R. Madada-Nyakauru1, R. Vella-Baldacchino3, A. Bellizzi3, F. Kazzazi2, P. Forouhi4, C. Malata4,5,6 1Cambridge University Hospitals NHS Foundation Trust,Plastic Surgery,Cambridge, Cambridge, United Kingdom 2University Of Cambridge,School Of Clinical Medicine,Cambridge, CAMBRIDGESHIRE, United Kingdom 3University Of Malta,Malta Medical School,Msida, MALTA, Malta 4Addenbrooke’s Hospital,Cambridge Breast Unit,Cambridge, CAMBRIDGESHIRE, United Kingdom 5Addenbrooke’s Hospital,Plastic & Reconstructive Surgery,Cambridge, CAMBRIDGESHIRE, United Kingdom 6Anglia Ruskin University,Postgraduate Medical Institute, Faculty Of Medical Science,Cambridge, CAMBRIDGESHIRE, United Kingdom
Introduction: Therapeutic mammoplasty (TM) is a well-established technique used by oncological and oncoplastic breast surgeons for wide local excision of tumours not amenable to standard breast conserving surgery. It utilises the principles of pedicled breast reduction techniques. In view of the broad experience of plastic surgeons it can easily be incorporated into their practice to treat selected breast cancers.
Methods: A retrospective review of one plastic surgeon’s experience with TM at a tertiary breast cancer referral centre over an 8-year period (2009-2017) was completed. All patients were operated on jointly with a breast surgeon. Clinical records were reviewed to identify relevant clinico-pathological features. Standardised photographs (taken by a professional) were evaluated to assess symmetry through the surgeon’s perspective and objectively with BCCT.coreTM software.
Results: A total of 20 patients who underwent 21 therapeutic mammoplasties were reviewed. Mean age was 50 years (range 37-64) and median bra cup size 36DD. All received adjuvant (postoperative) radiotherapy. Indications for TM included DCIS and invasive breast cancer. Tumour size ranged from 6 to 87mm (median=35mm). The median resection weight was 220g (range 16-1347g). Most tumours were located in zones 2 (19%) and 7 (14%) of the breast. The main pedicles used for reconstructing the lumpectomy defects/preserving the nipples were the superomedial (58%) and inferior (31%). Five patients had a secondary pedicle to facilitate breast reshaping and maintenance of a satisfactory contour. Three patients had a Grisotti rotation-advancement flap to recreate a neo-areola.
The pedicle technique used for simultaneous contralateral balancing reduction/lift was the same as for the index breast in 44%. Contralateral breast tissue resection weights ranged from 59 to 1238g (median 416g) and none contained tumour. No revision operations were requested/required and no further balancing surgeries have been performed.
Almost all patients achieved excellent symmetry when reviewed against a standard with the BCCT.coreTM software. Two patients’ cosmetic results were suboptimal due to complications: T-junction wound breakdown (with fat necrosis) and severe radiotherapy shrinkage. Adequate oncological outcomes were achieved as only one patient had positive resection margins (treated by mastectomy and DIEP flap immediate reconstruction). There have been no recurrences to date with a 6-month average follow up.
Conclusions: TM is effective in achieving good oncological and acceptable cosmetic outcomes in large resections during breast conserving surgery for cancer. The techniques employed are easy to learn and already in the repertoire of all plastic surgeons. They can easily be adopted by plastic surgeons in the treatment of breast cancer who, in close collaboration with breast surgeons, can achieve clear margins with minimal morbidity in selected patients whilst maintaining good cosmetic results.