Application Of Oncoplastic Techniques In Breast Conserving Surgery

Objective: To evaluate the clinical application of oncoplastic techniques in breastcancer patients with breast conserving surgery.By complications,objective andsubjective satisfaction surveys,patients were followed up to explore the safety,cosmeticand clinical value of oncoplastic techniques.Methods: Clinical data of60breast cancer patients who received oncoplastic breastsurgery from January2010to december2010were retrospectively analyzed.The breastincision was disigned based on the diameter and the location of tumor.Local expandedresection was used.Margin from the tumor edge distance was2cm.Many methods wereused to repair breast defects:1.Volume displacement techniques:(1)Pedicle flap ofbreast tissue,Suitable for direct suturing was difficult.Fully free the breast tissuebetween subcutaneous fat layerand and the pectoralis major fascia.Glandular flap wasrotated and Sutured.(2)Superior pedicle inverted-T mammaplasty was suitable for themass located in lower quadrant and near to inframammary fold.(3)Inferior pedicleinverted-T mammaplasty was suitable for the mass located in upper quadrant.(4)Peri-areolar mammaplasty was suitable for the mass near to nipple-areola complex.(5)Lateral mammaplasty was suitable for the mass located in lateral quadrant.(6)Medialmammaplasty was suitable for the mass located in medial quadrant.(7)Omegaplastywas suitable for the mass located in upper quadrant,special for sagging breast.2.Volumereplacement techniques:(1)Lateral thoracoaxillar fat tissue flap.(2)Inframammaryadipofascial flap.Objective evaluation and subjective satisfaction survey were assessedsix months after surgery. Results: The median age of the patients was45years(range29to66years)．Theaverage diameter of tumors was2.6cm(range1.0to5.0cm).27were in the left breastand33were in the right breast.There were26located in upper outer quadrant,11inupper inner quadrant,10in lower outer quadrant,7in lower inner quadrant,3near to thenipple and3located in inframammary.Surgical options:omegaplasty was8,peri-areolarmammaplasty was5,inferior pedicle inverted-T mammaplasty was11,superior pedicleinverted-T mammaplasty was8,medial mammaplasty was6,lateral mammaplasty was10,J-mammaplasty was4,Lateral thoracoaxillar fat tissue flap was5and Inframammaryadipofascial flap was3.Positive margin rate was8.3%(5/60).Objective cosmeticresults:32patients were Excellent,18were Good,7were Fair and3were Poor.50patients(83.3％)had good to excellent cosmetic results. Subjective cosmetic results:41were very satisfied,11were satisfied,6were ordinary,2were dissatisfied.The subjectivesatisfaction rate was86.7%.One patient experienced hematoma under the incision andone patient had incisional dehiscence.No cases of flap necrosis and nipple-areolanecrosis.The mean follow-up time was42months(range37to48months).3cases oflocal recurrence,4cases of distant metastasis,2had been dead.The local recurrence ratewas5%(3/60),distant metastasis rate was6.7%(4/60),3year survival was96.7%(58/60).Conclusion:Oncoplastic techniques is simple, does not require special equipment andfacilities, does not require sophisticated vascular anastomosis technology.Breastoncoplastic techniques benefit those whose tumors were enormous and located inspecial area of the breast,and can achieve an better cosmetical appearance.