Oncoplasty for lateral breast cancers.

Abstract

Abstract Abstract #5158 Introduction: 65% of breast cancers develop in the lateral pole, particularly superiorly. Following conservative treatment, , tumourectomy may produce a typical deformity of superolateral nipple-areolar complex (NAC) deviation. This unaesthetic deformity, is exaggerated by the post-operative irradiation mandated by contemporary breast conserving therapy. Primary utilisation of the oncoplastic technique, 'lateral mammaplasty', allows both the avoidance of such deformities and wider excision margins.
 Patients and methods: The principle behind the technique is the combination of a wide, wedge-shaped tumourectomy combined with NAC repositioning on a de-epithelialised dermoglandular pedicle. Sentinel lymph node biopsy or formal axillary dissection may be performed simultaneously either via a separate or combined incision for inferior and superior lateral mammaplasties respectively. Aesthetic outcomes were assessed on a five-point scale with 1 being excellent and 5 poor.
 Results: eighty-six patients, with a mean age of 53 years (range 29 – 75) underwent lateral mammaplasty. Fifty-five (64%) were palpable and 73 (86%) had simultaneous axillary surgery. Mean tumour size pre- and post-operatively were 29.8 mm (8 – 81) and 33.6 mm (0 – 140) respectively. Mean excision weight was 150g (24 – 484). Eleven (12.8%) required revisional surgery due to involved or close margins and the aesthetic outcome was graded highly satisfying or satisfying in 68 (79%).
 Discussion: lateral mammaplasty has been found to be simple to perform with a short learning-curve. With clear excision margins in 87.8%, it is oncologically sound and compares favourably with simple tumourectomy. It should be considered when the tumour-to-breast volume ratio anticipates an aesthetic deformity. We have found it to be particularly satisfactory after neo-adjuvant chemotherapy for large volume tumours when a positive clinical response allows conservative surgery. It is also useful for revisional surgery in cases of involved or close margins following initial tumourectomy.
 Conclusion: lateral mammaplasty became routine in our institution as it allows, with the assistance of a simple oncoplastic procedure, highly satisfying aesthetic outcomes and the added security of wide excision margins. Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 5158.