Oncoplastic resection of retroareolar breast cancer : central Quadrantectomy and reconstruction by local skin glandular flap

Background : Patients with central breast neoplasms account for 5 to 20 % of breast cancer cases and, for a long time, they have been denied Breast Conservation Surgery (BCS) and conventionally treated with mastecto¬my. The high incidence of Nipple-Areola-Complex (NAC) involvement usually associated with these tumors neces¬sitates nipple and areolar resection together with an ade¬quate safety margin around the tumor, which yields an unacceptable cosmetic result. With the help of Oncoplastic Surgical Techniques, BCS can be offered to these patients. In this study central quadrantectomy and breast recon¬struction by an infero-Iaterally based pediclcd flap were evaluated. Patients and Methods : This study comprised 23 women with central breast tumors treated at the National Cancer Institute (NCI), Cairo University and at the Aswan Cancer Center, Egyptian Ministry of Health. Their ages ranged from 31 to 62 years (mean: 48.4 ± 10.2 years). Twenty-two had a palpable mass, while only I had Pagct's disease of the nipple without mass. The size of their tumors ranged from 4 to 33mm (mean : I6.9 ± 8.6mm). Only 9 women showed clinical suspicion of NAC involvement in the form of nipple retraction. Seventeen cases had their tumors strictly in the relro-areolar region, while 5 had tumors extending for a maximum of 1.5Cm beyond the areolar edge. All patients underwent central quadrantec¬tomy with NAC resection removing a cylinder of breast tissue reaching down to the pectoral muscle together with axillary dissection. Advancement of an infero-Iaterally based skin-glandular flap was then carried out. All patients received adjuvant radiotherapy with or without chemo-therapy or hormonal therapy. Results : Fourteen patients showed pathological evi-dence of nipple infiltration (60.8 %). The free safety margin (SM) ranged from 9 to 13mm (mean: 10.2 + 0.9mm). This could be accomplished from the first attempt in 18 patients ; however, in 5 patients a second wider excision was needed to obtain an adequate margin. Positive axillary nodes were found in 10 / 23 patients (43.5 %). The procedure lasted a mean time of 195 ± 12.7 minutes and blood loss was esti¬mated at a mean of 225 ± 64.8mL. Hospital stay ranged from 2 to 10 days (median : 4 days). Post-opcratively, superficial flap sloughing occurred in 2 / 23 patients and full thickness sloughing in 1 / 23 patients. Cosmetic results were evaluated by both patient and surgeon according to a scoring system and were found excellent in 26