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

Lee S, Lee J, Lee S, Bae Y - World J Surg Oncol (2014)

Bottom Line: The cosmetic results were self-assessed after chemotherapy and radiotherapy by a four-point scoring system.Ptosis was graded as follows: two patients with grade 1, 10 patients with grade 2, and seven patients with grade 3.The cosmetic results were excellent in five patients, good in seven patients, fair in six patients, and poor in one patient.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Surgery, Medical Research Institute, Pusan National University, Ami-dong 1-ga, Seo-gu, Busan 602-739, Republic of Korea. bytae@pusan.ac.kr.

ABSTRACT

Background: The 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.

Methods: Nineteen 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.

Results: Ptosis 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.

Conclusion: The 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.

Show MeSH

Related in: MedlinePlus

Patient with multifocality. (A) Preoperative view with marking of the skin incision. (B) Defect (dot circle) by transillumination after partial mastectomy. (C) Skin incision marking for TEF. The width of TEF should be more than 8 cm. (D) TEF would be rotated to lower outer margin of LDMCF. (E) Combination of LDMCF and TEF is filling the defect. (F) Skin closure after combined pedicle flap.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC3974747&req=5

Figure 2: Patient with multifocality. (A) Preoperative view with marking of the skin incision. (B) Defect (dot circle) by transillumination after partial mastectomy. (C) Skin incision marking for TEF. The width of TEF should be more than 8 cm. (D) TEF would be rotated to lower outer margin of LDMCF. (E) Combination of LDMCF and TEF is filling the defect. (F) Skin closure after combined pedicle flap.

Mentions: Our technique, which consists of LDMCF, TEF, and IPRLF, had no limitation of tumor location and could obtain good cosmetic results despite of wide excision. As shown in Figure 2, patient 17 had been diagnosed with breast cancer in the central region. She had multiple daughter cells in the upper inner site around the main tumor mass. We had to resect more breast tissue to obtain oncologic safety; therefore, we tried combined pedicle flaps in this patient. Her tumor stage was IIA and the percentage of excised breast volume was identified as 36.7%. As shown in Table 2, the cosmetic result of this case was good. And we had six more patients with positive margin during the operation, and their cosmetic results were also good.


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

Lee S, Lee J, Lee S, Bae Y - World J Surg Oncol (2014)

Patient with multifocality. (A) Preoperative view with marking of the skin incision. (B) Defect (dot circle) by transillumination after partial mastectomy. (C) Skin incision marking for TEF. The width of TEF should be more than 8 cm. (D) TEF would be rotated to lower outer margin of LDMCF. (E) Combination of LDMCF and TEF is filling the defect. (F) Skin closure after combined pedicle flap.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3974747&req=5

Figure 2: Patient with multifocality. (A) Preoperative view with marking of the skin incision. (B) Defect (dot circle) by transillumination after partial mastectomy. (C) Skin incision marking for TEF. The width of TEF should be more than 8 cm. (D) TEF would be rotated to lower outer margin of LDMCF. (E) Combination of LDMCF and TEF is filling the defect. (F) Skin closure after combined pedicle flap.
Mentions: Our technique, which consists of LDMCF, TEF, and IPRLF, had no limitation of tumor location and could obtain good cosmetic results despite of wide excision. As shown in Figure 2, patient 17 had been diagnosed with breast cancer in the central region. She had multiple daughter cells in the upper inner site around the main tumor mass. We had to resect more breast tissue to obtain oncologic safety; therefore, we tried combined pedicle flaps in this patient. Her tumor stage was IIA and the percentage of excised breast volume was identified as 36.7%. As shown in Table 2, the cosmetic result of this case was good. And we had six more patients with positive margin during the operation, and their cosmetic results were also good.

Bottom Line: The cosmetic results were self-assessed after chemotherapy and radiotherapy by a four-point scoring system.Ptosis was graded as follows: two patients with grade 1, 10 patients with grade 2, and seven patients with grade 3.The cosmetic results were excellent in five patients, good in seven patients, fair in six patients, and poor in one patient.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Surgery, Medical Research Institute, Pusan National University, Ami-dong 1-ga, Seo-gu, Busan 602-739, Republic of Korea. bytae@pusan.ac.kr.

ABSTRACT

Background: The 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.

Methods: Nineteen 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.

Results: Ptosis 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.

Conclusion: The 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.

Show MeSH
Related in: MedlinePlus