Modification of oncoplastic breast surgery with immediate volume replacement using a thoracodorsal adipofascial flap

• Published in: Breast cancer (Tokyo, Japan) Vol. 29; no. 3; pp. 531 - 540
• Main Authors: Hirata, Munetsugu, Toda, Hiroko, Higo, Naotomo, Shinden, Yoshiaki, Ohtsuka, Takao, Kijima, Yuko
• Format: Journal Article
• Language: English
• Published: Singapore Springer Nature Singapore 01-05-2022; Springer
• Subjects: Breast Neoplasms - surgery; Cancer Research; Female; Health aspects; Humans; Lumpectomy; Mammaplasty - methods; Mastectomy; Mastectomy, Segmental - adverse effects; Mastectomy, Segmental - methods; Medicine; Medicine & Public Health; Oncology; Original; Original Article; Postoperative Complications - surgery; Surgery; Surgical Oncology; Modification; Breast conserving therapy; Volume replacement; Breast cancer; Thoracodorsal adipofascial flap; Oncoplastic surgery
• ISSN: 1340-6868; 1880-4233
• DOI: 10.1007/s12282-022-01331-7

Background
The treatment of early breast cancer using breast conservation therapy (BCT) commonly ensures local control and acceptable cosmetic results. We report a useful technique including the use of a thoracodorsal adipofascial cutaneous flap for reconstructing defects in the outer quadrant area after partial mastectomy, which achieved excellent results.
Methods
During the past 15 years, some modifications have been added to the original method at a rate of one modification every 2–5 years. We classified these modifications into the original method and four modified methods. Modification I: addition of a crescent-shaped dermis on the distant edge of the thoracodorsal adipofascial flap (TDAFF), Modification II: addition of a crescent-shaped dermis on the proximal edge of the TDAFF, Modification III: addition of inframammary formation plus Modification II, and Modification IV: change of a crescent-shaped dermis to a Benz-shaped (shaped like the Mercedes Benz logo) one plus Modification III. We compared the plastic period, postoperative complications, oncological results, and cosmetic results among the original and four modified groups.
Results
The patient number was 26, 9, 15, 23, and 10 in the original and Modification I, II, III, and IV groups, respectively. The median observation period was 115, 92, 67, 51, and 32 months, respectively. Postoperative complications were seen in 5 (19%), 0, 2 (13%), 1 (5%), and 0 patients, respectively. Local recurrence was seen in 3 (12%), 0, 0, 0, and 0 patients, respectively. Distant recurrence was seen in 1 (4%), 1 (11%), 3 (20%), 0, and 0 patients, respectively. Cosmetic results evaluated as good–excellent were seen in 19 (73%), 5 (56%), 11 (73%), 19 (83%), and 10 (100%) patients, respectively.
Conclusions
Oncoplastic surgery using an immediate volume replacement technique with a thoracodorsal adipofascial flap was improved by adding some modifications.