European Journal of Plastic Surgery THE INFERIOR PEDICLE FLAP USED AS "FILLER" IN BREAST CONSERVATIVE THERAPY (original) (raw)
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Research in Oncology
Background: Several studies have evaluated patient satisfaction following breast reconstruction with the transverse rectus abdominis myocutaneous (TRAM) flap and implant based latissimus dorsi flap. However, the effects of regional radiotherapy after pedicled TRAM flap breast reconstruction and Implant based Latissimus dorsi flap on aesthetic outcome have not been previously extensively studied. Aim of the work: Compare the effect of radiotherapy on patients undergoing immediate breast reconstruction using either TRAM flap or implant based latissimus dorsi flap as a regard the aesthetic aspect and the patient satisfaction. Patients and Methods: A retrospective review was conducted on 53 consecutive patients who underwent immediate Breast reconstruction followed by radiotherapy in Menofia University, Plastic surgery and Clinical Oncology departments from August 2005 to July 2009. The patients were divided into two groups: Group I: Included 21 patients who underwent TRAM flaps Group II: Included 32 patients who underwent Implant based Latissimus dorsi flap. Patients were polled on their age, mastectomy type, laterality of reconstruction and adjuvant therapy. Aesthetic satisfaction based on breast shape, symmetry of breast shape, breast size, symmetry of breast size, breast scarring and breast sensation, hyperpigmention, flap contracture was assessed using a 5-point scale. Results: 53 patients with 21 TRAM flaps and 32 Implant based latissimus dorsi flap responded. In terms of overall aesthetic outcome, the TRAM group consistently rated better than the post implant based latissimus dorsi flap (p = 0.021). The TRAM group also had clinically and statistically significant less hyper pigmentation and flap contracture than the post Implant based latissimus dorsi group (p = 0.0001, 0.0001, respectively). Conclusions: We concluded that aesthetic outcome and patient satisfaction after radiotherapy for the reconstructed breast is highly influenced by the type of reconstructive procedure which was better by using TRAM flap procedure than using Implant based latissimus dorsi flap procedure.
Plastic and Reconstructive Surgery, 2009
Of the relatively few studies that exist regarding the cosmetic satisfaction of patients following breast conservation therapy, several indicate significant dissatisfaction in many patients. Breast conservation often results in some of the most challenging and complex reconstructive problems. Indeed, even defining the problem or analyzing the defect can be difficult for the junior surgeon. For the more seasoned reconstructive surgeon, analyzing the problem and applying solutions may be less difficult, but clearly communicating the defects typically seen after an aggressive lumpectomy and radiotherapy can be difficult, especially with trainees or junior surgeons. The goal of this article, the third in a four-part series, is to provide a template for the analysis and surgical reconstruction of defects resulting from breast conservation therapy utilizing a systematic three-step method. Part I of this series described the three main anatomical features of the breast-the footprint, the conus of the breast, and the skin envelope-and how they interact. By systematically analyzing the breast with this three-step method, a "problem list" based in specific anatomic traits of the breast can be generated, allowing the surgeon to then generate an appropriate surgical plan for reconstruction. Surgical approaches based on the percentage of breast parenchyma resected are suggested, with a focus on glandular rearrangement, breast reduction techniques, and locoregional flaps. The three-step method of breast analysis, evaluating the anatomical deformation of the breast footprint, conus, and skin envelope, remains the fundamental "fall-back" principle of this approach.
Indian Journal of Surgical Oncology, 2019
Breast conservation surgery (BCS) is now the standard of care for patients with early breast cancer. The main contraindications for BCS besides the presence of multicentricity and diffuse microcalcifications are inadequate tumour size to breast size ratio. With the advent of oncoplastic techniques, the indications of BCS may be further extended to patient with larger tumour size and or small volume breast. We prospectively assessed 42 patients undergoing oncoplastic breast conservation surgery for cosmetic and oncologic outcomes. Cosmetic outcome assessment was done by comparison of operated breast to contralateral breast by an independent surgeon, nurse and patient's attendant at 6 months post-surgery. Risk factors for compromised oncologic outcomes included grades II/III tumours and non-ductal histology. Intraoperative margin assessment with frozen section analysis proved to be important in order to achieve negative surgical margins on final histopathology. By univariate analysis, tumours located in central quadrant and medial half of the breast had similar cosmetic outcomes comparable to tumours located in other quadrants. Majority of our patients (90%) had overall good to excellent cosmetic outcomes on Harvard scale. Oncoplastic breast conservation surgery techniques allow for larger parenchymal resections without compromising oncologic and cosmetic results. It further allows extension of BCS to patients otherwise denied for the same based on earlier recommendations for mastectomy. Oncoplastic techniques and intraoperative margin assessment with frozen section are vital in attaining adequate margins and also decrease chance of local recurrence and revision surgery for positive margins.
Oncoplastic and Reconstructive Breast Surgery: A Comprehensive Review
Cureus, 2022
Most of the approaches that were valid until recently in breast cancer surgery have undergone significant changes with rising awareness, increasing number of patients, and knowledge. It is important to repair the damage caused by surgical treatment performed in accordance with oncological principles and to obtain good cosmetic results. The quality-of-life indexes increase and body image is positively affected by the development of oncoplastic surgery and reconstruction techniques. The oncoplastic techniques are commonly used for the closure of glandular defects. Surgeons must pay attention to the breast volume, tumor location, the amount of breast tissue that would be removed, and the oncoplastic technique that may be required. Oncoplastic breast surgery allows wide local excision of the mass with good cosmetic results. In addition, a contralateral breast lift, breast augmentation or breast reduction may be required to accommodate the conceptually reconstructed breast. The use of oncoplastic breast surgery techniques results in lower mastectomy rates with equivalent local and long-term survival rates as compared with mastectomy and offers women the option of plastic and reconstructive interventions performed at the time of initial surgery. Mastectomy may be needed for large tumors, as breast-conserving surgery may not be possible or may not produce satisfactory cosmetic results. Breast reconstruction methods after mastectomy include autologous or implant-based breast reconstructions, which can be performed at the same time as the breast cancer surgery (immediate reconstruction) or at a later time (delayed reconstruction). Oncoplastic and reconstructive breast surgery minimizes the impact of breast cancer surgery and yields equivalent survival outcomes without psychological morbidity. With advanced techniques, better breast image than before can also be achieved. In this review, the technical details of oncoplastic breast surgery, surgical margin positivity management, reconstruction methods, radiation therapy given after reconstruction surgery, radiologic imaging modalities, and management of complications are discussed.
Oncoplastic breast surgery:current strategies and outcome
Sohag Medical Journal, 2018
Introduction Oncoplastic surgery has emerged as a new approach to allow wide excision for breast conserving surgery without compromising the natural shape of the breast. It is based on integration of plastic surgery techniques for immediate breast reshaping after wide excision for breast cancer. Objective:To study the different methods of oncoplastic surgery for breast reconstruction to achieve better aesthetic outcome and improve quality of life. Patients and Methods: Thirty patients with breast cancer, treated at Sohag University Hospital between July 2016 to May 2017 were included in this study. The oncoplastic techniques performed were Local glandular tissue displacement in (60%), latissimus dorsi flap (LD) in (16.6%), superior pedicle flap in(10%), implant insertion in (6.6%) and Transverse rectus abdominus myocutanous flap (TRAM) in (6.6%). The choice of the oncoplastic techniques depends on the achievement of free safety margins, the breast volume, and its ptotic degree. Results: The number of patients included in the study were thirty. The median age was 43 years (range; 20-60 ys). There were three major complications that require repeating the oncoplastic techniques. Recorded complications included wound infection (5/30, 16.6 %) donor site seroma (10/30, 33.3 %), postoperative haematoma (1/30, 3.3%), flap ischemia and necrosis (1/30, 3.3%). The 12-months subjective patient satisfaction was excellent in 27 (90%) patients, and bad in 3 (10 %) patients. There were two local recurrence, no systemic metastasis after an average follow-up duration of 12 months. Conclusion:Restoring the defect after resection of the breast cancer can be safely achieved using oncoplastic procedures including the previous techniques with immediate breast reconstruction. In our patients, these procedures yield a satisfactory aesthetic outcome with lower morbidity.
Oncoplastic and Reconstructive Breast Surgery
Springer eBooks, 2013
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European Journal of Plastic Surgery, 2010
Following mastectomy, nipple-areola complex (NAC) reconstruction is seen as the final step in creating a reconstructed breast which closely resembles the original. Multiple surgical techniques, of varying complexity and usefulness, are available for NAC reconstruction. The principal criterion for successful NAC reconstruction is symmetry of position, size, colour, and projection. This study evaluates patients' subjective satisfaction following NAC reconstruction and dermal tattooing, as well as objective comparison of colour match. Two techniques for NAC reconstruction were used; the modified star flap (n=18) or the skate flap (n=8) with full thickness skin grafting. All patients undergoing NAC reconstruction were surveyed via questionnaire and asked to rate their satisfaction using a standard scale. Objective colour matching was carried out using a computer programme to compare posttattooing photographs. Patient satisfaction was rated as very good or excellent for position, size, and colour match in all cases. There was no difference between those who had star flap or skate flap reconstructions. There was, however, a lower satisfaction with projection amongst those who had undergone skate flaps. This study shows a high level of patient satisfaction and good colour match following NAC reconstruction and dermal tattooing.
Breast reconstruction with pedicle fat dermal layer associated pectorallis muscle flap
Revista Brasileira de Cirurgia Plástica (RBCP) – Brazilian Journal of Plastic Sugery, 2014
Introduction: A mastectomy is the standard treatment for all types of breast cancer (CA). This disease, with the exception of non-melanoma skin cancers, ranks first cancers that affect women. Many are the possibilities for full mastectomy reconstruction, involving autologous flaps and implant placement. Advances in the use of these techniques have been refined over the years in order to provide excellent results.The aim of this study is to describe the technique of breast reconstruction with the fat dermal inferior pedicle flap associated with pectoral and analysis of postoperative results. Methods: Retrospective analysis of medical records of patients operated for treatment of breast cancer in the period 2008-2013, in the private practice of the author and all patients had tumors located in the upper quadrants were selected was performed. Results: Over this period, 210 patients underwent breast reconstruction. Of these, 17 (8.09%) underwent breast reconstruction by the proposed technique. Over this period, 210 patients underwent breast reconstruction. Of these, 17 (8.09%) underwent breast reconstruction by the proposed technique. Regarding postoperative complications, there was 1 case of skin necrosis and 1 case of asymmetry. Conclusions: Apart from technically simple and acceptable cosmetic results, the proposed flap does not result in donor site morbidity, prolonged recovery, muscle weakness with the advantage that, in most cases, be accomplished in a single operation.
Our experience of nipple reconstruction using the C-V flap technique: 1 year evaluation
Journal of Plastic, Reconstructive & Aesthetic Surgery, 2009
There are several procedures available for nipple and areola reconstruction after radical mastectomy, many of them providing good results. This study presents a 1 year evaluation of nipple and areola reconstruction, using the C-V flap technique and areola tattooing. Twenty-nine patients who underwent breast reconstruction with implants in our department, between January 2006 and January 2007, were evaluated and asked to return to conduct a follow-up control. They all completed a questionnaire focusing on patient satisfaction using a 1e10 point visual scale. Nipple measurements were taken with a calliper: the average nipple projection of the reconstructed nipple after 1 year was 3.52 mm, compared to 4.96 mm for the native nipple. The fading of colour of the tattooed areola and the match with the native areola were estimated with computer software (Adobe â Photoshop â ). The technique results were simple, reliable and safe; overall patient satisfaction with the procedure was good.