Reconstruction of the Breast Conservation Deformity

Abstract

The era of breast conserving treatment of early-stage breast carcinoma has created reconstructive challenges for the plastic surgeon. Although good to excellent cosmetic outcomes occur in the majority of patients, a significant number could benefit from additional reconstructive measures. Because of the need for continuing surveillance following breast-conserving therapy, estimated at 5-10% after fifteen years, plastic surgeons should choose techniques that do not interfere with the detection of recurrent breast carcinoma. Myocutaneous flaps-in particular, the latissimus dorsi and transverse rectus abdominishave fulfilled the reconstructive needs of these patients by providing well-vascularized soft tissue. Postoperative radiological evaluation has demonstrated that these flaps are radiolucent, unlike breast implants that can obscure accurate mammographic interpretation.Myocutaneous flaps have been used for both immediate and delayed reconstruction of post-breast conservation deformities. The delayed approach offers the benefit of an established contour deformity that usually involves cutaneous, parenchymal, and nippleareolar components. Moderate overcorrection of the defect has been advocated in anticipation of ongoing postradiation wound contraction and fibrosis. Immediate reconstruction of lumpectomy and partial mastectomy defects permits wider initial excision of the breast lesion, but can be compromised by positive histological margins. Long-term results suggest stability of the aesthetic outcome following reconstruction of delayed deformities.

The Role of the Lateral Thoracodorsal Fasciocutaneous Flap in Immediate Conservative Breast Surgery Reconstruction

“…In addition, reconstructive techniques that involve relocation of glandular tissue make reexcision difficult in cases where close or positive margins are observed in the permanent abnormality. 4 Although the lateral thoracodorsal fasciocutaneous flap technique did not obscure the original lumpectomy space, careful and coordinated planning with the oncologic surgeon is important in the event that reexploration is necessary. Similar to reduction mammaplasty reconstruction, we advocate orienting the glandular specimen and also placing surgical clips at the tumor margins.…”

“…Because the flap is not an axial flap, flap vascularization to the most distant parts is difficult to predict. 4,13 This situation can predispose to partial necrosis (skin and fat) and an undesirable result. Although our study demonstrated a low incidence of flap complications, care must be taken in high-risk patients such as smokers and patients with associated comorbid diseases.…”

“…[1][2][3] Recently, increasing attention has been focused on cosmetic results and reconstructive techniques. Among the main options, local flaps, 4 -6 latissimus dorsi myocutaneous flaps, 4,7 and reduction mammaplasty 8 -11 are the most commonly used techniques with more favorable results. Regardless of the fact that there is no consensus concerning the best approach, the criteria decision is determined by the surgeon's experience, tumor location, and the size of the defect in relation to the size of the remaining breast.…”

Is it possible to improve breast conserving surgery operations?

“…Вероятность получения не-гативного, с косметической точки зрения, результата после выполненной органосохраняющей операции, до внедрения в онкологию понятия качество жизни, была столь же часто встречаема, как и выполнение мастэктомии. Поэтому по-иски наиболее оптимального решения, которое сочетало бы онкологические принципы и понимание целостности органа, привели к развитию онкопластической хирургии, позволяющей без пренебрежения основными принципа-ми онкологии выполнить не только щадящее лечение, но и сохранить орган (молочную железу) в том виде, который ненамного отличал бы железу от исходного варианта [11,12]. Существует два основополагающих принципа, важных для получения хорошего результата: 1) выбор правильной методики операции на молочной железе; 2) коррекция контралатеральной молочной железы.…”

“…Железы размером А-С; 4. Желание пациентки сохранить молочную железу [4,10]. В ряде слу-чаев (у 5 больных) понадобилась редукционная пластика контрлатеральной молочной железы с целью достижения максимальной симметрии.…”