Expanding the role of breast conservation surgery by immediate volume replacement with the latissimus dorsi flap

Introduction : Many women wilh early breast cancer are treated with Mastectomy, instead of Breast Conserva¬tion Surgery (BCS), for fear of suboptimal tumor removal or cosmetic failure due to volume and shape loss. These women can be satisfactorily treated by BCS and immediate volume replacement. Synchronous breast augmentation by the autologous Latissimus Dorsi (LD) Muscle or My-ocutaneous Flaps in the treatment of relatively large and / or rctroarcolar breast tumors was investigated in this study held at the National Cancer Institute of Cairo University and at the Aswan Cancer Center. Patients and Methods : Between October 2000 and March 2003, 29 patients with histologically proven breast cancer were treated by BCS and immediate volume re¬placement with LD muscle or myocutancous flaps. Pa¬tients' age ranged from 32 to 57 years. Tumors" size ranged from 28 to 69mm. Axillary dissections revealed positive lymph glands in 58.6 % of cases. Tumor location was in the central quadrant in 45 %. in the upper quadrants in 41 % and in the lower quadrants in 14 % of cases. The LD myocutancous flap was used in 21 cases while, in the remaining 8 cases, only the LD muscle was needed. Results : The median size of the lumpectomy specimen was 219cm3. The safety margins obtained ranged between 9 and 28mm. The mean combined operating time was 238 minutes. The mean blood loss was 320ml and no patient required blood transfusion. The median hospital stay was 5 days. Persistent scroma in the back occurred in 52 % of patients, requiring a median of 5 weekly aspirations. No sepsis or flap viability problems were encountered. Cos¬metic results were satisfactory in 69 % of patients. Only 17 % showed some asymmetry in size, 7 % some discrep¬ancy in skin color and 7 % a mild difference in Nipple Areola Complex (NAC) level. Conclusion : Mastectomy can be avoided in a large number of women with small breast / tumor ratio or rctroar- eolar tumors. Immediate volume replacement with LD flap can extend the role of BCS to these patients. This can be achieved without compromising the adequacy of resection, with minimal morbidity, very satisfactory cos¬metic results, no need for prosthesis or contra lateral mammaplasty and no effect on postoperative clinical or radiological follow-up.