Thoracoepigastric Flap Research Articles

Indocyanine green is an integral part of breast reconstructive surgery using perforator flaps

The use of allotransplants for breast reconstruction in surgical stage of the the breast cancer treatment requires tissue perfusion control. The aim of the study was to analyze the effectiveness of using indocyanine green as a drug for determining the perfusion of perforant flaps in breast reconstructive surgery. A retrospective series of observations of 27 breast reconstructions using autologous transplants is presented: 19 reconstructions with DIEP-flap, 2 with SIEA-flap, 5 with TD-flap; 1 with thoracoepigastric flap. Intraoperative fluorescence angiography was performed using a Stryker device (5900 Optical Court, USA). The intensity of the flap fluorescence was recorded after intravenous bolus injection of 7.5 mg indocyanine green. The optimal time interval from the moment of drug administration to indicative visualization of flap perfusion was 55-60 seconds. In all patients, the area of insufficient blood flow was excised within intensively blood-supplied tissues, according to mapping data with the indocyanine green. With free transplant of flaps postoperative complications during follow-up were recorded in 1 (4.8%) case (marginal necrosis), which is associated with insufficient compression of auxiliary vessels (violation of the dominant vessel contrast technique). With non-free transplant of flaps no complications were detected in the postoperative period. Indocyanine green allows to prevent necrotic changes and reduce the rehabilitation period. The optimal time for the indicative visualization of flap perfusion was 55-60 seconds. The use of indocyanine green in free transplant of flaps ensured a postoperative period without complications in 20 (95.2%) cases, in non-free flap transplantation - in 6 (100%) cases.

Use of thoracoepigastric flap in the closure of large chest wall defects after surgical treatment of locally advanced breast tumor: a case report

A Revista Brasileira de Cirurgia Plástica é o órgão oficial de divulgação da Sociedade Brasileira de Cirurgia Plástica (SBCP), tem como objetivo registrar a produção científica em Cirurgia Plástica, fomentar o estudo, aperfeiçoamento e atualização dos profissionais da especialidade.

Incidence and Reconstruction of Chronic Radiation-Induced Chest Wall Ulceration in Postoperative Breast Cancer Patients

Background: Breast cancer patients who receive radiotherapy for postoperative tumor control are exposed to the possibility of adverse effects including osteoradionecrosis and ulceration. The purpose of this study is to explore reconstruction of ulcers according to their characteristics, and also to investigate the incidence of skin ulcers in patients who had undergone radiotherapy after modified radical mastectomy (MRM).Methods: Data of patients who underwent radiation therapy after MRM from 1979 to 2003 were collected. Demographics and radiation details were analyzed along with their reconstruction outcomes and pathologic characteristics. Effects of surgical debridement and reconstruction strategies for success were also assessed.Results: A total of 113 patients had radiotherapy after MRM in our institution, out of which nine patients (7.96%) developed ulcerations in the chest wall. Eleven patients underwent reconstructive surgery, including the nine patients who developed chest wall ulcerations and an additional two patients from other hospitals. Seven patients had thoracoepigastric flaps while three had latissimus dorsi musculocutaneous flaps and one had a perforator flap. The average initial wound size was 5.77 cm<sup>2</sup>, and this average was enlarged by 23.6 times after debridement. There was no reconstructive failure in any of the patients. Fibrosis, necrosis with ulceration, and dystrophic calcification were common pathological findings. Dystrophic calcification was found in seven of 11 cases. Additionally, ossification with bone formation was noted in three of seven cases with dystrophic calcification.Conclusion: A thorough preparation of the wound bed and reconstruction with flaps appropriate for the defect can successfully treat chronic radiation-induced ulceration.

Two Perforators Improve the Extent and Reliability of Paraumbilical Flaps for Upper Limb Reconstruction.

BACKGROUNDComplex defects of the forearm and arm are best reconstructed with free flaps. Free flaps are however not universally available. They require long operative time and may be contraindicated in patients with extensive injuries due to a lack of good recipient vessels. The alternatives to free flaps are distant flaps such as groin flaps, random abdominal flaps, thoracoepigastric flaps and paraumbilical perforator flaps. These are axial flaps that are limited by the angiosomes supplied by a given perforator or blood vessel. To improve the extent and reliabilities of the paraumbilical flaps, we incorporated two perforators in the flap.METHODSA total of 17 patients with extensive forearm defects were managed by two vessel paraumbilical perforator flaps between January 2013 and December 2018. The perforators were identified by a hand-held Doppler and the flap was fashioned with the perforators at the base. RESULTSThe mean length of the flap raised was 19.5 cm and width was 8.3 cm. The median age was 39 years. All the flaps were successful with no incidence of flap necrosis and no dehiscence.CONCLUSIONTwo vessel perforator flaps improved the reliability of the paraumbilical perforator flap, allowing for a bigger flap to be harvested and thus ensuring a cover of larger defects. The flaps were easy to raise and were easily tolerated by the patients.

The Utility of Thoracoepigastric Flap and Thoracoabdominal Flap for Extensive Skin Defects after Mastectomy

The Utility of Thoracoepigastric Flap and Thoracoabdominal Flap for Extensive Skin Defects after Mastectomy

Local Fascio-Cutaneous Flaps for Skin Cover after Large Mastectomies for Locally Advanced Breast Cancer – An Indian Perspective

Background: Many patients in India still present with locally-extensive breast cancer to the general surgeon. Surgical ablation for such tumours results in large chest wall defects management of which becomes difficult in absence of surgical oncologist- plastic surgeon team – as is the case in large parts of the country. The purpose of this article is to present simple local fascio-cutaneous flaps which can be done by general surgeons. Subjects and Methods: Among 8 local flaps, 5 were laterally based thoraco-abdominal (TA) flaps, and 3 were medially based thoraco-epigastric (TE) flaps. Clinical outcomes were compared including complications, the need for a secondary surgical intervention, and the timing of adjuvant therapy. Results: The mean defect size was 410.6 cm2 (range, 140–720 cm2). One case of wound dehiscence (12.5%) was noted in the lateral based (TE) flap group. All patients survived more than 1 year without any local recurrence or delay in adjuvant treatment. Conclusion: Local fascio-cutaneous flaps are a viable option to treat large chest wall defects after the excision of locally advanced breast cancer. They are simple, robust and can be performed easily by general surgeons.

Use of thoracoepigastric flap in large breast resections: phyllodes tumor case report

Use of thoracoepigastric flap in large breast resections: phyllodes tumor case report

Safety and viability of a new format of thoracoepigastric flap for reconstruction of the chest wall in locally advanced breast cancer: a cross-sectional study

A Revista Brasileira de Cirurgia Plástica é o órgão oficial de divulgação da Sociedade Brasileira de Cirurgia Plástica (SBCP), tem como objetivo registrar a produção científica em Cirurgia Plástica, fomentar o estudo, aperfeiçoamento e atualização dos profissionais da especialidade.

Oncological Outcomes and Complications After Volume Replacement Oncoplastic Breast Conservations-The Glasgow Experience.

INTRODUCTIONOncoplastic breast conservation surgery (OBCS) combines the principles of surgical oncology and plastic surgery. OBCS has now become a growing option for the treatment of breast cancer and forms a part of breast-conserving therapy (BCT). We sought to investigate and report our experience in two breast units in Glasgow (Victoria Infirmary and Western Infirmary) on volume replacement OBCS.MATERIALS AND METHODSDetails of patients treated with volume replacement OBCS were identified from a prospectively recorded database from November 2010 to October 2015. The clinical records included in the oncoplastic dataset were analyzed for demographics, tumor, treatment characteristics, and recurrences. The data were analyzed for follow-up to determine the pattern and timing of recurrence up to April 2016. The primary outcome of this study was tumor-free margin resection rates, and the secondary outcomes were locoregional and distant recurrence rates as these correlate with the overall oncological safety of volume replacement oncoplastic breast surgery (OPBS).RESULTSA total of 30 volume replacement oncoplastic breast conservation procedures have been carried out in this time period. The mean age of the former group was 51 years. Twice as many patients presented symptomatically than had tumors detected on screening. The mean preoperative tumor size on radiology was 25.4 mm. Patients underwent 13 thoracoepigastric flaps, 5 lateral intercostal artery perforator (LICAP) flaps, 2 thoracodorsal artery perforator (TDAP) flaps, 1 lateral thoracic artery perforator (LTAP) flap, 1 crescent flap volume replacement surgery, and 8 matrix rotations. Two patients had neoadjuvant chemotherapy. Fourteen patients had adjuvant chemotherapy, and all patients were treated with adjuvant radiotherapy. Twenty-two patients were treated with hormonal therapy and four patients were treated with Herceptin. The rate of incomplete excision was 10%. Median follow-up time was 48.5 months. Only one regional recurrence was detected. Eight patients encountered some form of complication.CONCLUSIONThis study continues to show the relative oncological safety of volume replacement oncoplastic conservations as an option for reconstruction in breast cancer patients. Further research is urgently needed to build robust evidence supporting the long-term oncological safety.

Review of Pedicled Groin and Thoracoepigastric Flaps in War-Related Extremity Trauma

BACKGROUND: War-related trauma can present substantial reconstructive challenges. The use of local tissue for extremity reconstruction is often impossible secondary to the large zone of injury associated with blast injuries. However, the torso is general protected by modern body armor. The purpose of this study is to investigate our experiences and outcomes of two stage pedicle flap procedures for complex upper extremity reconstruction in the war wounded. METHODS: This is a multi-institution retrospective consecutive case series review of all injured military personnel treated with flap coverage for complex extremity trauma from 2003 through 2012 within the National Capital Area (NCC). Data collected includes injury severity score (ISS), concomitant injuries, and treatment course. Outcomes measured includes flap and extremity complications such as infection, hematoma, and flap failure. RESULTS: From 2003 through 2012, 28 delayed pedicle groin and thoracoepigastric flaps were performed for upper extremity reconstruction after war-related injuries. All of the patients were male, age 19–35, with an average injury severity score of 20.1. Thirty percent of patients had a proximal vascular injury in the extremity reconstructed. Patients had a median of 6 (range 2–29) procedures performed on the affected extremity prior to flap transfer and 4 (range 1–27) performed after flap transfer. The total flap complication rate was 39%. The most common complication was partial necrosis (14%), followed by flap infection (11%). The flap failure rate was 7% (n=2), requiring additional flap transfer (free anterolateral thigh and pedicled lateral arm). There were no amputations in the group. The flap complication and failure rate were similar to the entire war-wounded extremity reconstruction cohort previously reported, 39 versus 27% and 7 versus 10%, respectively.1 Patients were followed for an average of 741 days. CONCULSION: Soft tissue coverage for complex extremity war-related trauma results has been highly successful with relatively low complication rates. In the critically injured war wounded patient, pedicle and free flaps have similar outcomes.2 However, when local tissue for pedicle flaps is not available, delayed reconstruction with groin or epigastric flaps is a good option that offers tissue from a protected region of the body and reliable blood supply with a low risk of failure.

Using local flaps in a chest wall reconstruction after mastectomy for locally advanced breast cancer.

BackgroundSurgical ablation for locally advanced breast cancer results in large chest wall defects, which can then be managed with local flaps or skin grafts. The purpose of this article is to evaluate the outcomes of three types of local skin flaps.MethodsAmong 25 local flaps in 24 patients, 6 were bilateral advancement (BA) flaps, 9 were thoracoabdominal (TA) flaps, and 10 were thoracoepigastric (TE) flaps. Clinical outcomes were compared including complications, the need for a secondary surgical intervention, and the timing of adjuvant therapy.ResultsThe mean defect size was 436.2 cm2. Two patients with TA flaps and 6 patients with TE flaps developed distal flap necrosis, and skin grafts were needed to treat 2 patients with TE flaps. Radiation was administered to the BA, TA, and TE patients after average postoperative durations of 28, 30, or 41 days, respectively. The incidence of flap necrosis tended to be higher in TE patients, which lead to significant delays in adjuvant radiation therapy (P=0.02).ConclusionsThree types of local skin flaps can be used to treat large chest wall defects after the excision of locally advanced breast cancer. Each flap has its own merits and demerits, and selecting flaps should be based on strict indications based on the dimensions and locations of the defects.

Thoraco-epigastric flap for breast reconstruction in cancer

Reconstructive surgery for breast cancer are an integral method of rehabilitation of cancer patients. Breast reconstruction may be delayed and instantaneous. The article presents a description of the thoraco-epigastric flap for breast reconstruction in cancer. The operation involves the replacement of the remote volume (after radical resection of the breast) and the breast skin adjacent tissues adjacent to the inframammary crease from the side of the anterior abdominal wall. Surgery is indicated when the tumor in the lower parts of the breast, closest to the skin, in combination with small size breast cancer. The article presents a clinical example of this operation. Described in detail the operation, received a good cosmetic result. The advantage of the application of thoraco-epigastric flap is in the simplicity of the technique of its execution, good blood supply, donor wound is easily sutured due to the possible wide separating cellular adjacent skin and subcutaneous tissue. The disadvantage of this method is limited and the need for careful monitoring of perforating branches of the upper epigastric artery. Thus, thoraco-epigastric flap, can be applicable when performing reconstructive operations for breast cancer in compliance with the necessary requirements for the formation of the flap and the correct attitude to feeding the flap vessels, and virtually eliminates possible complications with the healing of the flap. Undoubtedly, reconstructive plastic surgery for breast cancer, during the testimony and technical capabilities, are an essential component of surgical treatment.

P0096 Thoracoepigastric flap: A novel technique in chest wall reconstruction for locally recurrent breast cancer

Background Chest wall recurrence can occur after breast cancer. Isolated chest wall recurrences usually occur after treatment that uses all three methods: surgery, chemotherapy, and radiation to the chest wall. Chest wall recurrences usually require one or two rib resections for oncological clearance. Our aim was to assess the usefulness of thoracoepigastric flap in the reconstruction of chest wall for isolated chest wall local recurrence of breast carcinoma. Methods We studied 36 patients aged 31–65 years with isolated chest wall involvement, with or without rib infiltration, for 24 months. Patients underwent immediate chest wall reconstruction with mesh and a thoracoepigastric flap. Outcomes were oncological safety and cosmetic outcomes after chest wall reconstruction. To assess oncological safety we used margin status. We used a questionnaire to evaluate personal experience after the reconstruction. Findings After modified radical mastectomy, 16 patients had positive or close margins and 20 patients were margin-negative. Operating time ranged from 130 to 210 min (mean time 154 min). Blood loss ranged from 75 to 300 mL (mean volume 134 mL). The skin island used for volume replacement ranged from 4 cm by 3 cm to 10 cm by 6 cm. No patient had margin positivity or close margins. Major wound complications occurred in three patients. Minor wound complications occurred in five patients. Five patients developed seroma. We followed up patients for 12–23 months. Interpretation Isolated chest wall recurrences are completely resectable if we have oncoplastic options such as the thoracoepigastric flap. This technique has increased the oncological safety with less margin-positive resections after immediate reconstruction of chest wall with good cosmetic outcome and less donor site morbidity.

Oncoplastic breast surgery with latissimus dorsi myocutaneous flap for large defect in patients with ptotic breasts: is it feasible when combined with local flaps?

BackgroundThe latissimus dorsi myocutaneous flap (LDMCF) is frequently applied to breast cancer patients for breast reconstruction. However, the LDMCF is considered inappropriate for patients with ptotic breast. The authors investigated combining LDMCF and two local flaps for large defects of the breast after partial mastectomy in patients with ptosis.MethodsNineteen patients with breast cancer underwent a partial mastectomy with immediate reconstruction. Reconstruction methods consisted of LDMCF, thoraco-epigastric flap, and inferior pedicled rotational local flap, referred to as a combined pedicle flap. The cosmetic results were self-assessed after chemotherapy and radiotherapy by a four-point scoring system.ResultsPtosis was graded as follows: two patients with grade 1, 10 patients with grade 2, and seven patients with grade 3. The mean tumor size was 2.7 cm and multifocality was identified in 11 patients (57.9%). The mean excised volume was 468.5 cm3 and the percentage of excised volume was 46.2%. The cosmetic results were excellent in five patients, good in seven patients, fair in six patients, and poor in one patient.ConclusionThe combined pedicle flap, consisting of LDMCF, thoraco-epigastric flap, and inferior pedicled rotational local flap, allows good cosmesis in breast cancer patients with large breasts or ptosis despite a wide excision.

Oncoplastic volume replacement techniques according to the excised volume and tumor location in small- to moderate-sized breasts.

In the treatment of cancer patients with small breasts, breast-conserving surgery (BCS) with adjuvant radiotherapy has become popular. In Korean women, many of whom have small- to moderate-sized breasts, the removal of an adequate volume of tissue during breast cancer surgery may compromise the cosmetic outcome and sometimes cause unpleasant results. In such cases, oncoplastic volume replacement techniques can be valuable. Between January 2007 and December 2013, 213 women underwent 216 BCSs with various oncoplastic volume replacement techniques selected according to the volume of breast tissue excised. When the excised volume was <150 g, regional flaps such as a lateral thoracodorsal or thoracoepigastric flap, or perforator flaps such as an intercostal artery perforator (ICAP) flap or a thoracodorsal artery perforator (TDAP) flap were used. When the excised volume was >150 g, a latissimus dorsi (LD) myocutaneous flap was used. The mean age was 45.7 years, and the mean follow-up interval was 11.3 months. The mean excised volume was 148.4 g. The oncoplastic volume replacement techniques used included 22 lateral thoracodorsal flaps, 8 thoracoepigastric flaps, 29 ICAP flaps, 20 TDAP flaps, and 137 LD myocutaneous flaps. Postsurgical complications occurred in 30 cases, including 1 case of congestion and 26 cases of seroma in LD myocutaneous flaps, and 3 cases of fat necrosis in ICAP flaps. Most of the patients were satisfied with the cosmetic outcome. Oncoplastic volume replacement techniques according to the excised volume and tumor location are reliable and useful for the correction of breast deformity after BCS, especially in patients with small- to moderate-sized breasts.

Oncoplastic breast reconstruction after IORT

Prospective randomized clinical trials have shown that breast-conserving surgery followed by radiotherapy gives equivalent survival rates compared with mastectomy. The indications for breastconserving therapy in breast cancer are expanding. The integration of oncoplastic surgery techniques with breast-conserving segmentectomy is a new approach that allows more extensive resections and results in more cosmetic favourable outcomes. During the last years we have defined five reconstruction principles in oncoplastic breast-conserving surgery. With these five principles we were able to perform more than 95% of all immediate reconstructions of partial mastectomy defects during breast-conserving surgery, resulting in optimized local and aesthetic outcomes. The oncoplastic reconstruction principles of partial mastectomy defects during breast-conserving surgery are as follows: glandular rotation, dermoglandular rotation, tumoradapted reduction mammoplasty, thoracoepigastric flap, Latissimus dorsi flap. Usually the whole breast is percutaneously irradiated after breast-conserving surgery. Depending on different risk factors, a local boost dose is applied to the tumor bed, which leads to a further reduction of local recurrences. Recently, the concept of intraoperative radiotherapy (IORT) as boost during breast-conserving surgery has been introduced internationally. From a surgical point of view intraoperative boost radiotherapy with a mobile device generating low-energy X-rays (Intrabeam ® ) can be combined with all oncoplastic principles for reconstructing partial mastectomy defects. The advantage of an oncoplastic reconstruction after breastconserving surgery and IORT boost irradiation should be recommended to improve local outcome, to avoid seroma formation and to improve the cosmetic outcome after treatment.

Oncological Advantages of Oncoplastic Breast-Conserving Surgery in Treatment of Early Breast Cancer

The standard approach to breast-conserving surgery is wide local excision of the tumor and radiotherapy. However, a significant number of patients require further surgery to obtain oncologically clear margins, and may obtain a poor cosmetic result following adjuvant radiotherapy. Oncoplastic techniques may result in improved cosmesis, but few studies have investigated the oncological advantage of this approach. The aim of this retrospective study was to compare tumor clearance and the need for further margin excision following standard wide local excision (group A, 121 patients), and oncoplastic breast-conserving surgery (group B, 37 patients). These techniques included therapeutic mammoplasty, sub-axillary fat pad rotation mammoplasty, thoraco-epigastric flap, and central flap. Compared to standard surgery (group A), oncoplastic techniques (group B) can be employed for significantly larger tumors (17.6 mm versus 23.9 mm, p = 0.002). Oncoplastic breast-conserving surgery results in higher mean specimen weights (58.1 g versus 231.1 g, p < 0.0001), higher specimen volumes (112.3 cm(3) versus 484.5 cm(3) , p < 0.0001), and wider clear margins (6.1 mm versus 14.3 mm, p < 0.0001), resulting in lower rates of further surgery (28.9% versus 5.4%, p = 0.002). There was no statistical increase in complication rates following oncoplastic surgery. Oncoplastic breast-conserving surgery is more successful than standard wide local excision in treating larger tumors and obtaining wider radial margins, thus reducing the need for further margin excision, which delays adjuvant therapy. There was no increase in postoperative complication rate using an oncoplastic approach.

Abdominoplasty and thoraco-epigastric flaps for large anterior trunk defects after dermatofibrosarcoma protuberans wide resection: Two illustrative cases

INTRODUCTIONExcision of large dermatofibrosarcoma protuberans in the anterior aspect of the trunk often results in large surgical defects that frequently dictate the need for microsurgical reconstruction. However, this option is not always available. PRESENTATION OF CASEThe authors describe two patients with very large anterior trunk dermatofibrosarcoma protuberans: one in the epigastric region and the other in the hypogastric region. In the patient with the hypogastric tumor, a classical abdominoplasty flap associated with umbilical transposition was used to cover the skin defect after muscle and fascial plication, and placement of a polypropylene mesh. In the patient with the epigastric tumor, a synthetic mesh was also placed, and the skin and subcutaneous defect was reconstructed with a reverse abdominoplasty flap and two thoraco-epigastric flaps. In both cases, complete closure was possible without immediate or late complications. DISCUSSIONThe local options described in this paper present several potential advantages compared to microsurgical reconstruction, namely they are easier and faster to perform and teach; they provide a good skin color and texture match; they are not associated with distant donor site morbidity; follow-up is usually less cumbersome; the post-operative hospital stay tends to be shorter; they are less costly; they are less prone to complete failure. CONCLUSIONThe authors believe that these two patients clearly show that local flaps, although frequently neglected, continue to be valid options for reconstructing large anterior trunk defects, even in the current era of microsurgery enthusiasm.

Usefulness of Oncoplastic Volume Replacement Techniques after Breast Conserving Surgery in Small to Moderate-sized Breasts

BackgroundIn Korean women, many of whom have small to moderate-sized breasts, it is difficult to cover a partial breast defect using oncoplastic volume displacement techniques after removal of an adequate volume of tissue during oncologic surgery. In such cases, oncoplastic volume replacement techniques are more useful.MethodsFrom January 2007 to December 2011, 104 women underwent a total of 107 breast-conserving surgeries with various kinds of oncoplastic volume replacement techniques. We used latissimus dorsi (LD) myocutaneous flap for cases in which the resection mass was greater than 150 g. In case with a resection mass less than 150 g, we used regional flaps such as a lateral thoracodorsal flap, a thoracoepigastric flap, or perforator flaps such as an intercostal artery perforator (ICAP) flap or a thoracodorsal artery perforator (TDAP) flap.ResultsThe mean age was 46.1 years, and the average follow-up interval was 10.3 months. The patients underwent oncoplastic volume replacement techniques with a lateral thoracodorsal flap (n=9), thoracoepigastric flap (n=7), ICAP flap (n=25), TDAP flap (n=12), and LD flap (n=54). There was one case of congestion in an LD flap, and two cases of fat necrosis in an ICAP flap. Most of the patients were satisfied with the cosmetic results.ConclusionsOncoplastic volume replacement techniques can be reliable and useful for the correction of breast deformity after breast-conserving surgery, especially in patients with small to moderate-sized breasts.

Surgical Techniques for Personalized Oncoplastic Surgery in Breast Cancer Patients with Small- to Moderate-Sized Breasts (Part 2): Volume Replacement

Oncoplastic breast surgery has become a popular choice of treatment for breast reconstruction after mastectomy. There are two different techniques in oncoplastic surgery depending on the volume of the excised breast tissue. One is the volume displacement procedure, which combines resection with a variety of different breast-reshaping and breast-reduction techniques; the other is the volume replacement procedure in which the volume of excised breast tissue is replaced with autologous tissue. In this study, current authors performed various volume replacement techniques based on the weight of the excised tumor and its margin of resection. We used a latissimus dorsi myocutaneous flap for cases in which the resection mass was greater than 150 g, and for cases in which the resection mass was less than 150 g, we used a regional flap, such as a lateral thoracodorsal flap, a thoracoepigastric flap, or perforator flaps, such as an intercostal artery perforator flap or a thoracodorsal artery perforator flap. In the patients with small to moderate-sized breasts, when a postoperative deformity is expected due to a large-volume tumor resection, the replacement of non-breast tissue is required. Many of whom have small breasts, oncoplastic volume replacement techniques in breast-conserving surgery allow an extensive tumor excision without concern of compromising the cosmetic outcome and can be reliable and useful techniques with satisfactory aesthetic results.