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Practical guidelines for repair of partial mastectomy defects using the breast reduction technique in patients
Steven J Kronowitz1, Kelly K Hunt, Henry M Kuerer
1Houston, Texas From the Departments of Plastic and Reconstructive Surgery, Surgical Oncology, and Radiation Oncology, The University of Texas M. D. Anderson Cancer Center.
Background:
The authors previously compared the local tissue rearrangement, breast reduction, and latissimus dorsi flap reconstruction techniques for repairing partial mastectomy defects and showed the benefits of breast reduction.
Methods:
In this study, the authors focused solely on factors influencing outcome in 41 patients who underwent repair of a partial mastectomy defect using breast reduction.
Results:
Tumor location had a significant effect on the design of the parenchymal pedicle (p = 0.05). Most repairs were performed with an inferior pedicle. Fifty percent of the lower outer and central quadrant tumors required an amputative design with a free nipple graft. The complication rates for immediate and delayed repair were 24 and 50 percent, respectively. The superior pedicle was associated with the highest complication rates. Tumors in the upper outer quadrant of the breast were associated with the highest complication rate (35 percent). Ninety percent of patients with planned repairs had a viable nipple-areola complex (p = 0.05) and did not require a free nipple graft. More favorable cosmetic outcomes were achieved using an inferior pedicle; less favorable cosmetic outcomes were achieved for tumors in the upper inner quadrant of the breast. Larger defects did not result in less favorable cosmetic outcomes than smaller defects. Only 7 percent of patients had a positive tumor margin. Five percent of patients developed local breast cancer recurrence after a mean follow-up of 36 months.
Conclusion:
The authors provide practical guidelines for repairing a partial mastectomy defect using breast reduction that should minimize the occurrence of complications and optimize the cosmetic outcome.