J Breast Cancer.  2008 Dec;11(4):206-212. 10.4048/jbc.2008.11.4.206.

Immediate Breast Reconstruction with Contralateral Pectoralis Major Myomammary Flap for Breast Conserving Surgery

• Lee SJ
• Bae YT
• Seo HI
• Kang TW

• KMID: 2286587
• DOI: http://doi.org/10.4048/jbc.2008.11.4.206

Abstract

PURPOSE: There has been much reported data showing that breast reconstruction surgery does not result in reduced patient survival if the accepted principles of cancer surgery are closely followed. The proper reconstructive technique can be selected according to diverse factors, but breast size and the site of tumor are mostly important. The latissimus dorsi musculocutaneous flap (LDMCF) is one of the most commonly used techniques for early breast cancer patients who have small breasts. But, it has difficulties for supplying enough tissues to the widely excised tumor site. Especially for ptosis patients, reduction mammoplasty by itself is not enough to achieve symmetry of the breast. We suggest that the pectoralis major myomammary flap (PMMF) is a useful technique for the patients with ptosis.
METHODS
Seventeen patients with ptosis were treated with breast conserving surgery with PMMF reconstruction. A quadrantectomy rather than lumpectomy was performed through a planned skin incision, and axillary lymph node dissection was performed according to the results of sentinel lymph node biopsy. The PMMF is carefully harvested without perforating branch injury to the internal thoracic artery. Reconstruction was done via the PMMF through the medial tunnel between both breasts.
RESULTS
Among the seventeen patients, seroma occurred in two patients and no necrosis occurred at all. The cosmetic result was fair in 15 patients and poor in two patients, based on the four-point scoring system of breast cosmetics.
CONCLUSION
After performing enough quadrantectomy to adhere to the accepted principles of cancer surgery, PMMF was quite useful to supply enough proper tissues for breast reconstructions, and especially for the ptosis patients.

Keyword

Breast cancer; Ptosis; Pectoralis major myomammary flap

MeSH Terms

Breast
Breast Neoplasms
Cosmetics
Female
Humans
Lymph Node Excision
Mammaplasty
Mammary Arteries
Mastectomy, Segmental
Necrosis
Nitriles
Pyrethrins
Sentinel Lymph Node Biopsy
Seroma
Skin
Cosmetics
Nitriles
Pyrethrins

Figure

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  Fig 1 Resected breast cancer. Wide excision (free margin 1-2 cm) and axillary lymph node dissection, if sentinel node biopsy is positive, are performed through a planned skin incision.

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  Fig 2 Design of flap. After design of reduction mammoplasty, donor site of the breast fat tissue is marked.

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  Fig 3 The prepared pectoralis major myomammary flap. After skin incision is done according to previous design line of reduction mammoplasty, breast parenchyme tissue with pectoralis major muscle and its fascia are acquired carefully without injury of perforating branch of internal thoracic artery.

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  Fig 4 Reconstruction using pectoralis major myomammary flap (PMMF). PMMF is transferred to the defect through the tunnel between skin and the sternum and turned it upside down. Consequently, dorsal portion of PMMF is situated ventral portion in the defect.

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  Fig 5 Immediate postoperative state.

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  Fig 6 (A) 49 year-old-woman with the grade III of ptosis. The cosmetic result was fair. (B) 45-year-old women with multicentric breast cancer and the grade II of ptosis. The cosmetic result was fair but the skin color had been changed after radiotherapy. (C) 46-year-old woman with lesion involving nipple-areolar complex and the grade I of ptosis. The cosmetic result was poor. The level of nipple and scar in both sides are different each other. (D) 60-year-old woman with the grade II of ptosis. The cosmetic result was fair but the level of nipple and breast volume in both sides are slightly different each other.

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  Fig 7 Diagram of cancer location in breast. The figure in the box means the number of cases. I=inner; U=upper; O=outer; C=central, L=lower.

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