PURPOSE: Reconstructing the partial mastectomy defect prior to radiation has become increasingly popular. The purpose is to evaluate patient selection, safety, timing, technique, and outcome.
METHODS: A retrospective review of patients treated with partial mastectomy and reduction/mastopexy was performed. Reconstruction was performed simultaneously or once negative margins had been confirmed.
RESULTS:Fifty-four women were included in the series. Tissue diagnosis was invasive carcinoma (n=28), ductal carcinoma in situ (DCIS) (n=16), fibroadenoma (n=5) and benign breast tissue (n=5). The Wise pattern was used (n=42/54), with the pedicle tehchniques being superiormedial (n=28), inferior (n=15), and other (n=10). An algorithm was established for pedicle type based on tumor location. The average biopsy weight was 231gms. Total weight on the tumor side was 837gms and 850gms on the contralateral side, allowing for radiation fibrosis. Complications (20%) included delayed healing (n=4), hematoma (n=1), and fat necrosis determined by FNA (n=6). Completion mastectomy with reconstruction was required in 4 patients, 3 for positive margins extensive DCIS, and 1 for residual microcalcifications on follow up (biopsy DCIS). Seven patients required re-excisional biopsy. All patients had no evidence of disease at follow-up (mean: 3.25 years).
CONCLUSION: Oncoplastic reduction/mastopexy is used for symmetry and shape preservation in women with large ptotic breasts. Versatility exists using various pedicles and skin patterns to reconstruct all breast shapes and defect location. Patients with extensive DCIS are poor candidates for simultaneous reconstruction, and should be deferred until confirmation of negative margins. Completion mastectomy and reconstruction is possible with skin preservation and no adverse effects.