Oncoplastic surgery for breast cancer based on tumour location and a quadrant-per-quadrant atlas

Abstract

Abstract Background The majority of published techniques for oncoplastic surgery rely on an inverted-T mammoplasty, independent of tumour location. These techniques, although useful, cannot be adapted to all situations. A quadrant-per-quadrant atlas of mammoplasty techniques for large breast cancers was developed in order to offer breast surgeons a technique dependent on tumour location, which reduces the risk of postoperative complications and delay to adjuvant therapy. Methods From 2005 to 2010, a series of eligible women with breast cancer were treated by quadrant-specific oncoplastic techniques. All complications and any delay to adjuvant treatment were recorded prospectively, along with local and distant cancer recurrences. Cosmetic outcome was evaluated using a five-point scale. Results A total of 175 patients were analysed. The median tumour size, after histological examination, was 25 (range 4–90) mm. Twenty-three patients (13·1 per cent) had involved margins. Seventeen of these patients were treated by mastectomy and three had a re-excision. Complications occurred in 13 patients (7·4 per cent), which led to a delay to adjuvant treatment in three (1·7 per cent). After a median follow-up of 49 (range 23–96) months, three patients had developed a local recurrence. The mean score after cosmetic evaluation was 4·6 of 5. Conclusion A quadrant-per-quadrant approach to oncoplastic techniques for breast cancer was developed that tailors the mammoplasty for each tumour location. This panel of techniques should be a useful guide for breast surgeons, and extends the possibilities for breast conservation for large or poorly limited cancers, with a low complication rate and good cosmetic results.