DOI: http://dx.doi.org/10.18203/2349-2902.isj20220622

Breast conserving surgery with immediate partial breast reconstruction using a latissimus dorsi mini flap: oncological clearance and cosmetic outcomes

Raflis Ruzairee A., Ju Ann T., Nur Aziah A. A., Nor A. Hakim D., Nur Aina E.

Abstract


Background: In our center, a breast conserving surgery (BCS) with immediate partial breast reconstruction using a latissimus dorsi mini flap (LDMF) is performed in women with a large tumor-to-breast-size ratio who declined mastectomy. We conducted a study to assess the oncological clearance and cosmetic outcomes following a BCS with immediate LDMF partial breast reconstruction in women with various breast pathologies. 

Methods: A cross-sectional study was conducted involving patients who underwent a BCS with immediate LDMF reconstruction between January 2016 and January 2021 in the hospital Kuala Lumpur, Malaysia. The demographic data, tumor characteristics, operative details and post-operative complications were documented. The histopathological reports were reviewed to determine the oncological clearance. Patient’s satisfaction on the cosmetic outcomes evaluated using a standard breast-Q questionnaire.

Results: Thirty patients with various breast pathologies were recruited; invasive carcinoma (n=26, 86.7%), ductal carcinoma in-situ (DCIS) (n=1, 3.3%), phyllodes tumor (n=2, 6.7%), and dermatofibrosarcoma protuberans (n=1, 3.3%). The mean tumor size was 4.92 cm, giving the mean specimen weight of 224 g. Adequate oncological clearance was obtained in 96.7% of all cases. Seventeen of the patients (n=17, 56.6 %) were deeply satisfied and the remaining patients were satisfied (n=13, 43.3 %).

Conclusions: In a stage II/III breast cancer, a BCS with immediate partial breast reconstruction using a LDMF can be safely performed with satisfactory cosmetic outcomes in women with a large tumor-to-breast-size ratio.


Keywords


LDMF, BCS, Cosmetic outcomes, Oncological clearance

Full Text:

PDF

References


Clinical Practice Guideline (CPG) Management of Breast Cancer (Third Edition). 2019.https://www2.moh.gov.my/moh/resources/Penerbitan/CPG/Kanser/Breast%20Cancer/CPG_Management_of_Breast_Cancer_(Third_Edition) _130720.pdf. Accessed on 10 January 2020.

Losken A, Hamdi M. Partial breast reconstruction: current perspectives. Plastic Reconstructive Surg. 2009;124(3):722-36.

Blondeel P, Hijjawi J, Depypere H, Roche N, Van Landuyt K. Shaping the breast in aesthetic and reconstructive breast surgery: an easy three step principle. Part III e reconstruction following breast conservative treatment. Plast Reconstr Surg. 2009;124:28-38.

Haloua MH, Volders JH, Krekel NM, Barbe E, Sietses C, Jozwiak K et al. A nationwide pathology study on surgical margins and excision volumes after breast-conserving surgery: there is still much to be gained. Breast. 2016;25:14-21.

Bulstrode NW, Shrotria S. Prediction of cosmetic outcome following conservative breast surgery using breast volume measurements. Breast. 2001;10(2):124-6.13.

Cochrane RA, Valasiadou P, Wilson AR, Al-Ghazal SK, Macmillan RD. Cosmesis and satisfaction after breast-conserving surgery correlates with the percentage of breast volume excised. Br J Surg. 2003;90(12):1505-9.14.

Al-Ghazal SK, Blamey RW, Stewart J, Morgan AA. The cosmetic outcome in early breast cancer treated with breast conservation. Eur J Surg Oncol. 1999;25(6):566-70.

Hanna J, Lannin D, Killelea B, Horowitz N, Chagpar AB. Factors Associated with Persistently Positive Margin Status after Breast-Conserving Surgery in Women with Breast Cancer: An Analysis of the National Cancer Database. Am Surg. 2016;82(8):748-52.

Chagpar AB, Killelea BK, Tsangaris TN, Butler M, Stavris K, Li F et al. A randomized, controlled trial of cavity shave margins in breast cancer. N Engl J Med. 2015;373:503-10.

Waljee JF, Hu ES, Ubel PA, Smith DM, Newman LA, Alderman AK. Effect of esthetic outcome after breast-conserving surgery on psychosocial functioning and quality of life. J Clin Oncol. 2008;26:3331-7.

Grant Y, Al-Khudairi R, St John E, Barschkett M, Cunningham D, Al-Mufti R et al. Patient-level costs in margin re-excision for breast conserving surgery. Br J Surg. 2019;106:384-94.

Xavier Harmeling J, Kouwenberg CA, Bijlard E, Burger KN, Jager A, Mureau MA. The effect of immediate breast reconstruction on the timing of adjuvant chemotherapy: a systematic review. Breast Cancer Res Treat. 2015;153:241-51.

Losken A, Dugal CS, Styblo TM, Carlson GW. A meta-analysis comparing breast conservation therapy alone to the oncoplastic technique. Ann Plast Surg. 2014;72:145-9.

Ibraheem MH, Youssef MG, Abdalla Y, Boutrus R, Farouk A, Morsi A. The Use of Latissimus Dorsi Mini-Flap in Partial Breast Reconstruction. J Cancer Sci Clin Ther. 2019;3(4):240-50.

Dixon JM, Venizelos B, Chan P. Latissimus dorsi mini flap: a technique for extending breast conservation. The Breast. 2002;11:55-65.

Early Breast Cancer Trialists’ Collaborative Group (EBCTCG). Long-term outcomes for neoadjuvant versus adjuvant chemotherapy in early breast cancer: meta-analysis of individual patient data from ten randomized trials. Lancet Oncol. 2018;19(1):27-39.

Cortazar P, Zhang L, Untch M, Mehta K, Costantino JP, Wolmark N et al. Pathological complete response and long-term clinical benefit in breast cancer: the CTNeoBC pooled analysis. Lancet. 2014;384(9938):164-72.

Nano M, Gill P, Kollias J, Bochner M. Breast Volume Replacement Using the Latissimus Dorsi Miniflap. ANZ J Sur. 2004;74:98-104.

Elnahas W, Khater A, Hamdy M, Hamed E, Eldamshety O, Hegazy M. Latissimus Dorsi Mini-Flap as a Volume Replacement Technique after Partial Mastectomy for Breast Cancer in the Upper and Central Breast Quadrants: A Single Center Experience. Surg Sci. 2016;7:496-504.

Naguib SF. Expanding the Role of Breast Conservation Surgery by Immediate Volume Replacement with the Latissimus Dorsi Flap. J Egypt National Cancer Institute. 2006;18:216-26.