Top

Published in:

01-02-2007 | Case Report

Bilateral Reduction Mammaplasty for Immediate Breast Conservation Surgery Reconstruction and Intraoperative Radiotherapy: A Preliminary Report

Authors: Alexandre Mendonça Munhoz, M.D., José Roberto Filassi, M.D., Claudia Aldrighi, M.D., Marcos Desidério Ricci, M.D., Eduardo Martella, M.D., Alfredo Carlos de Barros, M.D., Ph.D., Rolf Gemperli, M.D., PhD., Marcus Castro Ferreira, M.D., Ph.D.

Published in: Aesthetic Plastic Surgery | Issue 1/2007

Abstract

Background

Breast conservation surgery and postoperative radiotherapy are widely accepted as the treatment of choice for patients with early breast cancer. Despite its oncologic benefits, the radiotherapy may cause unpredictable outcomes in soft tissues, especially in patients undergoing breast reconstruction. Described recently, intraoperative irradiation (IORT) has been indicated for selected patients as an alternative to radiotherapy with fewer adverse local effects. Clinical use of reduction mammaplasty (RM) techniques in oncologic breast surgery has been described previously. However, no previous studies have mentioned its application after breast conservation surgery and IORT.

Methods

The authors used RM to reconstruct a partial breast tissue defect secondary to breast conservation surgery followed by IORT treatment in a 46-year-old patient with an 11-mm invasive ductal carcinoma between the superior internal quadrants of the right breast.

Results

Satisfactory breast volume and shape were achieved, and no immediate or late complications were observed. After 2 postoperative years, no evidence of fat necrosis, tumor recurrence, or tissue volume loss was observed.

Conclusion

The initial data indicate that RM in the setting of breast conservation surgery reconstruction and IORT is feasible. With appropriate patient selection, respecting indications and limitations, RM has its place among the various reconstructive techniques. Additional studies with larger clinical series and longer follow-up periods are necessary to analyze the precise IORT effects in patients submitted to immediate breast conservation surgery reconstruction.

Battle JA, Dubois JB, Merrick HW, Dobelbower RR: IORT for breast cancer. In: Gunderson LL, Willet C, Harrison L, Calvo F (eds) Intraoperative irradiation; Technique and results. Humana Press, Totowa, NJ, USA, pp. 521–526, 1999

Berrino P, Campora E, Santi P: Postquadrantectomy breast deformities: Classification and techniques of surgical correction. Plast Reconstr Surg 79:567–572, 1987PubMedCrossRef

Bostwick J, Paleta C, Hartrampf CR: Conservative treatment for breast cancer: Complications requiring reconstructive surgery. Ann Surg 203:481–490, 1986PubMedCrossRef

Chang E, Johnson N, Webber B, Booth J, Rahhal D, Gannet D, Johnson W, Franzini D, Zegzula H: Bilateral reduction mammoplasty in combination with lumpectomy for treatment of breast cancer in patients with macromastia. Am J Surg 187:647–650, 2004PubMedCrossRef

Clough KB, Cuminet J, Fitoussi A, Nos C, Mosseri V: Cosmetic sequel after conservative treatment for breast cancer: Classification and results of surgical correction. Ann Plast Surg 41:471–481, 1998PubMedCrossRef

Clough KB, Kroll SS, Audretsch W: An approach to the repair of partial mastectomy defects. Plast Reconstr Surg 104:409–420, 1999PubMed

Clough KB, Lewis JS, Couturaud B, Fitoussi A, Nos C, Falcou MC: Oncoplastic techniques allow extensive resections for breast-conserving therapy of breast carcinomas. Ann Surg 237:26–34, 2003PubMedCrossRef

Clough KB, Nos C, Salmon RJ, Soussaline M, Durand JC: Conservative treatment of breast cancer by mammaplasty and irradiation: A new approach to lower quadrant tumors. Plast Reconstr Surg 96:363–370, 1995PubMedCrossRef

Cuncins-Hearn A, Saunders C, Walsh D, Borg M, Buckingham J, Frizelle F, Maddern G: A systematic review of intraoperative radiotherapy in early breast cancer. Breast Cancer Res Treat 85:271–280, 2004PubMedCrossRef

10.

Fisher B, Anderson S: Conservative surgery for the management of invasive and noninvasive carcinoma of the breast: NSABP trials. National Surgical Adjuvant Breast and Bowel Project. World J Surg 18:63–69, 1994PubMedCrossRef

11.

Intra M, Gatti G, Luini A, Galimberti V, Veronesi P, Zurrida S, Frasson A, Ciocca M, Orecchia R, Veronesi U: Surgical technique of intraoperative radiotherapy in conservative treatment of limited-stage breast cancer. Arch Surg 137:737–740, 2002PubMedCrossRef

12.

Laxenaire A, Barreau-Pouhaer L, Arriagada R, Petit JY: Role of immediate reduction mammaplasty and mammapexy in the conservative treatment of breast cancers. Ann Chir Plast Esthet 40:83–89, 1995PubMed

13.

Losken A, Elwood ET, Styblo TM, Bostwick J III: The role of reduction mammaplasty in reconstructing partial mastectomy defects. Plast Reconstr Surg 109:968–975, 2002PubMedCrossRef

14.

Merrick HW III, Battle JA, Padgett BJ, Dobelbower RR Jr: IORT for early breast cancer: A report on long-term results. Front Radiat Ther Oncol 31:126–130, 1997PubMed

15.

Munhoz AM, Montag E, Arruda EG, Aldrighi C, Aldrighi JM, Gemperli R, Ferreira MC: Outcome analysis of breast conservation surgery and immediate latissimus dorsi flap reconstruction in patients with T1 to T2 breast cancer. Plast Reconstr Surg 116:741–752, 2005PubMedCrossRef

16.

Munhoz AM, Montag E, Arruda EG, Aldrighi C, Aldrighi JM, Gemperli R, Ferreira MC: Superior–medial dermoglandular pedicle reduction mammaplasty for immediate conservative breast surgery reconstruction: Technical aspects and outcome. Ann Plast Surg 57(5): 502–508, 2006PubMedCrossRef

17.

Munhoz AM, Montag E, Arruda EG, Aldrighi C, Aldrighi JM, Gemperli R, Ferreira MC: The role of the lateral thoracodorsal fasciocutaneous flap in immediate conservative breast surgery reconstruction. Plast Reconstr Surg 117:1699–1710, 2006PubMedCrossRef

18.

Munhoz AM, Montag E, Fels KW, Arruda EG, Sturtz GP, Aldrighi C, Gemperli R, Ferreira MC: Critical analysis of reduction mammaplasty techniques in combination with conservative breast surgery for early breast cancer treatment. Plast Reconstr Surg 117:1091–1103, 2006PubMedCrossRef

19.

Newman LA, Kuerer HM, McNeese MD, Hunt KK, Gurtner GC, Vlastos GS, Robb G, Singletary SE: Reduction mammoplasty improves breast conservation therapy in patients with macromastia. Am J Surg 181:215–220, 2001PubMedCrossRef

20.

Rietjens M, De Lorenzi F, Veronesi P, Intra M, Venturino M, Gatti G, Petit JY: Breast conservative treatment in association with implant augmentation and intraoperative radiotherapy. JPRAS 59:532–535, 2006PubMed

21.

Sacchini V, Luini A, Tana S, Lozza L, Galimberti V, Veronesi P, Greco M: Quantitative and qualitative cosmetic evaluation after conservative treatment for breast cancer. Eur J Cancer 27:1395–1400, 1991PubMedCrossRef

22.

Shestak KC, Johnson RR, Greco RJ, Williams SL: Partial mastectomy and breast reduction as a valuable treatment option for patients with macromastia and carcinoma of the breast. Surg Gynecol Obstet 177:54–56, 1993PubMed

23.

Slavin SA, Halperin T: Reconstruction of the breast conservation deformity. Semin Plast Surg 18:89–95, 2004CrossRef

24.

Smith ML, Evans GR, Gurlek A, Bouvet M, Singletary SE, Ames FC, Janjan N, McNeese MD: Reduction mammaplasty: Its role in breast conservation surgery for early-stage breast cancer. Ann Plast Surg 41:234–239, 1998PubMedCrossRef

25.

Spear SL, Pelletiere CV, Wolfe AJ, Tsangaris TN, Pennanen MF: Experience with reduction mammaplasty combined with breast conservation therapy in the treatment of breast cancer. Plast Reconstr Surg 111:1102–1109, 2003PubMedCrossRef

26.

Stolier A, Allen R, Linares L: Breast conservation therapy with concomitant breast reduction in large-breasted women. Breast J 9:269–271, 2003PubMedCrossRef

27.

Veronesi U, Cascinelli N, Mariani L, Greco M, Saccozzi R, Luini A, Aguilar M, Marubini E: Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med 347:1227–1232, 2002PubMedCrossRef

28.

Veronesi U, Gatti G, Luini A, Intra M, Ciocca M, Sanchez D, Zurrida S, Navarro S, Orecchia R: Full-dose intraoperative radiotherapy with electrons during breast-conserving surgery. Arch Surg 138:1253–1256, 2003PubMedCrossRef

29.

Veronesi U, Gatti G, Luini A, Intra M, Orecchia R, Borgen P, Zelefsky M, McCormick B, Sacchini V: Intraoperative radiation therapy for breast cancer: Technical notes. Breast J 9:106–112, 2003PubMedCrossRef

30.

Veronesi U, Orecchia R, Luini A, Gatti G, Intra M, Zurrida S, Ivaldi G, Tosi G, Ciocca M, Tosoni A, De Lucia F: A preliminary report of intraoperative radiotherapy (IORT) in limited-stage breast cancers that are conservatively treated. Eur J Cancer 37:2178–2183, 2001PubMedCrossRef

Title: Bilateral Reduction Mammaplasty for Immediate Breast Conservation Surgery Reconstruction and Intraoperative Radiotherapy: A Preliminary Report
Authors: Alexandre Mendonça Munhoz, M.D.
José Roberto Filassi, M.D.
Claudia Aldrighi, M.D.
Marcos Desidério Ricci, M.D.
Eduardo Martella, M.D.
Alfredo Carlos de Barros, M.D., Ph.D.
Rolf Gemperli, M.D., PhD.
Marcus Castro Ferreira, M.D., Ph.D.
Publication date: 01-02-2007
Publisher: Springer-Verlag
Published in: Aesthetic Plastic Surgery / Issue 1/2007
Print ISSN: 0364-216X
Electronic ISSN: 1432-5241
DOI: https://doi.org/10.1007/s00266-006-0200-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Bilateral Reduction Mammaplasty for Immediate Breast Conservation Surgery Reconstruction and Intraoperative Radiotherapy: A Preliminary Report

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2007

Reconstructive Rhytidectomy?

Follicular Transplantation for the Correction of Various Stigmas After Rhytidoplasty

The Eurasian Nose: Aesthetic Principles and Techniques for Augmentation of the Asian Nose with Autogenous Grafting

Nipple Invagination: The Umbrella Effect

Follicular Transplantation for the Correction of Various Stigmas After Rhytidoplasty

Rhinoplasty and Hemophilia A