Therapeutic mammaplasty--analysis of 50 consecutive cases

This is a descriptive analysis of 50 consecutive cases of therapeutic mammaplasty, the use of reduction mammaplasty and radiotherapy to treat breast tumours. Breast cancers may lie within the normal excision site of a recognised mammaplasty method (scenario A) or outside of the expected excision sites (scenario B), then requiring a modified mammaplasty. A third group are central tumours requiring removal of the nipple. This series includes 13 scenario A, 27 scenario B and 10 central tumours. Wise pattern skin incision was used in 29 (58%) and vertical in 14 (28%). Seven different pedicles were employed but inferior (11), superior (9) and superio-medial (19) comprised the majority (78%). In the 27 scenario B cases an extension of the nipple aereolar pedicle was used to fill the tumour defect in 19 (70%) and a secondary pedicle in 8 (30%). There were no incomplete excisions of invasive tumour but incomplete excision of DCIS requiring mastectomy occurred in 4 (8%) patients. There are no deaths or recurrences to date (mean follow-up 13 months, range 3-32). Complications have occurred in 8 (16%) with a return to theatre for one complication (2%) and the four patients (8%) requiring mastectomy. No patient has had a delay in adjuvant treatment. Cosmetic outcome was deemed good/excellent in 63%, satisfactory in 33%, poor in 4%. Follow-up is restricted to 3-32 months.