Volume displacement onco-plastic surgery techniques for early stage primary breast cancer

Abstract

Background: Until recently, the breast surgery could provide only two options for patients with primary stage breast cancer, either modified radical mastectomy or segmental excision followed by radiation, but the introduction of the onco-plastic surgery (OPS) techniques at the time of tumor excision has delivered a third pathway, enabling surgeons to perform major resections involving up to 50% of breast volume without causing deformity. Volume displacement techniques are only possible in patients with medium to large breasts, whereas replacement techniques are suited to small breasted women. The choice of method is determined by both the breast volume and the size of the surgical cavity for infill. The aim of this study: Was to assess the outcome of applying volume displacement onco­ plastic surgery techniques for early stage primary breast cancer regarding resection margins of the tumor, rate of recuence and the aesthetic outcome. Patients and methods: This retrospective study was caied out on twenty-six female patients with early stage primary breast carcinoma treated by volume displacement onco-plastic surgery techniques throughout the period from September 2008 to September 2010. Patients within the inclusion criteria were evaluated by clinical examination, mammography and biopsy. Follow up ranged from 6 months to 2 years with a mean of 20 months. Assessment of the cosmetic outcome was an integral part. Results: Age of patients ranged from thirty to sixty-five years with a mean of 47.7 years. Fourteen patients in the study (54%) had previous history of breast disease or had previous breast biopsy or operation for suspected malignancy. Metastatic work up revealed no distant metastasis. By clinical examination, mammographic and ultrasonographic assessment, the pre­ operative mass size in 77% of cases ranged from 2 to 5 em. One patient had a mass smaller than 1 cm(4%) and five patients had no masses (post-excision) (19%), most patients (73%) were in grade II category, five were grade III (19%) and two were grade I (8%). Racquet mammoplasty was done in 15 cases (57.4%), the round block technique in 7 cases (27%) and the Grisotti technique in 4 cases (15.6%). All our specimens showed adequatefree margins, and all our cases showed no recuence. One case (3.9%) in grade III category developed distant metastasis. The cosmetic outcome was satisfactory. Conclusion: OPS allowed large-volume resections with free margins and fewer re-excisions and mastectomies than that reported with standard BCS. Volume displacement represents the simplest option for partial breast reconstruction and is usually prefeed over techniques for volume replacement which involve more extensive surgery with harvesting of a myocutaneous or subcutaneous flap. The cosmetic outcome was satisfactory both for the surgeons, as the general rule, it is much easier to prevent than to coect deformity; and for the patients, as the tumor was excised without amputation of their breasts and their body image was preserved