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Therapeutic mammoplasty combining partial mastectomy with nipple-areola grafting for patients with early breast cancer: a case series

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Abstract

Purpose

Therapeutic mammoplasty (TM) for breast cancer is a widely practiced oncoplastic technique. Intraductal spread towards the nipple or the location of the cancerous lesion on the central breast may become a contraindication for breast-conserving surgery. We herein report the results of TM in such cases.

Methods

Six patients underwent TM that combined partial mastectomy with free nipple-areola (NA) grafting. The nipple was removed together with the cancerous lesions, and the areola was preserved for NA reconstruction. The tumors were located in the lower quadrant (n = 1), the central area (n = 1), the upper-outer area (n = 2), and the upper-inner area (n = 2). The types of mammoplasty that were performed included: amputation (n = 1), inverted T mammoplasty (n = 3), and L mammoplasty (n = 2). With the exception of one patient, all patients underwent inverted T mammoplasty on the contralateral breast in order to achieve symmetry.

Results

The total surgical and plastic periods ranged from 155 to 235 min (mean 207 min) and 100 to 150 min (mean 121 min), respectively. Oncological safety and excellent cosmetic results were achieved.

Conclusions

TM combining partial mastectomy with NA grafting was successfully performed in patients with early-stage cancer in all quadrant areas.

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References

  1. Audretsch W, Rezai M, Kolotas C, Zamboglou N, Schnabel T, Bojar H. Onco-plastic surgery: “target” volume reduction (BCT-mastopexy), lumpectomy reconstruction (BCT-reconstruction) and flap-supported operability in breast cancer. In: Proceeding of 2nd European Congress on Senology. 1994 October 2–6, pp. 139–57.

  2. Audretsch W, Rezai M, Kolotas C, Zamboglou N, Schnabel T, Bojar H. Tumor-specific immediate reconstruction in breast cancer patients. Perspect Plast Surg. 1998;11:71–106.

    Google Scholar 

  3. Clough KB, Cuminet J, Fitoussi A, Nos C, Mosseri V. Cosmetic sequelae after conservative treatment for breast cancer: classification and results of surgical correction. Ann Plast Surg. 1998;41(5):471–81.

    Article  CAS  PubMed  Google Scholar 

  4. Clough KB, Thomas SS, Fitoussi AD, Couturaud B, Reyal F, Falcou MC. Reconstruction after conservative treatment for breast cancer: cosmetic sequelae classification revisited. Plast Reconstr Surg. 2004;114(7):1743–53.

    Article  PubMed  Google Scholar 

  5. Waljee JF, Hu ES, Ubel PA, Smith DM, Newman LA, Alderman AK. Effect of esthetic outcome after breast-conserving surgery on psychosocial functioning and quality of life. J Clin Oncol. 2008;26(20):3331–7.

    Article  PubMed  Google Scholar 

  6. Keith DJ, Walker MB, Walker LG, Heys SD, Sarkar TK, Hutcheon AW, et al. Women who wish breast reconstruction: characteristics, fears, and hopes. Plast Reconstr Surg. 2003;111(3):1051–6 (discussion 7–9).

    Article  PubMed  Google Scholar 

  7. Rowland JH, Desmond KA, Meyerowitz BE, Belin TR, Wyatt GE, Ganz PA. Role of breast reconstructive surgery in physical and emotional outcomes among breast cancer survivors. J Natl Cancer Inst. 2000;92(17):1422–9.

    Article  CAS  PubMed  Google Scholar 

  8. 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(7):539–45.

    Article  PubMed  Google Scholar 

  9. Petit JY, Rietjens M, Contesso G, Bertin F, Gilles R. Contralateral mastoplasty for breast reconstruction: a good opportunity for glandular exploration and occult carcinomas diagnosis. Ann Surg Oncol. 1997;4(6):511–5.

    Article  CAS  PubMed  Google Scholar 

  10. Losken A, Elwood ET, Styblo TM, Bostwick J 3rd. The role of reduction mammaplasty in reconstructing partial mastectomy defects. Plast Reconstr Surg. 2002;109(3):968–75 (discussion 76–7).

    Article  PubMed  Google Scholar 

  11. Petit JY, Garusi C, Greuse M, Rietiens M, Youssef O, Luini A, et al. One hundred and eleven cases of breast conservation treatment with simultaneous reconstruction at the European Institute of Oncology (Milan). Tumori. 2002;88(1):41–7.

    PubMed  Google Scholar 

  12. Brierley JD, Paterson IC, Lallemand RC, Rostom AY. The influence of breast size on late radiation reaction following excision and radiotherapy for early breast cancer. Clin Oncol (R Coll Radiol). 1991;3(1):6–9.

    Article  CAS  Google Scholar 

  13. Gray JR, McCormick B, Cox L, Yahalom J. Primary breast irradiation in large-breasted or heavy women: analysis of cosmetic outcome. Int J Radiat Oncol Biol Phys. 1991;21(2):347–54.

    Article  CAS  PubMed  Google Scholar 

  14. Masetti R, Pirulli P, Magno S, Franceschini G, Chiesa F, Antinori A. Oncoplastic techniques in the conservative surgical treatment of breast cancer. Breast Cancer. 2000;7(4):276–80.

    Article  CAS  PubMed  Google Scholar 

  15. Kijima Y, Yoshinaka H, Funasako Y, Natsugoe S, Aikou T. Oncoplastic surgery after mammary reduction and mastopexy for bilateral breast cancer lesions: report of a case. Surg Today. 2008;38(4):335–9.

    Article  PubMed  Google Scholar 

  16. Zaha H, Hakazu O, Watanabe M, Higa M. Breast-conserving surgery using reduction mammoplasty. J Jpn Surg Assoc. 2008;223:211–5.

    Google Scholar 

  17. Kijima Y, Yoshinaka H, Funasako Y, Kaneko K, Hirata M, Ishigami S, et al. Immediate reconstruction using thoracodorsal adipofascial flap after partial mastectomy. Breast. 2009;18(2):126–9.

    Article  PubMed  Google Scholar 

  18. Kijima Y, Yoshinaka H, Owaki T, Aikou T. Early experience of immediate reconstruction using autologous free dermal fat graft after breast conservational surgery. J Plast Reconstr Aesthet Surg. 2007;60(5):495–502.

    Article  PubMed  Google Scholar 

  19. Kijima Y, Yoshinaka H, Hirata M, Umekita Y, Sohda M, Koriyama C, et al. Clinical and pathologic evaluation of implanted free dermal fat grafts after breast cancer surgery: a retrospective analysis. Surgery. 2012;151(3):444–55.

    Article  PubMed  Google Scholar 

  20. Kijima Y, Yoshinaka H, Shinden Y, Hirata M, Nakajo A, Arima H, et al. Oncoplastic breast surgery for centrally located breast cancer: a case series. Gland Surg. 2014;3(1):62–73.

    PubMed  PubMed Central  Google Scholar 

  21. Kijima Y, Yoshinaka H, Hirata M, Mizoguchi T, Ishigami S, Nakajo A, et al. Oncoplastic surgery in a Japanese patient with breast cancer in the lower inner quadrant area: partial mastectomy using horizontal reduction mammoplasty. Breast Cancer. 2014;21(3):375–8.

    Article  PubMed  Google Scholar 

  22. Kijima Y, Yoshinaka H, Hirata M, Mizoguchi T, Ishigami S, Arima H, et al. Oncoplastic surgery combining partial mastectomy with breast reconstruction using a free nipple-areola graft for ductal carcinoma in situ in a ptotic breast: report of a case. Surg Today. 2011;41(3):390–5.

    Article  PubMed  Google Scholar 

  23. Kijima Y, Yoshinaka H, Ishigami S, Hirata M, Kaneko K, Mizoguchi T, et al. Oncoplastic surgery for Japanese patients with ptotic breasts. Breast Cancer. 2011;18(4):273–81.

    Article  PubMed  Google Scholar 

  24. Kijima Y, Yoshinaka H, Hirata M, Shinden Y, Ishigami S, Nakajo A, et al. Oncoplastic breast surgery using spindle shaped-partial mastectomy for early breast cancer in the upper quadrant area. Mod Plastic Surg. 2013;3:57–64.

    Article  Google Scholar 

  25. Kijima Y, Yoshinaka H, Hirata M, Nakajo A, Arima H, Okumura H, et al. Oncoplastic breast surgery combining partial mastectomy with immediate breast resha** using a keyhole-shaped skin glandular flap for Paget’s disease. Surg Today. 2013.

  26. Grubnik A, Benn C, Edwards G. Therapeutic mammaplasty for breast cancer: oncological and aesthetic outcomes. World J Surg. 2013;37(1):72–83.

    Article  PubMed  Google Scholar 

  27. Bostwick J 3rd, Paletta C, Hartrampf C. Conservative treatment for breast cancer. Complications requiring reconstructive surgery. Ann Surg. 1986;203(5):481–90.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Petit JY, Rietjens M. Deformities following tumorectomy and partial mastectomy. In: Noon B, editor. Plastic and reconstructive surgery of the breast. Philadelphia: Marcel Decker; 1991.

    Google Scholar 

  29. Clough KB, Nos C, Salmon RJ, Soussaline M, Durand JC. Conservative treatment of breast cancers by mammaplasty and irradiation: a new approach to lower quadrant tumors. Plast Reconstr Surg. 1995;96(2):363–70.

    Article  CAS  PubMed  Google Scholar 

  30. Noguchi M, Saito Y, Mizukami Y, Nonomura A, Ohta N, Koyasaki N, et al. Breast deformity, its correction, and assessment of breast conserving surgery. Breast Cancer Res Treat. 1991;18(2):111–8.

    Article  CAS  PubMed  Google Scholar 

  31. Kijima Y, Yoshinaka H, Hirata M, Arima H, Nakajo A, Shinden Y, et al. Oncoplastic surgery combining partial mastectomy and immediate volume replacement using a thoracodorsal adipofascial cutaneous flap with a crescent-shaped dermis. Surg Today. 2014;44(11):2098–105.

    Article  PubMed  Google Scholar 

  32. Kijima Y, Yoshinaka H, Hirata M, Nakajo A, Arima H, Okumura H, et al. Oncoplastic breast surgery combining partial mastectomy with immediate breast resha** using a keyhole-shaped skin glandular flap for Paget’s disease. Surg Today. 2014;44(9):1783–8.

    Article  PubMed  Google Scholar 

  33. Clough KB, Kaufman GJ, Nos C, Buccimazza I, Sarfati IM. Improving breast cancer surgery: a classification and quadrant per quadrant atlas for oncoplastic surgery. Ann Surg Oncol. 2010;17(5):1375–91.

    Article  PubMed  Google Scholar 

  34. Berry MG, Fitoussi AD, Curnier A, Couturaud B, Salmon RJ. Oncoplastic breast surgery: a review and systematic approach. J Plast Reconstr Aesthet Surg. 2010;63(8):1233–43.

    Article  CAS  PubMed  Google Scholar 

  35. Hoffmann J, Wallwiener D. Classifying breast cancer surgery: a novel, complexity-based system for oncological, oncoplastic and reconstructive procedures, and proof of principle by analysis of 1225 operations in 1166 patients. BMC Cancer. 2009;9:108.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Oneal RM, Goldstein JA, Rohrich R, Izenberg PH, Pollock RA. Reduction mammoplasty with free-nipple transplantation: indications and technical refinements. Ann Plast Surg. 1991;26(2):117–21.

    Article  CAS  PubMed  Google Scholar 

  37. Munhoz AM, Montag E, Arruda EG, Aldrighi C, Gemperli R, Aldrighi JM, et al. Superior-medial dermoglandular pedicle reduction mammaplasty for immediate conservative breast surgery reconstruction: technical aspects and outcome. Ann Plast Surg. 2006;57(5):502–8.

    Article  CAS  PubMed  Google Scholar 

  38. Kronowitz SJ, Hunt KK, Kuerer HM, Strom EA, Buchholz TA, Ensor JE, et al. Practical guidelines for repair of partial mastectomy defects using the breast reduction technique in patients undergoing breast conservation therapy. Plast Reconstr Surg. 2007;120(7):1755–68.

    Article  CAS  PubMed  Google Scholar 

  39. Munhoz AM, Aldrighi CM, Montag E, Arruda E, Brasil JA, Filassi JR, et al. Outcome analysis of immediate and delayed conservative breast surgery reconstruction with mastopexy and reduction mammaplasty techniques. Ann Plast Surg. 2011;67(3):220–5.

    Article  CAS  PubMed  Google Scholar 

  40. Waljee JF, Hawley S, Alderman AK, Morrow M, Katz SJ. Patient satisfaction with treatment of breast cancer: does surgeon specialization matter? J Clin Oncol. 2007;25(24):3694–8.

    Article  PubMed  Google Scholar 

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Correspondence to Yuko Kijima.

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Kijima, Y., Yoshinaka, H., Hirata, M. et al. Therapeutic mammoplasty combining partial mastectomy with nipple-areola grafting for patients with early breast cancer: a case series. Surg Today 46, 1187–1195 (2016). https://doi.org/10.1007/s00595-015-1294-0

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