Abstract
Background: An anticipated poor cosmetic result has traditionally been deemed a relative contraindication for breast conservation therapy (BCT). We sought to determine whether a local rotational flap could achieve satisfactory cosmesis in patients who were anticipated to have a poor cosmetic result following standard segmental mastectomy but who nevertheless desired BCT.
Methods: Within the past 3 years, nine patients were treated with BCT using local rotational flap techniques. Their records were reviewed for patient characteristics, pre- and postoperative treatment, disease-free status, and patient satisfaction with cosmesis.
Results: The cosmetic outcome following a segmental mastectomy was anticipated to be unacceptable due to the following features: a large previous biopsy cavity with unknown or positive margins (three patients); initial large primary tumors with unknown extent of residual disease following induction chemotherapy (five patients); and pre-existing poor cosmesis (one patient). One patient had refused modified radical mastectomy and had satellitosis from inadequately treated primary tumor (excisional biopsy with positive margins and no further therapy). The median initial tumor size was 2.7 cm (range, 1.5 cm to 5.0 cm). Final resection margins were negative in all patients. Postoperative radiotherapy was given in seven patients; one patient did not receive radiotherapy because of a pre-lupus condition and one did not require radiotherapy because her pathologic diagnosis was Paget's disease without an invasive component. Cosmesis was judged to be good to excellent by eight of nine patients. The patient who refused mastectomy was dissatisfied with cosmesis because of mild asymmetry. With a median follow-up of 24 months, only one patient has developed a local recurrence.
Conclusion: Local rotational flaps composed of adjacent breast tissue are an acceptable method of achieving satisfactory cosmesis in selected patients who desire BCT.
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References
Balch CM, Singletary SE, Bland KI. Clinical decision-making in early breast cancer.Ann Surg 1993;217:207–25.
Noguchi M, Kinne DW, Miyazaki I. Breast-conserving treatment: controversies and consensus.J Surg Oncol 1996;62:228–34.
Borgen PI, Moore MP, Heerdt AS, Petrek JA. Breast conservation therapy for invasive carcinoma of the breast.Curr Probl Surg 1995;32:191–239.
Fisher B, Anderson S, Redmond CK, Wolmark N, Wickerham DL, Cronin WM. Reanalysis and results after 12 years of follow-up in a randomized clinical trial comparing total mastectomy with lump-ectomy with or without irradiation in the treatment of breast cancer.N Engl J Med 1995;333:1456–61.
Veronesi U, Luini A, Galimberti V, Zurrida S. Conservation approaches for the management of stage I/II carcinoma of the breast: Milan Cancer Institute trials.World J Surg 1994;18:70–5.
Singletary SE, Schusterman MA, McNeese MD. Breast conservation vs. breast reconstruction.Cancer Bulletin 1993;45:512–6.
Sibbering DM, Galea MH, Morgan DAL, Elston CW, Ellis IO, Robertson JFR, Blamey RW. Safe selection criteria for breast conservation without radical excision in primary operable invasive breast cancer.Eur J Cancer 1995;31A:2191–5.
Matory WE Jr, Wertheimer M, Love S, Matory WE. Partial mastectomy: technical considerations in achieving cosmesis.Breast Disease 1992;5:225–33.
Radford DM, Wells SA Jr. Surgical techniques in breast conservation.Adv Surg 1993;26:1–27.
Berrino P, Campora E, Santi P. Postquadrantectomy breast deformities: classification and techniques of surgical correction.Plast Reconstr Surg 1987;79:567–72.
Singletary SE, McNeese MD, Hortabagyi GN. Feasibility of breast-conservation surgery after induction chemotherapy for locally advanced breast carcinoma.Cancer 1992;69:2849–52.
Grant CS. Changes in the treatment of early breast cancer at the Mayo Clinic: 1988–1992.Eur J Surg 1996;162:93–6.
Wickman M. Breast reconstruction—past achievements, current status and future goals.Scand J Plast Reconstr Surg Hand Surg 1995;29:81–100.
Slavin SA, Love SM, Sadowsky NL. Reconstruction of the radiated partial mastectomy defect with autogenous tissues.Plast Reconstr Surg 1992;90:854–65.
Kroll SS, Doores S. Nipple centralization for the correction of breast deformity from segmental mastectomy.Ann Plast Surg 1990;24:271–4.
Daher JC. Breast island flaps.Ann Plast Surg 1993;30:217–23.
Berrino P, Campora E, Leone S, Santi P. Correction of type II breast deformities following conservative cancer surgery.Plast Reconstr Surg 1992;90:846–53.
McCraw JB, Papp C, Edwards A, McMellin A. The autogenous latissimus breast reconstruction.Clin Plast Surg 1994;21:279–88.
Smitt MC, Nowels KW, Zdeblick MJ, Jeffrey S, Carlson RW, Stockdale FE, Goffinet DR. The importance of the lumpectomy surgical margin status in long-term results of breast conservation.Cancer 1995;76:259–67.
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Bold, R.J., Kroll, S.S., Baldwin, B.J. et al. Local rotational flaps for breast conservation therapy as an alternative to mastectomy. Annals of Surgical Oncology 4, 540–544 (1997). https://doi.org/10.1007/BF02305533
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DOI: https://doi.org/10.1007/BF02305533