Oncoplastic Surgery for Upper/Upper Inner Quadrant Breast Cancer

Abstract

Tumors located in the upper/upper inner quadrant of the breast warrant more attention. A small lesion relative to the size of breast in this location may be resolved by performing a level I oncoplastic technique. However, a wide excision may significantly reduce the overall quality of the breast shape by distorting the visible breast line. From June 2012 to April 2015, 36 patients with breast cancer located in the upper/upper inner quadrant underwent breast-conservation surgery with matrix rotation mammoplasty. According to the size and location of the tumor relative to the nipple-areola complex, 11 patients underwent matrix rotation with periareolar de-epithelialization (donut group) and the other 25 underwent matrix rotation only (non-donut group). The cosmetic results were self-assessed by questionnaires. The average weights of the excised breast lumps in the donut and non-donut groups were 104.1 and 84.5 g, respectively. During the 3-year follow-up period, local recurrence was observed in one case and was managed with nipple-sparing mastectomy followed by breast reconstruction with prosthetic implants. In total, 31 patients (88.6%) ranked their postoperative result as either acceptable or satisfactory. The treated breasts were also self-evaluated by 27 patients (77.1%) to be nearly identical to or just slightly different from the untreated side. Matrix rotation is an easy breast-preserving technique for treating breast cancer located in the upper/upper inner quadrant of the breast that requires a relatively wide excision. With this technique, a larger breast tumor could be removed without compromising the breast appearance.

Burow’s triangle advancement flap: a reliabletool on oncoplastic breast-conserving surgery

“…The application of Burow's triangle advancement flapfirst described in the early 19 th century 12 for facial defects -to the breast 11,28 has become a fast and straightforward technique, allowing resecting the whole thickness of the affected breast quadrant, including its skin, and partial breast reconstruction with a volume displacement approach involving lateral dermoglandular rotation and advancement flap. Burow's triangle corresponds to a compensatory excision of redundant tissue at the proximal edge of any advancement flap in order to improve cosmesis and avoid standing cones 14 .…”

“…Tumors located at the superior edge of the upper quadrant or at the upper inner quadrant usually replace the whole breast thickness, compromising the anterior margin and making it difficult to preserve the skin. Tumors at these locations are a challenge for conservative surgery, whenever necessary to resect the entire breast thickness, as it might produce secondary glandular deformity, high risk of positive tumor margins, and upper NAC deviation 11 .…”

The poor prognosis of lower-inner quadrant breast cancer in patients who received neoadjuvant chemotherapy

“…Surgical techniques have also been developed for inner-quadrant breast cancer. Improving the clinical effect of surgical approaches for inner-quadrant breast cancer will require more insights into the factors that affect the thoracic cavity (18)(19)(20).…”

Oncoplastic breast surgery: Achieving oncological and aesthetic outcomes

“…In the recent decades, the surgical management of breast cancer has steadily evolved from radical surgery to breast conservation. As a result, oncoplastic surgical techniques have emerged and are expanding dramatically . Oncoplastic surgery combines oncologic resection with immediate breast reconstruction using techniques derived from plastic surgery.…”