstruction by a rotation of lateral thoracodorsal fasciocutaneous flap.

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  Figure 6D Postoperative view three-month after lateral thoracodorsal fasciocutaneous flap.

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  Figure 7A Preoperative view of patient with ductal carcinoma in situ in the upper and lower outer quadrants of left breast with diffuse microcalcification.

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  Figure 7B The drawing of supra-areolar incision for standard nipple areolar sparing mastectomy.

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  Figure 7C The nipple was inverted by index finger and the milk ducts were exposed. After cutting the milk ducts with tips of Mezenbaum scissors, the tissue was sent for frozen section. This procedure was repeated to expose the clear margin of nipple-areolar complex.

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  Figure 7D Intraoperative view by transillumination with the dissected skin flap containing subcutaneous fat and superficial fascia of the gland to avoid any breast parenchyma remained on the skin flap.

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  Figure 7E A specimen mammographic view showing diffuse microcalcifications and adequate margins.

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  Figure 7F A view of skin closure of nipple areolar sparing mastectomy with immediate reconstruction with latissimus dorsi flap with implant.

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  Figure 7G Postoperative view six-month after of nipple areolar sparing mastectomy with immediate reconstruction with latissimus dorsi flap with implant.

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