E8. Surgical techniques in breast conservation
Resident, General Surgery, Ucla Medical Center, Los Angeles, California.European Journal of Cancer (Impact Factor: 5.42). 03/2002; 38(11):S16–S18. DOI: 10.1016/S0959-8049(02)81234-5
The surgical treatment of breast cancer has changed dramatically in the last 30 years. The era of the Halsted radical mastectomy has passed, and less deforming surgeries have come into use. Partial mastectomy in association with axillary lymph node dissection has become a viable alternative for stage 1 and 2 carcinomas; more advanced tumors may be treated with breast conservative surgery when neoadjuvant chemotherapy is utilized. Further, the use of mammography in screening for breast cancer has led to an increase in the diagnosis of ductal carcinoma in situ (DCIS), another lesion for which breast conservation is often indicated.
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ABSTRACT: 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. 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. 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. 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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ABSTRACT: Breast conserving therapy is the best method to the breast cancer treatment when concerning the psychological sequelae to the patient. Cosmetic results after conservative surgery are not always acceptable: about 20% of patients need a revision operation and correcting the residual defect of the breast or asymmetry of the breasts afterwards. Oncoplastic surgery means that the methods familiar to plastic surgeon are used to increase the number of patients treated with conservative surgery without compromising the oncologic results. Even wider margins than in normal breast conservation can be gained, if local glandular flaps, musculocutaneous latissimus dorsi flaps or microvascular free TRAM flaps are used to immediately preserve the shape and symmetry of the breasts. With plastic surgery it is possible to reshape the breast, replace the nipple and gain breast symmetry. As we know every tenth woman will have a breast cancer during her lifetime, and 80% of breast cancer women will survive. It is important to operate breast cancer immediately to save costs and help a patient feel that her breasts are still a part of her own body.
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