Abstract
Tumors located in the upper/upper inner quadrant of the breast warrant more attention. A small lesion relative to the size of breast in this location may be resolved by performing a level I oncoplastic technique. However, a wide excision may significantly reduce the overall quality of the breast shape by distorting the visible breast line. From June 2012 to April 2015, 36 patients with breast cancer located in the upper/upper inner quadrant underwent breast-conservation surgery with matrix rotation mammoplasty. According to the size and location of the tumor relative to the nipple-areola complex, 11 patients underwent matrix rotation with periareolar de-epithelialization (donut group) and the other 25 underwent matrix rotation only (non-donut group). The cosmetic results were self-assessed by questionnaires. The average weights of the excised breast lumps in the donut and non-donut groups were 104.1 and 84.5 g, respectively. During the 3-year follow-up period, local recurrence was observed in one case and was managed with nipple-sparing mastectomy followed by breast reconstruction with prosthetic implants. In total, 31 patients (88.6%) ranked their postoperative result as either acceptable or satisfactory. The treated breasts were also self-evaluated by 27 patients (77.1%) to be nearly identical to or just slightly different from the untreated side. Matrix rotation is an easy breast-preserving technique for treating breast cancer located in the upper/upper inner quadrant of the breast that requires a relatively wide excision. With this technique, a larger breast tumor could be removed without compromising the breast appearance.
Highlights
The approval of breast-conserving surgery (BCS) by the World Health Organization Committee of Investigations for Evaluation of Methods of Diagnosis and Treatment of Breast Cancer since 1996 [1] has offered an alternative treatment method for early-stage breast cancer besides radical mastectomy
Local recurrence was observed in one case, and it was managed with nipple-sparing mastectomy followed by breast reconstruction with prosthetic implants
Several techniques have been developed for each breast quadrant; the upper inner quadrant is still a less favorable location
Summary
The approval of breast-conserving surgery (BCS) by the World Health Organization Committee of Investigations for Evaluation of Methods of Diagnosis and Treatment of Breast Cancer since 1996 [1] has offered an alternative treatment method for early-stage breast cancer besides radical mastectomy. The ultimate goals of BCS for breast cancer are to completely resect the breast tumor with adequate margins and to simultaneously preserve the natural shape of the breast. As contradictory as it sounds, it can be difficult to remove a tumor which is large relative to the size of the breast without sacrificing esthetics. In conventional BCS, approximately 5%–18% of cases had positive margins, which led to high re-excision rates [6, 7]. These high re-excision rates can be significant in terms of complications, morbidity, and deformity
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