Autologous breast fibrofatty flaps for immediate breast reconstruction after excision of small cancer mass (<50 mm) improves surgical and aesthetical outcomes and patients’ quality of life


  • Waseem A Shoda Department of General Surgery, Mansoura Military Hospital, Mansoura
  • Shereen M. Abdel Wahab Department of Community Environmental and Occupational Medicine, Faculty of Medicine, Benha



Immediate breast reconstruction, Small breast mass (<50 mm), Quality of life questionnaire, Functional breast function evaluation


Background: Evaluation of surgical feasibility, aesthetic outcomes and 6-m postoperative (PO) effect of immediate breast reconstruction (IBR) using autologous fibrofatty flaps after localized small breast mass excision.

Methods: Total 29 women had duct carcinoma of <50 mm in diameter with N1-3 regional lymphadenopathy were studied. Through diamond-shape incision, breast gland was removed with 1 cm circumferential free safety margin, then the medial and lateral fibrofatty flaps were undermined and approximated for IBR. Breast measurements; the nipple-to-suprasternal notch distance and the nipple-to-nipple distance were determined preoperatively and 6-m PO. Quality of life (QoL) evaluation was performed preoperatively and 6-m PO using the short-form-36 (SF-36), the multidimensional body self-relations questionnaire appearance assessment and the European organization for research and treatment of cancer breast cancer-specific QoL questionnaire scores in breast cancer.

Results: Mean operative time was 94.5±15.4 min; mean intraoperative blood loss was 170.1±34.9 ml and 25 patients had returned home on the same operative day. Two patients had PO wound seroma and one patient had wound hematoma, but were resolved spontaneously. PO breast measurements showed non-significant differences in comparison to preoperative measurements of the same breast, and to measurements of the contralateral breast. PO evaluation of QoL showed significantly improved PO scoring in line with improved body image and future perspectives, and sexual scores in comparison to preoperative scorings.   

Conclusions: The applied procedure of localized excision of BC mass of<50 mm with IBR using the breast remnant fibrofatty flaps provided acceptable surgical and esthetical outcomes and allowed improvement of patients’ QoL.



Xuan S, de Barros A, Nunes R, Ricci-Junior E, da Silva A, Sahid M, et al. Radioactive gold nanocluster (198-AuNCs) showed inhibitory effects on cancer cells lines. Artif Cells Nanomed Biotechnol. 2020;48(1):1214-21.

De Lorenzi F, Hubner G, Rotmensz N, Bagnardi V, Loschi P, Maisonneuve P, et al. Oncological results of oncoplastic breast-conserving surgery: Long term follow-up of a large series at a single institution: A matched-cohort analysis. Eur J Surg Oncol. 2016;42(1):71-7.

Lombardi A, Maggi S, Stanzani G, Vitale V, Bersigotti L, Romano C, et al. Oncological outcomes in oncoplastic breast surgery: a single institution analysis. G Chir. 2019;40(5):417-20.

Yan M, Bustos S, Kuruoglu D, Forte A, Manrique O: Oncological safety of lipofilling after breast conserving surgery. Gland Surg. 2020;9(3):620-1.

Rehnke R, Schusterman 2nd M, Clarke J, Price B, Waheed U, Debski R, et al. Breast Reconstruction Using a Three-Dimensional Absorbable Mesh Scaffold and Autologous Fat Grafting: A Composite Strategy Based on Tissue-Engineering Principles. Plast Reconstr Surg. 2020;146(4):409e-13e.

McCamley C, Mills C, Chow Y, Ross D, Fox J Determinants influencing immediate breast reconstruction in an Australian tertiary public hospital. ANZ J Surg. 2020.

Patel N, Ramakrishnan V. Microsurgical Tissue Transfer in Breast Reconstruction. Clin Plast Surg. 2020;47(4):595-609.

Agrawal A, Garreffa E "Medial Hemi-Mastopexy": An Innovation to Avoid Medial Pole Emptiness in Reduction Mammaplasty. Ann Plast Surg. 2020; 85(4):363-8.

Piat J, Tomazzoni G, Giovinazzo V, Dubost V, Maiato A, Ho Quoc C. Lipofilled Mini Dorsi Flap: An Efficient Less Invasive Concept for Immediate Breast Reconstruction. Ann Plast Surg. 2020; 85(4):369-75.

National Comprehensive Cancer Network. (NCCN) NCCN Clinical Practice Guidelines in Oncology: Breast Cancer. Fort Washington PA: NCCN; 2015

Dilhuydy MH. Breast imaging reporting and data system (BI-RADS) or French "classification ACR" What tool for what use? A point of view. Eur J Radiol. 2007;61(2):187-91.

Ware JE Jr. The SF-36 health survey. In Quality of Life and Pharmacoeconomics in Clinical Trials Second edition. Edited by: Spilker B. Philadelphia PA: Lippincott-Raven Press. 1996:337-45.

Cash TF, Pruzinsky T. Body images: Development, deviance, and change. New York: The Guilford Press; 1990.

Snyder C, Blackford A, Okuyama T, Akechi T, Yamashita H, Toyama T, et al. Using the EORTC-QLQ-C30 in clinical practice for patient management: identifying scores requiring a clinician's attention. Qual Life Res. 2013; 22(10):2685-91.

Yamamoto M, Yano T, Shimizu D, Yokoyama A, Ito O. L-positioned Perforator Propeller Flap for Partial Breast Reconstruction with Axillary Dead Space. Plast Reconstr Surg Glob Open. 2016;4(6):e762.

Słowik A, Jabłoński M, Michałowska-Kaczmarczyk A, Jach R. Evaluation of quality of life in women with breast cancer, with particular emphasis on sexual satisfaction, future perspectives and body image, depending on the method of surgery. Psychiatr Pol. 2017;51(5):871-88.

Biazus J, Stumpf C, Melo M, Zucatto A, Cericatto R, Cavalheiro J, et al. Breast-Conserving Surgery with Immediate Autologous Fat Grafting Reconstruction: Oncologic Outcomes. Aesthetic Plast Surg. 2018;42(5):1195-201.

Bachleitner K, Weitgasser L, Amr A, Schoeller T. Autologous Unilateral Breast Reconstruction with Venous Supercharged IMAP-Flaps: A Step by Step Guide of the Split Breast Technique. J Clin Med. 2020;9(9):3030.

Dorogi B, Mátrai T, Újhelyi M, Kenessey I, Kelemen P, Sávolt A, et al. Assessing the needs of Hungarian breast cancer patients for modern oncoplastic breast surgical treatment. Questionnaire study of 500 patients]. Orv Hetil. 2020; 161(29):1221-8.

Kosasih S, Tayeh S, Mokbel F, Kasem A. Is oncoplastic breast conserving surgery oncologically safe? A meta-analysis of 18,103 patients. Am J Surg. 2020;220(2):385-92.

Borm K, Schönknecht C, Nestler A, Oechsner M, Waschulzik B, Combs S, et al. Outcomes of immediate oncoplastic surgery and adjuvant radiotherapy in breast cancer patients. Brit Med Cent Canc. 2019;19(1):907.

Pearce B, Fiddes R, Paramanathan N, Chand N, Laws S, Rainsbury R. Extreme oncoplastic conservation is a safe new alternative to mastectomy. Eur J Surg Oncol. 2020;46(1):71-6.

Niinikoski L, Leidenius M, Vaara P, Voynov A, Heikkilä P, Mattson J, et al. Resection margins and local recurrences in breast cancer: Comparison between conventional and oncoplastic breast conserving surgery. Eur J Surg Oncol. 2019; 45(6):976-82.

Türk K, Yılmaz M. The Effect on Quality of Life and Body Image of Mastectomy among Breast Cancer Survivors. Eur J Breast Health. 2018; 14(4):205-10.

Bhat V, Roshini A, Ramesh R. Does Quality of Life Among Modified Radical Mastectomy and Breast Conservation Surgery Patients Differ? A 5-Year Comparative Study. Ind J Surg Oncol. 2019; 10(4):643-8.

Wu T, Chang T, Chang S, Lin Y, Wang J, Kuo Y. Dynamic Changes Of Body Image And Quality Of Life In Breast Cancer Patients. Cancer Manag Res. 2019;11:10563-71.

Deepa K, Gadgil A, Löfgren J, Mehare S, Bhandarkar P, Roy N. Is quality of life after mastectomy comparable to that after breast conservation surgery? A 5-year follow up study from Mumbai, India. Qual Life Res. 2020;29(3):683-92.

Rosenberg S, Dominici L, Gelber S, Poorvu P, Ruddy K, Wong J, et al. Association of Breast Cancer Surgery with Quality of Life and Psychosocial Well-being in Young Breast Cancer Survivors. J Am Medic Assoc Surg. 2020;e203325.






Original Research Articles