Esthetic result of rhomboid flap repair after breast-conserving surgery for lower quadrant breast cancer lesion with skin invasion: Report of two cases

Abstract

Breast-conserving surgery (BCS) has been increasingly performed as a standard operative strategy for patients with breast cancer. The primary purpose of BCS is to acquire both local control and good cosmetic results. An insignifi cant difference in cancer treatment results has been shown between BCS and total mastectomy. However, achieving suffi ciently cosmetic results can be diffi cult, particularly in patients with tumors that are large or localized to the lower quadrant. To avoid breast deformities and asymmetries after BCS, immediate reconstruction using autologous tissue has been accepted as the standard option. Rhomboid skin and adipose fl ap repair is a simple, less invasive procedure than the myocutaneous fl ap, which has primarily been performed in patients with upper quadrant lesions. We herein report the cases of two patients with lower quadrant breast cancer with skin invasion, who underwent BCS with immediate breast repair using a rhomboid fl ap. This procedure is therefore worth considering as one of the fi rst options for immediate repair after BCS.

Rhomboid Flap Technique in Breast-conserving Surgery: An Alternative Method for the Reconstruction of Lumpectomy Defects

“…RF reconstruction was used for upper outer quadrant defects in breast cancer patients in their study (8). Because of its adequate cosmetic results, Tanaka et al applied RF in distressed breast fields, involving two lower outer quadrant defects (9). We think that RF gives better cosmetic results in lower outer quadrant defects than upper outer quadrant defects because the scar tissue is hidden in the former (Figure 3).…”

“…Unintended consequences, such as deviation or distortion of the nipple-areola complex, loss of gland or skin, breast retraction, and breast asymmetry, may be seen after BCS (9)(10)(11)(12). Large tumor size is a relative contraindication for BCS.…”

“…However, patients with a large tumor size in comparison with the breast and tumors close to the skin generally lose an opportunity to undergo BCS because of poor outcome of cosmetic results against a safe margin of resection (11,13). After BCS, RF and other reconstructive methods, such as implant application, rotation flap approach, autologous free dermal fat graft, intramammarian flap reconstruction, latissimus dorsi flap application, and pedicled local flap to the defective region, are currently used (7,9,11,(14)(15)(16)(17)(18). Reconstructions of lumpectomy defects include volume displacement and replacement techniques.…”

“…The RF technique in BCS was first described in 1978 by Cooperman and Dinner (7), and it provides immediate reconstruction of partial defects of tissue and skin at the time of BCS, especially for outer quadrant tumors (7)(8)(9)(10).…”

Two Cases of Breast Reconstruction with a Limberg Flap

“…The upper outer aspect of the breast is a particularly good candidate because the scar will be well hidden and axillary lymph node dissection is possible without an additional incision. LF reconstruction of the outer lower aspect of the breast is possible, but constriction of the inframammary groove has been reported 7) . However, according to Da Silva et al, such constriction can be corrected later with no technical difficulty 8) .…”