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. 2014 Aug;57(4):E134-40.
doi: 10.1503/cjs.031213.

Oncoplastic reduction using the vertical scar superior-medial pedicle pattern technique for immediate partial breast reconstruction

Yoav Barnea  1 , Amir Inbal  2 , Daphna Barsuk  3 , Tehila Menes  3 , Arik Zaretski  1 , David Leshem  1 , Jerry Weiss  1 , Schlomo Schneebaum  3 , Eyal Gur  1
Affiliations

Oncoplastic reduction using the vertical scar superior-medial pedicle pattern technique for immediate partial breast reconstruction

Yoav Barnea et al. Can J Surg. 2014 Aug.

Abstract
in English, French

Background: Oncoplastic breast reduction in women with medium to large breasts has reportedly benefitted them both oncologically and cosmetically. We present our experience with an oncoplastic breast reduction technique using a vertical scar superior-medial pedicle pattern for immediate partial breast reconstruction.

Methods: All patients with breast tumours who underwent vertical scar superior-medial pedicle reduction pattern oncoplastic surgery at our centre between September 2006 and June 2010 were retrospectively studied. Follow-up continued from 12 months to 6 years.

Results: Twenty women (age 28-72 yr) were enrolled: 16 with invasive carcinoma and 4 with benign tumours. They all had tumour-free surgical margins, and no further oncological operations were required. The patients expressed a high degree of satisfaction from the surgical outcome in terms of improved quality of life and a good cosmetic result.

Conclusion: The vertical scar superior-medial pedicle reduction pattern is a versatile oncoplastic technique that allows breast tissue rearrangement for various tumour locations. It is oncologically beneficial and is associated with high patient satisfaction.

Contexte: Chez des femmes qui avaient une poitrine de moyenne à volumineuse, la réduction mammaire oncoplastique aurait exercé des bienfaits, tant au plan oncologique que cosmétique. Nous présentons notre expérience d’une technique de réduction mammaire oncoplastique à cicatrice verticale et pédicule supéromédian pour une reconstruction mammaire partielle immédiate.

Méthodes: Tous les cas de tumeurs mammaires soumis à la réduction à cicatrice verticale et pédicule supéromédian en chirurgie oncoplastique dans notre centre entre septembre 2006 et juin 2010 ont été passés en revue rétrospectivement. Le suivi s’est échelonné sur 1 à 6 ans.

Résultats: Vingt femmes (âgées de 28 à 72 ans) ont été inscrites : 16 étaient atteintes d’un cancer envahissant et 4 de tumeurs bénignes. Elles présentaient toutes des marges chirurgicales libres de tumeur et aucune autre intervention oncologique n’a été nécessaire. Les patientes ont exprimé un degré élevé de satisfaction à l’endroit des résultats de la chirurgie pour ce qui est de l’amélioration de leur qualité de vie et de l’effet cosmétique positif.

Conclusion: La technique de réduction à cicatrice verticale et pédicule supéromédian est une technique oncoplastique flexible qui permet un réarrangement des tissus mammaires en fonction de la localisation des tumeurs. Au plan oncologique, elle est bénéfique et associée à un degré élevé de satisfaction chez les patientes.

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Figures

Fig. 1
Fig. 1
A 45-year-old patient with infiltrating ductal carcinoma (IDC) of her left breast located at the lateral pole (A, B). She previously underwent left lumpectomy with a periareolar incision twice, with involved tumour margins on both occasions. She underwent left relumpectomy with vertical scar superior-medial pedicle reduction pattern oncoplastic surgery and right breast reduction. Postoperative pictures (C, D) 1.5 years after surgery and radiation therapy to the left breast.
Fig. 2
Fig. 2
A 46-year-old patient with infiltrating ductal carcinoma (IDC) of her right breast located under the nipple/areola complex (NAC) (A, B). The patient underwent right lumpectomy, including the NAC, leaving a large central defect (C). Glandular tissue from the inferior-medial pole based medially was rotated to the central area of the breast to fill in the defect (D). The left breast was reduced simultaneously. Postoperative pictures (E, F) 1 year after surgery and radiation therapy to the right breast.
Fig. 3
Fig. 3
Schematic illustration of patients’ breast tumour locations (22 tumours in 20 patients).
Fig. 4
Fig. 4
A 56-year-old patient with a history of left breast cancer and current diagnosis of bilateral breast cancer (A). She underwent left mastectomy and immediate reconstruction with implant and right lumpectomy with vertical scar superior-medial pedicle reduction pattern oncoplastic surgery (B). She underwent right revision surgery owing to breast asymmetry and nipple position (C).
Fig. 5
Fig. 5
A 39-year-old patient with infiltrating ductal carcinoma (IDC) of her right breast located at the upper-lateral pole (A). She underwent right lumpectomy with vertical scar superior-medial pedicle reduction pattern oncoplastic surgery and left breast reduction. Postoperative picture (B) 1 year after surgery and radiation therapy to the right breast.
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Supplementary concepts