Breast deformity, its correction, and assessment of breast conserving surgery

Abstract

A combination of quadrantectomy, axillary dissection, and radiotherapy (QUART) is the regimen most favored by Japanese surgeons among a variety of breast conserving therapies currently available against breast cancer. Unfortunately, extensive resections such as quadrantectomy often give poor local cosmetic results in patients with small breasts. With the aim of improving the cosmetic aspect after an extensive resection, immediate transposition of the latissimus dorsi muscle (LDM) was carried out in breast conserving surgery. To date, twenty-one patients have been entered in this study. Post-quadrantectomy breast deformity was not corrected in six patients including one with bilateral breast cancers, but was corrected by transposition of a part of LDM in 14 other patients. In the last patient, who also had bilateral breast cancers, the right breast was treated by QUART and the left breast by subcutaneous mastectomy followed by transposition of LDM. The cosmetic outcome for these patients was assessed both subjectively and objectively; the objective assessment used a Moire topography camera. The postoperative appearance and topography revealed a satisfactory symmetry of breasts in the transposed patients, especially those with small breasts, when compared with non-transposed patients. It may be concluded that the transposition of LDM is useful in preventing breast deformity following an extensive resection in breast conserving surgery.

Oncoplastic surgery combining partial mastectomy with breast reconstruction using a free nipple-areola graft for ductal carcinoma in situ in a ptotic breast: Report of a case

“…9 The fi nal cosmetic result of BCT is dependent on many factors, including the size and location of the tumor, breast volume, the extent of surgery, chemotherapy, radiotherapy, hormone therapy, and age. [10][11][12][13][14] The tumor size in relation to the breast size is one of the most important factors to consider when attempting to obtain a cosmetically favorable result. Performing a resection that is wide enough to obtain optimal oncologic control often requires removing so much breast tissue that it leaves a deformed breast or a large discrepancy compared with the other breast.…”

Immediate breast reconstruction using autologous free dermal fat grafts provides better cosmetic results for patients with upper inner cancerous lesions

“…One was a minor procedure that corrected the defect immediately by transposing adipose tissue and an adjacent normal gland, and the other was immediate reconstruction using a latissimus dorsi (LD) muscle fl ap. 11,17,18 The former method was convenient, but the cosmetic outcome sometimes failed shortly after the operation. Regarding the latter method, although it was possible to achieve a good cosmetic outcome, the surgical procedure was complicated and the operation was longer.…”

“…[5][6][7][8] Different methods of parenchymal redistribution have been described to fi ll small or moderate defects in the breast. [9][10][11][12][13] These all fundamentally rely on advancement, rotation, or transposition of a large area of the breast in order to fi ll the defect. This effectively absorbs the volume loss over a much larger area, thus decreasing the risk of a localized defect; however, wide excision removes a large amount of breast tissue and often results in poor local cosmetic results in patients with small breasts.…”

Demand for Plastic Surgical Operations after Primary Breast Cancer Surgery

“…Oncoplastic surgery has been suggested to improve the cosmetic outcome of the primary breast cancer operation without compromising the oncologic results. (10,11,12) There are only a few studies with varying results evaluating the proportion of women wanting to have a reconstruction after mastectomy. An Australian study implies that breast reconstruction after mastectomy is chosen by approximately 10 % of Australian women (13).…”