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...
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| description | 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 |
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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 26.1 %, good in 34.8 %, satisfactory in 30.4 %, poor in 8.7 % and very poor in none. The procedure did not delay the start of adjuvant treatment nor did it hamper clinical and main-mographic follow-up.
Conclusion : Oncoplastic techniques have succeeded in expanding the role of 13CS to rclro-arcolar tumors. Central quadrantectomy with repair by a skin-glandular flap is a relatively simple procedure that yields very satisfactory cosmetic results with minimal complications and it may be considered as one of the noteworthy thera-peutic options for patients with central breast tumors.</description><identifier>ISSN: 1110-0362</identifier><identifier>EISSN: 1687-9996</identifier><identifier>PMID: 18301457</identifier><language>eng</language><publisher>Cairo, Egypt: Cairo University, National Cancer Institute</publisher><subject>Adult ; Breast ; Breast Neoplasms - drug therapy ; Breast Neoplasms - pathology ; Breast Neoplasms - surgery ; Cancer ; Carcinoma, Ductal - drug therapy ; Carcinoma, Ductal - pathology ; Carcinoma, Ductal - surgery ; Carcinoma, Lobular - drug therapy ; Carcinoma, Lobular - pathology ; Carcinoma, Lobular - surgery ; Chemotherapy, Adjuvant ; Diagnosis ; Female ; Follow-Up Studies ; Humans ; Lymphatic Metastasis ; Mammaplasty - adverse effects ; Mammaplasty - methods ; Mastectomy, Segmental - adverse effects ; Mastectomy, Segmental - methods ; Middle Aged ; Neoplasm Invasiveness ; Nipples - surgery ; Postoperative Complications ; Skin Transplantation - methods ; Surgery ; Surgical Flaps ; Time Factors ; التشخيص ; الثدي ; الجراحة ; السرطان</subject><ispartof>Journal of Egyptian National Cancer Institute, 2006-12, Vol.18 (4), p.334-347</ispartof><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/18301457$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Najib, Sharif F.</creatorcontrib><title>Oncoplastic resection of retroareolar breast cancer : central Quadrantectomy and reconstruction by local skin glandular flap</title><title>Journal of Egyptian National Cancer Institute</title><addtitle>J Egypt Natl Canc Inst</addtitle><description>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 26.1 %, good in 34.8 %, satisfactory in 30.4 %, poor in 8.7 % and very poor in none. The procedure did not delay the start of adjuvant treatment nor did it hamper clinical and main-mographic follow-up.
Conclusion : Oncoplastic techniques have succeeded in expanding the role of 13CS to rclro-arcolar tumors. Central quadrantectomy with repair by a skin-glandular flap is a relatively simple procedure that yields very satisfactory cosmetic results with minimal complications and it may be considered as one of the noteworthy thera-peutic options for patients with central breast tumors.</description><subject>Adult</subject><subject>Breast</subject><subject>Breast Neoplasms - drug therapy</subject><subject>Breast Neoplasms - pathology</subject><subject>Breast Neoplasms - surgery</subject><subject>Cancer</subject><subject>Carcinoma, Ductal - drug therapy</subject><subject>Carcinoma, Ductal - pathology</subject><subject>Carcinoma, Ductal - surgery</subject><subject>Carcinoma, Lobular - drug therapy</subject><subject>Carcinoma, Lobular - pathology</subject><subject>Carcinoma, Lobular - surgery</subject><subject>Chemotherapy, Adjuvant</subject><subject>Diagnosis</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Lymphatic Metastasis</subject><subject>Mammaplasty - adverse effects</subject><subject>Mammaplasty - methods</subject><subject>Mastectomy, Segmental - adverse effects</subject><subject>Mastectomy, Segmental - methods</subject><subject>Middle Aged</subject><subject>Neoplasm Invasiveness</subject><subject>Nipples - surgery</subject><subject>Postoperative Complications</subject><subject>Skin Transplantation - methods</subject><subject>Surgery</subject><subject>Surgical Flaps</subject><subject>Time Factors</subject><subject>التشخيص</subject><subject>الثدي</subject><subject>الجراحة</subject><subject>السرطان</subject><issn>1110-0362</issn><issn>1687-9996</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2006</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNo90E1LxDAQBuAiiqur_0AkJ2-FfLRp6k0Wv2BhEfRcpslEqm2yJulhwR9vZFdPmRmeeRlyVJwxqZqybVt5nGvGaEmF5IviPMYPSqWkTX1aLJgSlFV1c1Z8b5z22xFiGjQJGFGnwTvibW5S8BDQjxBIHzATosFpDOSWaHQpwEheZjABXMprftoRcCbvae9iCvM-qd-R0etM4-fgyPuYyfybaEfYXhQnFsaIl4d3Wbw93L-unsr15vF5dbcuMR-ZSiNsSxk3XBjZ8kZwTU3f1AAUKyUpMm5RVFAZq6CpOWrWS2maXlcS0RotlsXNPncb_NeMMXXTEDWO-Rj0c-ykqiitlMjw-gDnfkLTbcMwQdh1f_-VwdUeYJ6jhX_BW6W4-AEzlnTo</recordid><startdate>200612</startdate><enddate>200612</enddate><creator>Najib, Sharif F.</creator><general>Cairo University, National Cancer Institute</general><scope>ADJCN</scope><scope>AFFIF</scope><scope>AHFXO</scope><scope>AHHHR</scope><scope>AHQOB</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>7X8</scope></search><sort><creationdate>200612</creationdate><title>Oncoplastic resection of retroareolar breast cancer : central Quadrantectomy and reconstruction by local skin glandular flap</title><author>Najib, Sharif F.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-e145t-d3f9012d23d692732c0db75aa0e4860e12fe34a4df8a752ec1b66d7bc46eefdc3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2006</creationdate><topic>Adult</topic><topic>Breast</topic><topic>Breast Neoplasms - drug therapy</topic><topic>Breast Neoplasms - pathology</topic><topic>Breast Neoplasms - surgery</topic><topic>Cancer</topic><topic>Carcinoma, Ductal - drug therapy</topic><topic>Carcinoma, Ductal - pathology</topic><topic>Carcinoma, Ductal - surgery</topic><topic>Carcinoma, Lobular - drug therapy</topic><topic>Carcinoma, Lobular - pathology</topic><topic>Carcinoma, Lobular - surgery</topic><topic>Chemotherapy, Adjuvant</topic><topic>Diagnosis</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>Lymphatic Metastasis</topic><topic>Mammaplasty - adverse effects</topic><topic>Mammaplasty - methods</topic><topic>Mastectomy, Segmental - adverse effects</topic><topic>Mastectomy, Segmental - methods</topic><topic>Middle Aged</topic><topic>Neoplasm Invasiveness</topic><topic>Nipples - surgery</topic><topic>Postoperative Complications</topic><topic>Skin Transplantation - methods</topic><topic>Surgery</topic><topic>Surgical Flaps</topic><topic>Time Factors</topic><topic>التشخيص</topic><topic>الثدي</topic><topic>الجراحة</topic><topic>السرطان</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Najib, Sharif F.</creatorcontrib><collection>الدوريات العلمية والإحصائية - e-Marefa Academic and Statistical Periodicals</collection><collection>قاعدة دراسات المرأة - e-Marefa Women Studies</collection><collection>معرفة - المحتوى العربي الأكاديمي المتكامل - e-Marefa Academic Complete</collection><collection>دراسات الشرق الأوسط - e-Marefa Middle Eastern Studies</collection><collection>الشؤون الدولية والعربية - e-Marefa International & Arab Affairs</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of Egyptian National Cancer Institute</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Najib, Sharif F.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Oncoplastic resection of retroareolar breast cancer : central Quadrantectomy and reconstruction by local skin glandular flap</atitle><jtitle>Journal of Egyptian National Cancer Institute</jtitle><addtitle>J Egypt Natl Canc Inst</addtitle><date>2006-12</date><risdate>2006</risdate><volume>18</volume><issue>4</issue><spage>334</spage><epage>347</epage><pages>334-347</pages><issn>1110-0362</issn><eissn>1687-9996</eissn><abstract>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 26.1 %, good in 34.8 %, satisfactory in 30.4 %, poor in 8.7 % and very poor in none. The procedure did not delay the start of adjuvant treatment nor did it hamper clinical and main-mographic follow-up.
Conclusion : Oncoplastic techniques have succeeded in expanding the role of 13CS to rclro-arcolar tumors. Central quadrantectomy with repair by a skin-glandular flap is a relatively simple procedure that yields very satisfactory cosmetic results with minimal complications and it may be considered as one of the noteworthy thera-peutic options for patients with central breast tumors.</abstract><cop>Cairo, Egypt</cop><pub>Cairo University, National Cancer Institute</pub><pmid>18301457</pmid><tpages>14</tpages></addata></record> |
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| subjects | Adult Breast Breast Neoplasms - drug therapy Breast Neoplasms - pathology Breast Neoplasms - surgery Cancer Carcinoma, Ductal - drug therapy Carcinoma, Ductal - pathology Carcinoma, Ductal - surgery Carcinoma, Lobular - drug therapy Carcinoma, Lobular - pathology Carcinoma, Lobular - surgery Chemotherapy, Adjuvant Diagnosis Female Follow-Up Studies Humans Lymphatic Metastasis Mammaplasty - adverse effects Mammaplasty - methods Mastectomy, Segmental - adverse effects Mastectomy, Segmental - methods Middle Aged Neoplasm Invasiveness Nipples - surgery Postoperative Complications Skin Transplantation - methods Surgery Surgical Flaps Time Factors التشخيص الثدي الجراحة السرطان |
| title | Oncoplastic resection of retroareolar breast cancer : central Quadrantectomy and reconstruction by local skin glandular flap |
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