Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Apr 24;18(Suppl 1):21.
doi: 10.1186/s12893-018-0467-3.

The axillary flap in oncoplastic resection of breast cancers located in the upper-outer quadrants: a new surgical technique

Daniele Bordoni  1 , Pierfrancesco Cadenelli  2 , Matteo Ornelli  3 , Giuseppe Falco  4 , Antonello Accurso  5 , Antonio Gloria  6 , Saverio Maietta  7 , Nicola Rocco  8 , Cesare Magalotti  1
Affiliations

The axillary flap in oncoplastic resection of breast cancers located in the upper-outer quadrants: a new surgical technique

Daniele Bordoni et al. BMC Surg. .

Abstract

Background: The combination of breast conserving surgery (BCS) with plastic surgery techniques has provided a useful surgical tool matching the radicality of the oncological excision with the preservation of breast cosmesis. Even though BCS represents a good option for surgical treatment of tumors located in these quadrants, wide excisions often necessitate breast reshaping in order to avoid nipple areola complex (NAC) displacement and skin retraction. We present a new surgical technique to repair upper-outer quadrants' defects following breast cancer excision using dermo-glandular flaps and an axillary adipo-fascial flap.

Methods: During the period from January 2014 to December 2015, 168 patients with an upper-outer quadrant's breast cancer have been treated in our Department. 83 women have been treated with the described oncoplastic technique and immediate contra-lateral symmetrisation and 85 women underwent standard BCS. We present surgical, oncological and cosmetic outcomes comparing our results with standard BCS.

Results: At a mean follow-up of 27 months loco-regional recurrences in the two groups were comparable. Short-term complication rates were comparable between the two groups. Re-intervention rates for positive margins were significantly higher in the standard BCS group. The overall satisfaction with cosmetic outcome both assessed by the patient and the surgeon was significantly higher in the oncoplastic group.

Conclusions: The proposed oncoplastic technique represents a safe and effective solution for reshaping that follows upper-outer breast cancer wide excision, achieving comparable complication rates, lower re-intervention rates for positive margins and better cosmetic results when compared with standard BCS.

Keywords: Breast Cancer; Oncoplastic breast surgery; Surgical technique.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Case 1. a = Pre-operative drawings; b = Intra-operative view: the skin overlying the tumour is undermined in a mastectomy fashion (3–4 mm flap thickness) and a wide excision of the tumour down to the pectoralis fascia is performed (yellow circle); c, d, e = Intra-operative view: the axillary flap is rotated to fill the defect in the Upper-Outer Quadrant (yellow arrows); f = 1-year follow-up result
Fig. 2
Fig. 2
Case 2. a, b = Pre-operative drawings; c = Intra-operative view: the skin overlying the tumour is undermined in a mastectomy fashion (3–4 mm flap thickness) and a wide excision of the tumour down to the pectoralis fascia is performed (yellow circle); d, e, f = Intra-operative view: the axillary flap is rotated to fill the defect in the Upper-Outer Quadrant (yellow arrows); g = Immediate post-operative result; h = 1-year follow- up result
See this image and copyright information in PMC

References

    1. Kronowitz SJ, Feledy JA, Hunt KK, et al. Determining the optimal approach to breast reconstruction after partial mastectomy. Plast Reconstr Surg. 2006;117:1–11. doi: 10.1097/01.prs.0000194899.01875.d6. - DOI - PubMed
    1. Baja AK, Kon PS, Oberg KC, Miles DA. Aesthetic outcomes in patients undergoing breast conservation therapy for the treatment of localized breast cancer. Plast Reconstr Surg. 2004;114:1442. doi: 10.1097/01.PRS.0000138813.64478.A7. - DOI - PubMed
    1. Jacobs L. Positive margins: the challenge continues for breast surgeons. Ann Surg Oncol. 2008;15:1271–1272. doi: 10.1245/s10434-007-9766-0. - DOI - PMC - PubMed
    1. Morrow M, Hamilton AS, Katz SJ. Why do women get mastectomy? Results from a population-based study. J Clin Oncol. 2007;25:605. - PubMed
    1. Bordoni D, Cadenelli P, Rocco N, Ornelli M, Tessone A, Falco G, Magalotti C. Oncoplastic resection of breast cancers located in the upper-inner quadrants: a safe and effective surgical technique. Eur J Plast Surg. 2017. 10.1007/s00238-017-1340-9.