Oncoplastic reconstruction combined with latissimus dorsi myocutaneous flap after lateral quadrant tumor resection in small to moderate-sized breasts

doi:10.3969/j.issn.1009-976X.2015.01.005

Abstract

Abstract:

【Abstract】〓Objective〓To investigate the aesthetic effect of oncoplastic reconstruction with latissimus dorsi myocutaneous flap after the lateral quadrant tumor resectionin small to moderate-sized breasts. Methods〓We enrolled 14 patients with invasive breast cancer located in the lateral quadrant of the breast, which were located more than 3 cm apart from the nipple, after breast completing a quadrantectomy defect volume of more than 20% patients, repair the defect with oncoplastic reconstruction with latissimusdorsimyocutaneous flap. Results〓Median tumor size was 3.2 cm (ranged, 2.2-8.1 cm) and median resected volume was 62.0 g (range, 50.0-100.0 g). With a mean follow-up of 17.0 months (range, 3.0~42.0 months), cosmetic outcomes were good (79%) to fair (21%), and there was no local or systemic recurrence during the short term follow-up period. Conclusion〓This type of oncoplastic reconstruction with latissimus dorsi-mysocutaneous flap reconstruction is an oncologically safe and a cosmetically sound procedure,especially for cosmetic treatment of small to medium-sized breasts after lateral quadrant tumor resection, defect volume of more than 20% patients.

Key words: Mammoplasty, Breast neoplasms, Latissimus dorsi myocutaneous flap, Breast reconstruction

摘要：

【摘要】〓目的〓探讨肿瘤整形技术联合背阔肌肌皮瓣在中-小型乳房外侧象限乳腺癌保乳重建中的美容效果。方法〓选择肿瘤位于乳房外侧象限的14例中-小型乳房乳腺癌患者,肿瘤距离乳头乳晕大于3 cm,保乳术后缺损体积超过20%的病人,采取肿瘤整形技术联合部分背阔肌肌皮瓣修复缺损。结果〓肿瘤直径中位大小3.2 cm(2.2~8.1 cm),切除中位体积为62.0 g(50.0~100.0 g),中位随访17(3.0~42.0)月,术后美容效果14例患者11例(79%)为优,3例(21%)为良,随访期间无1例复发及转移。结论〓肿瘤整形技术联合部分背阔肌皮瓣是一种安全有效修复保乳术后缺损的方法,特别适合肿瘤位于外侧象限,术后缺损体积超过20%的中-小型乳房。

关键词: 乳腺肿瘤, 乳房成形术, 乳房重建, 背阔肌肌皮瓣

CLC Number:

Hu Xiaowu, Zhang Lehong, Xia Ting, Cao Tengfei, Jia Haixia. Oncoplastic reconstruction combined with latissimus dorsi myocutaneous flap after lateral quadrant tumor resection in small to moderate-sized breasts[J]. Lingnan Modern Clinics in Surgery, 2015, 15(01): 22-26.

胡小戊章乐虹夏婷曹腾飞贾海霞. 肿瘤整形术联合背阔肌肌皮瓣在中-小型外侧象限乳腺癌保乳重建中的应用体会[J]. 岭南现代临床外科, 2015, 15(01): 22-26.

References

1. Bulstrode NW, Shrotria S. Prediction of cosmetic outcome following conservative breast surgery using breast volume measurements. Breast 2001;10:124-6.
2. 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;17:1375-91.
3.Kim, J.Yoo, J.Lee, J.Chang, et al. Oncoplastic reconstruction with superior based lateral breast rotation flap after lower quadrant tumor resection. Gland Surg 2013.;(3):163-9.
4. O. Abe, R. Abe, K. Asaishi et al., “Effects of radiotherapy and surgery in early breast cancer: an overview of the randomized trials,” The New England Journal of Medicine, 1995,22(333) 1444–1455.
5.G. Y. Locker, J. R. Sainsbury, and J. Cuzick, “Breast surgery in the ’Arimidex, Tamoxifen Alone or in Combination’ (ATAC) trial: american women are more likely than women from the United Kingdom to undergo mastectomy,” Cancer, 2004，4(101) 735–740.
6. R. A. Cochrane, P. Valasiadou, A. R. M. Wilson, S. K. Al- Ghazal, and R. D. Macmillan, “Cosmesis and satisfaction after breast-conserving surgery correlates with the percentage of breast volume excised,” British Journal of Surgery,2003,12(90) 1505–1509 .
7. Baildam AD. Oncoplastic surgery of the breast. Br J Surg 2002;89:532-33.
8. AsgeirssonKS,RasheedT,McCulleySJ,etal.Oncological and cosmetic outcomes of oncoplastic breast conserving surgery. Eur J Surg Oncol 2005;31:817-23.
9. Quinn McGlothin TD. Breast surgery as a specialized practice. Am J Surg 2005;190:264-68.
10. Brédart A, Petit JY. Partial mastectomy: a balance between oncology and aesthetics? Lancet Oncol 2005;6:130.
11. McCulley SJ, Macmillan RD. Planning and use of therapeutic mammo- plasty: Nottingham approach. Br J Plast Surg 2005;58:889-901.
12. 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 conserva- tion therapy. Plast Reconstr Surg 2007;120:1755-68.
13. Clough KB, Ihrai T, Oden S, Kaufman G, Massey E, Nos C. Oncoplastic surgery for breast cancer based on tumour location and a quadrant- per-quadrant atlas. Br J Surg 2012;99:1389-95.
14.Almasad JK, Salah B. Breast reconstruction by local flaps after conserv- ing surgery for breast cancer: an added asset to oncoplastic techniques. Breast J 2008;14:340-4. ?
15. Yang, J. D.Kim, M. C.Lee, J. W. Usefulness of Oncoplastic Volume Replacement Techniques after Breast Conserving Surgery in Small to Moderate-sized Breasts. Arch Plast Surg2012.39(5)489-96.
16. R. Masetti, P. G. Pirulli, S. Magno, G. Franceschini, F. Chiesa, and A. Antinori, “Oncoplastic techniques in the conservative surgical treatment of breast cancer,” Breast Cancer,2000，4(7) 276–280.
17. O. Anderson, R. Masetti, and M. J. Silverstein, “Oncoplastic approaches to partial mastectomy: an overview of volume- displacement techniques,” The Lancet Oncology2005, 3(6) 145–157.
18.E.Wagner,P.Schrenk,G.M.Huemer,A.Sir,M.Schreiner,and W.Wayand, “Central quadrantectomy with resection of the nipple-areola complex compared with mastectomy in patients with retroareolar breast cancer,” The Breast Journal 2007,6(13) 557–563.
19.Baudet J. Successful clinical tranfer of two free thoracodorsal axillary flaps [J] Plast Reconstr Surg,1976,58:680- 684.
20.Schwabegger AH,Harpf C,Rainer C.Muscle -sparing latissimus dorsimyocutaneous flap with maintenance of muscle innervation, function,and aesthetic appearance of the donor site [J].Plast Reconstr Surg,2003,111:1407- 1411.
21.Rietjens M，Urban CA,Rey PC,et al.Long-term oncological results of breast conservative treatment with oncoplastic surgery.Breast,2007,16:389-95.

[1]	HU Xiao-wu, ZHANG Le-hong, HE Yong, CHEN Xin-xin, XIA Ting, CAO Teng-fei, JIA Hai-xia. Targeted intraoperative radio therapy boost in breast conserving surgery for early breast cancer [J]. Lingnan Modern Clinics In Surgery, 2020, 20(06): 689-693.
[2]	CHEN Huiyi， DING Yu， ZENG Minhua， GE Shiyao. Prevention and nursing measures of perioperative infection and complications of breast reconstruction with deep inferior epigastric perforator flap [J]. Lingnan Modern Clinics in Surgery, 2019, 19(04): 510-.
[3]	ZHEN Lefeng， CHEN Xiaoming， HUANG Tao， WANG Jinzhong， WEN Dahui. Comparison of clinical application of Mammotome Biopsy system and wire localization in nonpalpable breast lesions [J]. Lingnan Modern Clinics in Surgery, 2019, 19(03): 289-292.
[4]	DING Zhuliang， WU Zhiyong.. Diagnosis and treatment of isolated locoregional breast cancer recurrences [J]. Lingnan Modern Clinics in Surgery, 2017, 17(03): 371-375.
[5]	ZHANG Xiao，YE Yifeng. Application of soft?tissue expander in implant reconstruction for breast cancer [J]. Lingnan Modern Clinics in Surgery, 2017, 17(02): 194-197.
[6]	CAO Tengfei, TANG Tian, XU Qingya, JIANG Haihan, JIA Haixia, ZHANG Lehong. Analysis of influencing factors to non?sentinel lymph nodes in breast cancer patients with 1 or 2 positive sentinel lymph nodes [J]. Lingnan Modern Clinics in Surgery, 2017, 17(01): 11-14.
[7]	Xu Tai, Li Shunrong, Lai Yeqian, Huang Jiewen, Qiu Dongqing, Fan Yuanlin, Li Lu. Clinical experience of using Mammotome system in treatment of breast tumors [J]. Lingnan Modern Clinics in Surgery, 2014, 14(03): 291-293.
[8]	Yang Jianmin, Wang Qi, Yu Haijing, Zhang Anqin, Li Wenping, Xu Juan. Stage Ⅰ/Ⅱ breast reconstruction with prosthetic implantation after total mastectomy in breast cancer [J]. Lingnan Modern Clinics in Surgery, 2013, 13(04): 295-297.
[9]	Xu Juan, Zhu Caixia, Yang Jianmin, Chen Zhongyang, Lian Zhenqiang, Han Xiaorong. Analysis of clinical pathological features of 130 patients with pT_1a and pT_1b breast cancer [J]. Lingnan Modern Clinics in Surgery, 2013, 13(03): 177-180.