Reduction and Mastopexy Techniques for Optimal Results in Oncoplastic Breast Reconstruction

Abstract

Breast conservation therapy has emerged as an important option for select cancer patients as survival rates are similar to those after mastectomy. Large tumor size and the effect of radiation create cosmetic deformities in the shape of the breast after lumpectomy alone. Volume loss, nipple displacement, and asymmetry of the contralateral breast are just a few concerns. Reconstruction of lumpectomy defects with local tissue rearrangement in concert with reduction and mastopexy techniques have allowed for outstanding aesthetic results. In patients who have a reasonable tumor- to breast-size ratio, this oncoplastic surgery can successfully treat the patient's cancer while often improving upon preoperative breast shape. Specific surgical guidelines in reduction and mastopexy help achieve predictable aesthetic results, despite the effects of radiation, and can allow for a single surgical procedure for cancer removal, reconstruction, and contralateral symmetry in one stage.

Keywords: breast cancer; breast conservation therapy; breast reconstruction; oncoplastic surgery.

Fig. 1

Patient who underwent lumpectomy without oncoplastic surgery and a cosmetically unfavorable result.

Fig. 2

Patient who had a vertical skin pattern excision. (A) Preoperative markings. (B) Intraoperative exposure. (C) Preradiation. (D) Final result at 9 months after radiation therapy.

Fig. 3

Traditional Wise-pattern markings and tumor identified with wire localization.

Fig. 4

Patient with left upper-outer quadrant breast cancer. (A) Preoperative anterior view. (B) Preoperative lateral view. (C) One year after radiation, anterior view. (D) One year after radiation, lateral view, showing reasonable symmetry in a single surgical intervention.

Fig. 5

Patient status post right lumpectomy and radiation. (A) Preoncoplastic surgery at time of referral. (B) Intraoperative view showing measurements. Note distance of inframammary fold to the nipple–areolar complex on radiated side is purposefully placed 1 cm longer to account for settling of the contralateral nonradiated breast. (C) Final postoperative result.