[Plastic reconstructive surgical methods in breast saving therapy of breast carcinoma: our concept of modified...

The conservative treatment of carcinoma of the breast pursued since 1987 at the Gynecological Clinic of St. Elisabeth's Hospital in Saarlouis has resulted in a steady increasingly in the application of local flapping techniques, tumor-adapted reductive or mastoplastic procedures and latissimus dorsi flaps. A total of 446 breast tumors were removed by surgery and the breast preserved in 198 cases (= 44.4%). In 151 of these, the plastic correction of the defect was performed simultaneously. Transposition flaps (37 cases), rotation flaps (28 cases), modified reductive and mastoplastic techniques (71 cases), and latissimus flaps (15 cases) were applied, depending on the individual situation. In 22 cases a secondary operation was required: in 7 cases a mastectomy (5 cases of multifocal tumor growth, 1 flap necrosis during chemotherapy and 1 local recurrence), in 5 cases an excision biopsy owing to suspected recurrence with granuloma and in two cases a correction of the mamillary localization. 5 patients underwent an adaptive reduction of the healthy breast. The cosmetic results were: in 97 cases (65%) excellent or good, only 9 (6%) were evaluated by the operators as poor. Local recurrences were observed in 5 patients. These methods are intended to combine the oncological advantages of Veronesi's QUART principle (quadrantectomy, axillary dissection, radiation therapy) with improved cosmetics results, making it possible to operate larger tumors and smaller breasts with a satisfactory outcome.