Single Center Experience of Round Block Technique for Breast Surgery; Oncologic Safety and Patient Satisfaction

Abstract

Background: Round block technique (RBT) is a versatile technique for the excision of benign and malignant breast lesions with oncologic safety. Although a technically challenging procedure, it has the benefit of an inconspicuous scar and desirable aesthetic outcomes and wider exposure for tissue resection and remodelling. This study discusses the utility of RBT for the excision of different pathologies, complications, and cosmetic outcomes as it is underutilized in the developing countries. Methods: The study was conducted at the breast surgery clinic, at Liaquat National Hospital. All patients with benign (fibroadenomas, benign phyllodes) or malignant (carcinoma, malignant phyllodes) lesions undergoing the round block technique were included. The clinical size, site, distance from the nipple, pathology, pathological size, and margin status were recorded. Early and late complications were documented during the follow-up. At the time of the final study analysis, patients were interviewed for cosmetic outcome satisfaction using the Harvard scale (4-point Likert score) Results: Overall, 49 patients were included in the study over 2.5 years. The mean clinical tumor size was 4.72cm, of which 63% were in the upper quadrant, and the average distance from the areolar margin was 1.71cm. The pathology included 21 fibroadenomas and 18 carcinomas, with the mean size of 4.14cm. Early complications were seen in 12 cases, and late complications were observed in 2 cases which were all managed conservatively. The cosmetic outcome was found to be fair by 6.1% of the patients, good by 87%, and excellent by the 6.1% of them. Conclusion: RBT is a technically challenging procedure but is easily adaptable. It provides good exposure for excision of both benign and malignant tumors of the breast while maintaining the oncologic safety margin and good cosmesis, especially for young patients with large lesion in the upper inner quadrant.