Surgical techniques for personalized oncoplastic surgery in breast cancer patients with small- to moderate-sized breasts (part 2): volume replacement

Abstract

Oncoplastic breast surgery has become a popular choice of treatment for breast reconstruction after mastectomy. There are two different techniques in oncoplastic surgery depending on the volume of the excised breast tissue. One is the volume displacement procedure, which combines resection with a variety of different breast-reshaping and breast-reduction techniques; the other is the volume replacement procedure in which the volume of excised breast tissue is replaced with autologous tissue. In this study, current authors performed various volume replacement techniques based on the weight of the excised tumor and its margin of resection. We used a latissimus dorsi myocutaneous flap for cases in which the resection mass was greater than 150 g, and for cases in which the resection mass was less than 150 g, we used a regional flap, such as a lateral thoracodorsal flap, a thoracoepigastric flap, or perforator flaps, such as an intercostal artery perforator flap or a thoracodorsal artery perforator flap. In the patients with small to moderate-sized breasts, when a postoperative deformity is expected due to a large-volume tumor resection, the replacement of non-breast tissue is required. Many of whom have small breasts, oncoplastic volume replacement techniques in breast-conserving surgery allow an extensive tumor excision without concern of compromising the cosmetic outcome and can be reliable and useful techniques with satisfactory aesthetic results.

Keywords: Breast conserving surgery; Breast neoplasms; Onocoplastic; Volume replacement.

Figure 1

This figure shows an algorithm of partial breast reconstruction with oncoplastic techniques in small- to moderate-sized breasts. ICAP=intercostal artery perforator; TDAP=thoracodorsal artery perforator; LD=latissimus dorsi.

Figure 2

A 43-year-old woman with invasive ductal carcinoma in left lower outer breast. (A) Preoperative view. (B, C) Intraoperative views of elevation and insetting of adipofascial flap after partial mastectomy. (D) 3-month postoperative outcome.

Figure 3

A 51-year-old woman with invasive ductal carcinoma in left upper outer breast. (A) Preoperative view. (B) Intraoperative view of designed lateral thoracodorsal flap after partial mastectomy. (C) Intraoperative view of the elevated flap. (D) 24-month postoperative outcome.

Figure 4

A 60-year-old woman with invasive ductal carcinoma in right upper outer breast. (A) Preoperative view. (B) Intraoperative view of designed thoracoepigastric flap after partial mastectomy. (C) Intraoperative view of the inset flap. (D) 20-month postoperative outcome.

Figure 5

A 39-year-old woman with invasive ductal carcinoma in right upper outer breast. (A) Preoperative view. (B, C) Intraoperative views of elevated intercostal artery perforator flap after partial mastectomy. (D) 13-month postoperative outcome.

Figure 6

A 59-year-old woman with invasive ductal carcinoma in left central breast. (A) Preoperative view. (B) Intraoperative view of designed thoracodorsal artery perforator flap after partial mastectomy. (C) Intraoperative view of the elevated flap. (D) 2-month postoperative outcome.

Figure 7

A 39-year-old woman with ductal carcinoma in situ in right upper outer breast. (A) Preoperative view. (B) Intraoperative view of designed Latissimus dorsi myocutaneous flap. (C) Intraoperative view of the elevated flap. (D) 10-month postoperative outcome.