Oncoplastic Surgery: Keeping It Simple With 5 Essential Volume Displacement Techniques for Breast Conservation in a Patient With Moderate- to Large-Sized Breasts

Oncoplastic surgery is an evolving field in breast surgery combining the strengths of breast surgical oncology with plastic surgery. It provides the surgeon the ability to excise large areas of the breast in the oncologic resection without compromising, and possibly improving, its aesthetic appearance. The purpose of this review is to provide a guide that could help a breast surgeon excise breast cancer in most areas of the breast using 5 oncoplastic techniques. These techniques would be used depending primarily on the location of the cancer in the breast and also on the size of the tumor

Oncoplastic Surgery: Keeping It Simple With 5 Essential Volume Displacement Techniques for Breast Conservation in a Patient With Moderate- to Large-Sized Breasts

Oncoplastic surgery is an evolving field in breast surgery combining the strengths of breast surgical oncology with plastic surgery. It provides the surgeon the ability to excise large areas of the breast in the oncologic resection without compromising, and possibly improving, its aesthetic appearance. The purpose of this review is to provide a guide that could help a breast surgeon excise breast cancer in most areas of the breast using 5 oncoplastic techniques. These techniques would be used depending primarily on the location of the cancer in the breast and also on the size of the tumor

Outcomes of Breast Reconstruction After Mastectomy Using Deep Inferior Epigastric Perforator Flap After Massive Weight Loss.

BACKGROUND: Because of the correlation between breast cancer and obesity, plastic surgeons may encounter patients requiring reconstructive breast surgery after massive weight loss (MWL). Use of redundant abdominal skin for deep inferior epigastric artery perforator (DIEP) flap in these patients is a novel concept whose value has not been adequately studied. OBJECTIVE: Assess the outcomes of the DIEP technique for breast reconstruction in the massive weight loss population. PATIENTS: From 103 breast reconstruction patients having 150 DIEP flap procedures, 9 DIEP flaps were performed in MWL patients. Propensity score matching was used in a 1:2 ratio. Eighteen nonweight loss (NWL) patients were selected for comparison with 9 DIEP flaps performed in 6 MWL patients. MEASUREMENTS: Patients in 2 groups were matched for age and body mass index (BMI). Massive weight loss patients were compared with NWL patients on the basis of immediate versus delayed reconstruction and history of radiation; DIEP flap characteristics, including coupler size, additional venous anastomosis, need for re-exploration, and flap loss; length of hospital stay; abdominal wound healing complication; and hernia or bulging. RESULTS: There was no difference in the incidence of flap failures, bulging, or hernias requiring surgery in the MWL group. Additionally, there was no statistical difference in flap survival, abdominal complications, hospitalization days, operative time, or operative characteristics between the 2 groups. There was a significant positive correlation between immediate wound healing complications and comorbidities (P = 0.041). However, there was no correlation between wound healing complications and weight loss history. LIMITATIONS: Only 6 MWL patients of a single surgeon were studied. CONCLUSIONS: For breast reconstruction after mastectomy, DIEP flaps can be used in MWL and NWL populations with equal flap success and abdominal donor site results. Therefore, cosmetic surgeons performing contouring procedures should consider sparing redundant abdominal tissues in patients requiring breast reconstruction

Vertical Mastectomy Incision in Implant Breast Reconstruction After Skin Sparing Mastectomy: Advantages and Outcomes.

BACKGROUND: The type of since skin-sparing mastectomy (SSM) incision directly impacts the final aesthetic and functional results of reconstruction. Different incisions are used for SSM depending on tumor location, previous biopsy scars, breast weight, and ptosis degree. A vertical scar is less visible to the patient, reminiscent of a mastopexy, and patients may not have the stigma of mastectomy. OBJECTIVE: This study investigates complication rates, patient demographics, patient reported outcomes, and plastic surgeon evaluations to compare vertical incision mastectomy to other incisions. METHODS: After institutional review board approval, a retrospective chart review was performed. A total population of 167 patients that underwent mastectomy with tissue expander reconstruction was separated into vertical incision and nonvertical incision mastectomy groups consisting of 38 and 129 patients, respectively. Patient demographics, complications, tumor margins, staging, breast weight, and breast implant volume were compared. BREASTQ Survey analysis was conducted using patient reported outcomes from the patient\u27s perspective. Aesthetic evaluations of postoperative photos were systematically scored by plastic surgeons to obtain data from the plastic surgeon\u27s perspective. RESULTS: Vertical incision orientation did not increase surgical complication rates or mastectomy skin necrosis (P = 0.142). Vertical incisions did not interfere with obtaining adequate tumor margins (P = 0.907). Vertical incisions did not have a significantly different breast weight or implant volume. There was no statistical difference for patient satisfaction or plastic surgeon aesthetic evaluation. CONCLUSIONS: The use of vertical incision does not increase complication rates; does not interfere with tumor margins; and can be applied to all age, BMI, breast weight, and breast implant volume groups