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Oncoplastic surgery for breast cancer based on tumour location and a quadrant‐per‐quadrant atlas. BJS 2012; 99: 1389-1395.

Published: 7th September 2012

Authors: K. B. Clough, T. Ihrai, S. Oden, G. Kaufman, E. Massey, C. Nos et al.

Background

The majority of published techniques for oncoplastic surgery rely on an inverted‐$hbox{T}$ mammoplasty, independent of tumour location. These techniques, although useful, cannot be adapted to all situations. A quadrant‐per‐quadrant atlas of mammoplasty techniques for large breast cancers was developed in order to offer breast surgeons a technique dependent on tumour location, which reduces the risk of postoperative complications and delay to adjuvant therapy.

Method

From 2005 to 2010, a series of eligible women with breast cancer were treated by quadrant‐specific oncoplastic techniques. All complications and any delay to adjuvant treatment were recorded prospectively, along with local and distant cancer recurrences. Cosmetic outcome was evaluated using a five‐point scale.

Results

A total of 175 patients were analysed. The median tumour size, after histological examination, was 25 (range 4–90) mm. Twenty‐three patients (13·1 per cent) had involved margins. Seventeen of these patients were treated by mastectomy and three had a re‐excision. Complications occurred in 13 patients (7·4 per cent), which led to a delay to adjuvant treatment in three (1·7 per cent). After a median follow‐up of 49 (range 23–96) months, three patients had developed a local recurrence. The mean score after cosmetic evaluation was 4·6 of 5.

Conclusion

A quadrant‐per‐quadrant approach to oncoplastic techniques for breast cancer was developed that tailors the mammoplasty for each tumour location. This panel of techniques should be a useful guide for breast surgeons, and extends the possibilities for breast conservation for large or poorly limited cancers, with a low complication rate and good cosmetic results. Copyright © 2012 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

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