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. 2013 Apr;95(3):192-5.
doi: 10.1308/003588413X13511609958091.

Using therapeutic mammoplasty to extend the role of breast-conserving surgery in women with larger or ptotic breasts

A Currie  1 , K Chong, G L Davies
Affiliations

Using therapeutic mammoplasty to extend the role of breast-conserving surgery in women with larger or ptotic breasts

A Currie et al. Ann R Coll Surg Engl. 2013 Apr.

Abstract

Introduction: The equivalence of breast-conserving surgery followed by postoperative radiotherapy against mastectomy is now firmly established in patients with early breast cancer. The results of surgery in large-breasted women can be poor, with radiation-induced fibrosis, chronic pain and poor cosmesis contributing to long-term psychological and physical morbidity. Therapeutic mammoplasty offers an alternative management strategy to both enhance the role of breast-conserving surgery and provide better outcomes.

Methods: A retrospective note review was undertaken of all patients undergoing therapeutic mammoplasty for breast malignancy between 2007 and 2011. All cases were performed using a Wise pattern-reduction technique. Histology and pathological outcomes were assessed. Postoperative outcomes reviewed included wound infection, seroma and need for further intervention.

Results: During the study period, 20 patients underwent therapeutic mammoplasty with a mean follow-up duration of 36 months. The mean weight of the lumpectomy specimen was 330g. The average cancer size was 34mm, with a mean margin clearance of 7mm. There was one episode of wound infection and three of delayed wound healing at the T-junction. One patient required a mastectomy for involved margins. There were no recurrences at the most recent follow-up visit.

Conclusions: Therapeutic mammoplasty offers a tailored approach to women with larger breasts and early breast cancers with good cosmetic results and oncological outcomes.

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Figures

Figure 1
Figure 1
Example operative approach demonstrating technique. Cancer excised in reduction pattern excision on affected side with mirror reduction pattern excision of contralateral breast. Top: preoperative incision marking (dotted line) and example tumour location (star); middle: de-epithelialised pedicle flap (tinted area) with skin flaps closed over defect; bottom: postoperative wound closure and suture lines
Figure 2
Figure 2
Preoperative photograph of patient with 8cm right upper outer quadrant tumour undergoing therapeutic mammoplasty with preoperative markings
Figure 3
Figure 3
Postoperative photograph of patient at 1 year following therapeutic mammoplasty, radiotherapy and chemotherapy for 8cm right upper outer quadrant tumour
See this image and copyright information in PMC

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