J Breast Cancer.  2012 Sep;15(3):350-355. 10.4048/jbc.2012.15.3.350.

Oncoplastic Reconstruction with Superior Based Lateral Breast Rotation Flap after Lower Quadrant Tumor Resection

• Kim J
• Yoo J
• Lee J
• Chang E
• Suh K

• KMID: 2286462
• DOI: http://doi.org/10.4048/jbc.2012.15.3.350

Abstract

PURPOSE
Poor cosmetic outcome have been reported as a result of breast cancer operation due to lower quadrant breast tumors; this is particularly true for women with small, firm breasts. Herein, we report here on the use of superior based lateral breast rotation flap reconstruction to improve cosmetic outcome in patients with lower quadrant breast cancer.
METHODS
We enrolled 33 patients with invasive breast cancer located in the lower quadrant of the breast, which were located more than 2 cm apart from the nipple. After completing a quadrantectomy, a single S-shaped or reverse S-shaped incision was made from axilla to tumor site. Two triangular skin islands, one on the axilla and one overlying the tumor were marked for excision. Once the fibroglandular tissues and the additional fatty tissue of the lateral chest wall were appropriately mobilized, the breast defect was closed at the mid-point of the parenchymal thickness in order to keep the natural position of the infra mammary fold.
RESULTS
Median tumor size was 2.3 cm (range, 0.7-3.5 cm) and median resected volume was 35.5 g (range, 27.0-51.0 g). With a mean follow-up of 24.5 months (range, 9.0-33.5 months), cosmetic outcomes were good (94.0%) to fair (6.0%) at 6 months after the procedure, and there was no local or systemic recurrence during the short term follow-up period.
CONCLUSION
Clearly, this type of rotation flap reconstruction is an oncologically safe and a cosmetically sound procedure. Hopefully this rotation flap reconstruction technique will become more widely available and perhaps a standard procedure for lower quadrant breast tumors, especially for cosmetic treatment of small to medium-sized breasts.

Keyword

Breast; Carcinoma; Mammoplasty

MeSH Terms

Adipose Tissue
Axilla
Breast
Breast Neoplasms
Cosmetics
Female
Follow-Up Studies
Humans
Islands
Mammaplasty
Nipples
Recurrence
Skin
Thoracic Wall
Cosmetics

Figure

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  Figure 1 Operative design for patients with lower half located breast cancer. If margin status of the quadrantectomy specimen was adequate, a long skin incision was made from the axilla to the tumor site along the anterior axillary line and inframammary fold. The axillary triangles: axillary skin and underlying fibrofatty tissue which was later removed in this procedure. The triangles with dots: tumor sites where the overlying skin and the tumor down to the chest wall will be removed. Dotted lines indicate the direction of the motion of the skin along the long incision line.

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  Figure 2 Quadrantectomy and axillary dissection with superior based lateral rotation flap reconstruction for left caudal located breast cancer. (A) Depict the skin triangles to be removed with underlying tissue, one in the axilla and one in the overlying the tumor. (B) After completing quadrantectomy, single S-shaped incision was made from axilla to tumor site and triangular skin islands in the axilla were removed. (C) Once the fibroglandular tissues and the additional fatty tissue of the lateral chest wall were appropriately mobilized, the breast defect was closed. (D, E) Postoperative photos from the front and those from the lateral show a good cosmetic outcome.

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  Figure 3 Quadrantectomy and sentinel lymph node biopsy with superior based lateral rotation flap reconstruction for right lower lateral located breast cancer. Operative procedures (A-C) and postoperative photos from the front and lateral (D, E) views show reverse S-shaped incision and scar.

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