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Breast Reconstruction by Local flaps after Conserving Surgery for Breast Cancer: An Added Asset to Oncoplastic Techniques

Abstract:  This study describes and evaluates the results of a proposed simple technique of volume replacement by local flaps to reconstruct the breast after conserving surgery for breast cancer. Twenty‐five patients with breast cancer were enrolled in the study between 1998 and 2004. All patients were surgically treated by wide local excision and axillary dissection of level I & II. The primary closure was not feasible because of resulting large defect in proportion to the breast size. The defect was constructed by local flap raised from adjacent skin and subcutaneous tissue with or without glandular breast tissue. Data analyzed includes: age, tumor location, tumor size, histopathology results, operative techniques, complications, long‐term oncological events, and cosmetic outcome. The mean follow‐up was 48 months. The mean age was 45.3 years. The mean tumor size was 3.1 cm. All tumors had upper outer or upper central location. Fourteen tumors were in left breast. Histopathological analysis had revealed 84% infiltrating ductal carcinoma of no otherwise specified type, 12% medullary type, and 4% tubulo‐lobular carcinoma. Additional ductal carcinoma in situ was found in three patients. One patient had focally positive deep margin. One hematoma and one fat necrosis during radiotherapy were documented. During follow‐up, one patient developed local recurrence after 4 years and required mastectomy, another patient developed concomitant local recurrence and distant metastasis in the lung and brain after 18 months of the primary treatment and died 1 year later. In this study, 84% of women were satisfied with their cosmetic outcome. This study demonstrated the value of local flaps to reconstruct breast defects after wide local excision of tumors in upper outer or upper central location as simple alternative to latissimus dorsi flap and other volume displacement techniques.