Published in:
01-12-2017 | Breast Oncology
Simplifying Level 2 Oncoplastic Surgery for Lower Inner Quadrant Breast Cancers
Published in: Annals of Surgical Oncology | Special Issue 3/2017
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As one with an interest in oncoplastic breast surgery, the recent article by Clough et al. entitled “Level 2 Oncoplastic Surgery for Lower Inner Quadrant Breast Cancers: The LIQ-V Mammoplasty” drew my particular attention.1 It is known that lesions in the lower inner quadrant (LIQ) are problematic, and if proper operative care is not undertaken, deformity is likely to occur after breast conservation therapy is complete. Their new level 2 technique allows for a good cosmetic outcome following excision of more than 20% of tissue volume. The mean pathologic tumour size for invasive disease in their study cohort was 19 (range 8–31) mm, whereas that for ductal carcinoma in situ was 27 (range 4–50) mm. Instead of the LIV-Q mammoplasty, there is the possibility of using a simpler approach to tackle similar-sized lesions. This involves a boomerang incision and direct closure of the parenchymal pillars surrounding the excision cavity (Fig. 1a–d).2
Fig. 1
The sequence of events for a 69-year-old woman with multifocal lesions in the lower inner quadrant of the left breast. a The relative positions of the palpable mass, the localising wire, and the planned boomerang incision are indicated. The boomerang incision may be easily incorporated into a mastectomy ellipse if needed. A request was made of the radiologist to use a mediolateral approach instead of a craniocaudal one for the localisation to facilitate dissection. b The specimen radiograph, illustrating the en bloc excision of both the palpable tumour and the localised microcalcifications. The widest radiologic distance between the calcifications and the edge of the main tumour was 50 mm. The en bloc wide excision specimen measured 80 mm × 50 mm. Histology of the larger medial lesion was reported as a 17-mm Grade 2 IDC, and that for the microcalcifications sited laterally was ductal carcinoma in situ, 14 mm at the largest dimension. All pathologic margins were in excess of 2 mm. Two axillary sentinel lymph nodes retrieved were negative for tumour. c and d Postoperative results 18 months after surgery. The patient is currently well 78 months after surgery
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