Oncoplastic Mammaplasty with Geometric Compensation – A Novel Technique for Breast Conservation

Abstract

INTRODUCTION: Oncoplastic mammaplasties can prevent many mastectomies, but there are still limitations regarding their use for tumors close to the skin, in areas outside the classic mammaplasty drawings. This study describes a novel means of oncoplastic mammaplasty, named geometric compensation. MATERIAL AND METHODS: Between March 2007 and June 2012, thirteen patients were included in the study, after signing an informed consent statement. Six patients were from the Federal University of Goias, four from the private office, and three from the Santa Casa de Misericordia of Sao Paulo. They had malignant masses, needing skin resection in areas not usually resected in conventional mammaplasties. The preoperative markings followed the “Wise Pattern” technique, and the aberrant skin resection was geometrically compensated with another area of preserved skin. The tumors were excised with a macroscopic margin of 2 cm. The compromised quadrants were: superior in 5 (38.46%) cases, inferior in 4 (30.77%), and central in one (7.70%). Multiple quadrants were involved in 3 (23.08%) patients. The nipple-areola complex (NAC) was resected in 3 cases (23.08%), and it was kept attached to the superior pedicle in 5 (38.46%), to the inferior pedicle in 4 (30.77%) and to the lateral pedicle in 1 (7.70%), depending on the best available vascularization. Metal clips were emplaced to guide radiotherapy. The contralateral breast symmetry was corrected. RESULTS: The patients’ mean age was 53.46 (+ 11.24) years. The mean pathological tumor size was 44.00mm (+34,06mm). There were 5 (38.46%) locally advanced tumors (T3 or T4), the largest one measuring 140mm. Sentinel node biopsy was performed in 8 (61.54%) cases, all of them successfully. Three (23.07%) patients have lymph nodes with metastasis. Five (38.46%) patients were submitted to neoadjuvant and the remaining to adjuvant chemotherapy. The adjuvant radiotherapy was indicated in all cases. Eleven (84.61%) patients received hormone therapy (10 tamoxifen alone and one sequential aromatase inhibitor). The median preoperative ptosis was grade 2 (range: 1-3), and it was corrected in all cases. The volume and shape symmetry were considered adequate in all cases by surgeons and patients. Invasive ductal carcinoma was the commonest tumor, in 7 (53.84%) cases. One (7.70%) patient was smoker, five (38.46%) had high blood pressure, and one (7.70%) was diabetic. All tumors were excised with free margins. There was not any case of reoperation, hematoma, seroma or dehiscence. There was one (7.70%) small fat necrosis, and one (7.70%) enlarged scar. There was not any case of local or distant recurrence in a mean follow-up of 20.92 (+18.64) months. CONCLUSION: The technique allowed breast conservation in some difficult oncologic situations, which required large aberrant skin excisions, permitting free margins, ptosis correction, satisfactory symmetry and low rate of complications.