Surgical techniques for personalized oncoplastic surgery in breast cancer patients with small- to moderate-sized breasts (part 1): volume displacement

Abstract

Despite the popularity of breast-conserving surgery (BCS), which constitutes 50-60% of all breast cancer surgeries, discussions regarding cosmetic results after BCS are not specifically conducted. The simple conservation of breast tissue is no longer adequate to qualify for BCS completion. The incorporation of oncological and plastic surgery techniques allows for the complete resection of local disease while achieving superior cosmetic outcome. Oncoplastic BCS can be performed in one of the following two ways: 1) volume displacement techniques and 2) volume replacement techniques. This study reports volume displacement surgical techniques, which allow the use of remaining breast tissue after BCS by glandular reshaping or reduction techniques for better cosmetic results. Thorough understanding of these procedures and careful consideration of the patient's breast size, tumor location, excised volume, and volume of the remaining breast tissue during the surgery in choosing appropriate patient and surgical techniques will result in good cosmetic results. Surgery of the contralateral breast may be requested to improve symmetry and may take the form of a reduction mammoplasty or mastopexy. The timing of such surgery and the merits of synchronous versus delayed approaches should be discussed in full with the patients. Because Korean women have relatively small breast sizes compared to Western women, it is not very easy to apply the oncoplastic volume displacement technique to cover defects. However, we have performed various types of oncoplastic volume displacement techniques on Korean women, and based on our experience, we report a number of oncoplastic volume displacement techniques that are applicable to Korean women with small- to moderate-sized breasts.

Keywords: Breast conserving surgery; Breast neopasms; Cosmetic surgery; Volume displacement.

Figure 1

Parallelogram mastopexy lumpectomy. (A) Preoperative design with parallelogram form. (B) Lumpectomy. (C) Glandular reshaping.

Figure 2

Purse-string suture. (A) Preoperative design including tumor and nipple-areolar complex. (B) Purse-string suture with nearby breast tissue. (C) Purse-string suture with skin. (D) Final result at closure.

Figure 3

Round block technique. (A) Preoperative design with two circular skin marking. (B) Lumpectomy and de-epithelization. (C) Undermining and approximation of nearby breast tissue. (D) Postoperative periareolar scar.

Figure 4

Batwing mastopexy. (A) Preoperative design with batwing form. (B) Lumpectomy. (C) Pulling up the inferior breast tissue.

Figure 5

Tennis racket method. (A) Preoperative design with racket form. (B) Lumpectomy and de-epithelization. (C) Filling and nipple-areolar complex reposition.

Figure 6

Rotation flap. (A) Preoperative design. (B) Lumpectomy and flap elevation. (C) Flap rotation and closure.

Figure 7

Wise pattern (inverted T) reduction with inferiorly based pedicle. (A) Preoperative design. (B) Lumpectomy and deepithelized pedicle elevation. (C) Transposition of the pedicle into the new location.

Figure 8

Wise pattern (inverted T) reduction with superiorly based pedicle. (A) Preoperative design. (B) Lumpectomy and deepithelized pedicle elevation. (C) Transposition of the pedicle into the new location.

Figure 9

Vertical reduction. (A) Preoperative design. (B) Lumpectomy and deepithelized pedicle elevation. (C) New nipple positioning.