Abstract
Purpose
Oncoplastic breast conserving surgery is a new concept in breast cancer surgery. We performed immediate latissimus dorsi flap reconstruction after breast conserving surgery (BCS) to get an adequate resection margin and a good cosmetic results. The aim of this study is to evaluate the effect of immediate latissimus dorsi flap reconstruction after BCS.
Methods
From January to December, 2007, we performed BCS and immediate latissimus dosi myocutaneous flap reconstruction for 44 breast cancer patients. We evaluated the status of the post operative resection margin, the complications and the cosmetic results. The cosmetic results were evaluated with paying particular attention to the symmetry of the breasts, the breast shape, the location of the nipple and the post-operative scar by a three person panel that consisted of one doctor and two nurses.
Results
Reoperation was performed in 3 patients out of 44 (6.8%) because of positive resection margin. Flap complications didn't occurred and donor-site complications such as seroma occurred in only 3 cases. The mean score for the overall cosmetic outcome by the panel was 7.03 (SD=1.36) out of 10 and the cosmesis was deemed to be fair for 52% and, good for 48%. The mean subjective score by the patients was 6.5 (SD=2.29) out of 10 and the cosmesis was deemed to be poor for 14%, fair for 46% and, good for 40%. The most influential factors for the overall cosmetic results were breast symmetry and shape, and the breast scar in descending order (p<0.05).
References
1. Arriagada R, Lê MG, Rochard F, Contesso G. Institut Gustave-Roussy Breast Cancer Group. Conservative treatment versus mastectomy in early breast cancer: patterns of failure with 15 years of follow up data. J Clin Oncol. 1996. 14:1558–1564.
2. Fisher B, Anderson S, Bryant J, Margolese RG, Deutsch M, Fisher ER, et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med. 2002. 347:1233–1241.
3. Jacobson JA, Danforth DN, Cowan KH, d'Angelo T, Steinberg SM, Pierce L, et al. Ten-year results of a comparison of conservation with mastectomy in the treatment of stage I and II breast cancer. N Engl J Med. 1995. 332:907–911.
4. van Dongen JA, Voogd AC, Fentiman IS, Legrand C, Sylvester RJ, Tong D, et al. Long-term results of a randomized trial comparing breast-conserving therapy with mastectomy: European Organization for Research and Treatment of Cancer 10801 trial. J Natl Cancer Inst. 2000. 92:1143–1150.
5. Veronesi U, Cascinelli N, Mariani L, Greco M, Saccozzi R, Luini A, et al. Twenty-year follow up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med. 2002. 347:1227–1232.
6. Inaji H, Yanagisawa T, Komoike Y, Motomura K, Koyama H. Wide excision as a method of breast-conserving surgery for breast cancer. Nippon Geka Gakkai Zasshi. 2002. 103:806–810.
7. Leong C, Boyages J, Jayasinghe UW, Bilous M, Ung O, Chua B, et al. Effect of margins on ipsilateral breast tumor recurrence after breast conservation therapy for lymph node-negative breast carcinoma. Cancer. 2004. 100:1823–1832.
8. Al-Ghazal SK, Fallowfield L, Blamey RW. Patient evaluation of cosmetic outcome after conserving surgery for treatment of primary breast cancer. Eur J Surg Oncol. 1999. 25:344–346.
9. Olivotto IA, Rose MA, Osteen RT, Love S, Cady B, Silver B, et al. Late cosmetic outcome after conservative surgery and radiotherapy: analysis of causes of cosmetic failure. Int J Radiat Oncol Biol Phys. 1989. 17:747–753.
10. Cochrane RA, Valasiadou P, Wilson AR, Al-Ghazal SK, Macmillan RD. Cosmesis and satisfaction after breast-conserving surgery correlates with the percentage of breast volume excised. Br J Surg. 2003. 90:1505–1509.
11. Anderson BO, Masetti R, Silverstein MJ. Oncoplastic approaches to partial mastectomy: an overview of volume-displacement techniques. Lancet Oncol. 2005. 6:145–157.
12. Papp C, McCraw JB. Autogenous latissimus breast reconstruction. Clin Plast Surg. 1998. 25:261–266.
13. Kaur N, Petit JY, Rietjens M, Maffini F, Luini A, Gatti G, et al. Comparative study of surgical margins in oncoplastic surgery and quadrantectomy in breast cancer. Ann Surg Oncol. 2005. 12:539–545.
14. Tansini I. Nuovo processo per l'amputazione della mamella per cancre. Reforma Med. 1896. 12:3. Cited from Kim SH, Kim TY, Kim SY, Lim CW, Lee MH. Immediate volume replacement with latissimus dorsi muscle flap after quadrantectomy for patients with breast cancer. J Korean Breast Cancer Soc 2003;6:117-23.
15. Noguchi M, Taniya T, Miyazaki I, Saito Y. Immediate transposition of a latissimus dorsi muscle for correcting a postquadrantectomy breast deformity in Japanese patients. Int Surg. 1990. 75:166–170.
16. Hernanz F, Regaño S, Redondo-Figuero C, Orallo V, Erasun F, Gómez-Fleitas M. Oncoplastic breast-conserving surgery: analysis of quadrantectomy and immediate reconstruction with latissimus dorsi flap. World J Surg. 2007. 31:1934–1940.
17. Papp C, Wechselberger G, Schoeller T. Autologous breast reconstruction after breast-conserving cancer surgery. Plast Reconstr Surg. 1998. 102:1932–1936.
18. Clough KB, Lewis JS, Couturaud B, Fitoussi A, Nos C, Falcou MC. Oncoplastic techniques allow extensive resections for breast-conserving therapy of breast carcinomas. Ann Surg. 2003. 237:26–34.
19. Raja MA, Straker VF, Rainsbury RM. Extending the role of breast-conserving surgery by immediate volume replacement. Br J Surg. 1997. 84:101–105.
20. Woerdeman LA, Hage JJ, Thio EA, Zoetmulder FA, Rutgers EJ. Breast-conserving therapy in patients with a relatively large (T2 or T3) breast cancer: long-term local control and cosmetic outcome of a feasibility study. Plast Reconstr Surg. 2004. 113:1607–1616.
21. Fitzal F, Mittlboeck M, Trischler H, Krois W, Nehrer G, Deutinger M, et al. Breast conserving therapy for centrally located breast cancer. Ann Surg. 2008. 247:470–476.
22. Pezner RD, Patterson MP, Hill LR, Vora N, Desai KR, Archambeau JO, et al. Breast retraction assessment: an objective evaluation of cosmetic results of patients treated conservatively for breast cancer. Int J Radiat Oncol Biol Phys. 1985. 11:575–578.
23. Van Limbergen E, Van der Schueren E, Van Tongelen K. Cosmetic evaluation of breast conserving treatment for mammary cancer. 1. Proposal of a quantitative scoring system. Radiother Oncol. 1989. 16:159–167.
24. Wechselberger G, Schoeller T, Otto A, Papp C. Extending the role of breast-conserving surgery by immediate volume replacement. Br J Surg. 1997. 84:1172–1173.
25. Munhoz AM, Montag E, Fels KW, Arruda EG, Sturtz GP, Aldrighi C, et al. Outcome analysis of breast-conservation surgery and immediate latissimus dorsi flap reconstruction in patients with T1 to T2 breast cancer. Plast Reconstr Surg. 2005. 116:741–752.