Superior Pedicle Reduction Mammoplasty and Defect Reconstruction Using an Inferior-Based Pedicle with a Skin Island
The 67-year-old woman was diagnosed with a 24 mm receptor-positive, HER2-neu-negative G2 carcinoma in the upper central quadrant of the left breast about 15 cm above the nipple (Fig. 22.1a, b). The tumor was fixed to the skin but not to the pectoralis maj
- PDF / 877,677 Bytes
- 4 Pages / 504.57 x 720 pts Page_size
- 43 Downloads / 220 Views
22
Peter Schrenk
22.1
The Patient
The 67-year-old woman was diagnosed with a 24 mm receptor-positive, HER2-neu-negative G2 carcinoma in the upper central quadrant of the left breast about 15 cm above the nipple (Fig. 22.1a, b). The tumor was fixed to the skin but not to the pectoralis major muscle. Preoperative chemotherapy or endocrine therapy to decrease the tumor in size has been discussed but was declined by the patient. The breast was ptotic and of large volume size with the left breast slightly smaller than the right breast (Fig. 22.1a, b).
22.2
Surgery
The tumor was resected together with the overlying skin and the pectoralis major muscle fascia. Intraoperative frozen section found wide tumorfree margins. Sentinel node biopsy revealed two negative sentinel nodes. A superior-based pedicle reduction mammoplasty was performed. The inferior pedicle which usually is discarded in a reduction mammoplasty was de-epithelialized
P. Schrenk, MD Second Department of Surgery, Breast Care Center, Akh – LFKK Linz, Linz, Austria e-mail: [email protected]
except a small skin island which corresponded to the size of the skin resected with the tumor. A tunnel was made dissecting the superior part of the breast off the fascia, and the inferior pedicle was transferred through this tunnel to reconstruct the defect in the upper quadrant of the breast (Fig. 22.2a–d).
22.3
Clinical and Cosmetic Outcome
Final histology found a 24 mm invasive cancer with the closest margin being 12 mm cranially. Postoperative course was uneventful and the patient received radiation and endocrine treatment. The cosmetic result was excellent with the left breast of good breast volume and form (Fig. 22.3a, b). Although the size of the breast was smaller than the right breast, the patient declined to undergo reduction mammoplasty.
22.4
Comments of the Author
• In this patient, two aspects had to be considered. First, the tumor was located far cranially in the breast, and second, it was fixed to the skin requiring resection of skin. This, however, excluded most oncoplastic techniques commonly used in breast surgery. Standard
© Springer-Verlag Vienna 2015 F. Fitzal, P. Schrenk (eds.), Oncoplastic Breast Surgery: A Guide to Clinical Practice, DOI 10.1007/978-3-7091-1874-0_22
81
P. Schrenk
82
a
b
Fig. 22.1 (a, b) Preoperative view. The tumor was in the upper central quadrant of the left breast and was fixed to the skin. The breast was of large size and ptotic
a
c
b
d
Fig. 22.2 (a–d) Intraoperative view. The tumor is resected with the skin (a) and the de-epithelialized inferior pedicle (b) is transferred into the defect (c, d)
22
Superior Pedicle Reduction Mammoplasty and Defect Reconstruction with an Inferior Pedicle
a
83
b
Fig. 22.3 (a, b) Early postoperative result
a
b
Fig. 22.4 (a, b) “Cake-like” excision. The tissue of the lateral breast is mobilized and transferred medially to close the defect
quadrantectomy with resection of skin would have been possible but would have resulted in a poor cosmetic outcome wi
Data Loading...
