Oncoplastic surgery for inner quadrant breast cancer: fish-hook incision rotation flap

In oncoplastic breast surgery, the size and location of the defect are two of the major factors affecting the post-operative cosmetic outcome after partial mastectomy. We introduce a modified superior-based dermoglandular rotation flap technique, which can be applied for relatively large tumours and in cases of inner quadrant defects of the breast without surgery of the contralateral breast.

Between January 2007 and December 2012, a total of 34 female patients with breast cancer underwent breast-conserving surgery using the 'fish-hook incision rotational flap'. A fish-hook-shaped skin incision line was designed from an axillary site to the tumour, about 2-3 cm below the skin crease of the inframammary fold. After partial mastectomy, a superior-based dermoglandular tissue flap was mobilized off the pectoralis major muscle and the lower abdominal flap was dissected downward. The dermoglandular flap was then rotated and the lower dissected lower abdominal flap was advanced in the upward direction to fill the defect and restore the breast shape. The cosmetic results were self-estimated 12 months after surgery.

Mean excised volume of the breast was 23.2 ± 6.1%. The location of the tumours was as follows: upper inner (n = 13, 38.2%) and lower inner quadrant (n = 21, 61.8%). The overall cosmetic satisfaction was self-estimated as follows: excellent (n = 19, 55.9%); good (n = 10, 29.4%); fair (n = 4, 11.8%); poor (n = 1, 2.9%).

The 'fish-hook incision rotation flap' is a feasible, effective oncoplastic technique that can be applicable to a relatively large defect located in the inner quadrant of the breast.