Intramammarian Flap Reconstruction Technique in Breast Conserving Surgery: a Case Report

Authors

  • Wikran Sornthom, M.D. กลุ่มงานศัลยกรรม โรงพยาบาลมะเร็งอุบลราชธานี

Keywords:

Breast conserving surgery, Intramammarian flap reconstruction, Flap reconstruction, Early stage breast cancer

Abstract

Breast conserving surgery and radiotherapy is widely used with early stage breast cancer treatment. Current evidence reveals that it is oncologically safe and low morbidity. Breast defect after primary tumor resection is a point of concern. Most problem-solving techniques are complex and require surgical experience. However, Intramammarian flap reconstruction is new, simplified, and low complication rate technique. A case report 38-year-old Thai woman with medium size, non-ptosis breasts. Presented with two small right breast mass. The pathological results from core needle biopsies were discordant lesions. Then she had an excisional biopsy and it was confirmed as cancer. She decided to undergo wide excision and sentinel lymph node biopsy with subsequent intramammarian flap reconstruction. Histopathology showed a moderately - grade invasive ductal carcinoma without lymph node metastasis. The tumor was free margin. It was negative for human epidermal growth factor receptor 2 (HER2), progesterone receptor (PR), and positive for estrogen receptor (ER), the patient received planned adjuvant treatment included chemotherapy, tamoxifen, and radiation therapy. She remained complication free to date. Intramammarian flap reconstruction is a safe and suitable method for non-ptosis small to medium size breast patients. It is also easily operated with nonexperienced surgeon.

Downloads

Download data is not yet available.

References

Halsted WS. I. The Results of Operations for the Cure of Cancer of the Breast Performed at the Johns Hopkins Hospital from June 1889 to January 1894. Ann Surg 1894;20:497-555.

Fisher B, Anderson S, Bryant J, Margolese RG, Deutsch M, Fisher ER, et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med 2002;347:1233-41.

Veronesi U, Cascinelli N, Mariani L, Greco M, Saccozzi R, Luini A,et al. Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med 2002;347:1227–32.

Darby S, McGale P, Correa C, Taylor C, Arriagada R, Clarke M,et al. Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10,801 women in 17 randomised trials. Lancet 2011;378:1707-16.

Coulombe G, Tyldesley S, Speers C, Paltiel C, Aquino-Parsons C, Bernstein V, et al. Is mastectomy superior to breastconserving treatment for young women? Int J Radiat Oncol Biol Phys 2007;67:1282–90.

Clough KB, Kaufman GJ, Nos C, Buccimazza I, Sarfati IM. Improving breast cancer surgery: a classification and quadrant per quadrant atlas for oncoplastic surgery. Ann Surg Oncol 2010;17: 1375–91.

Moran MS, Schnitt SJ, Giuliano AE, Harris JR, Khan SA, Horton J, et al. Society of Surgical Oncology-American Society for Radiation Oncology consensus guideline on margins for breast-conserving surgery with whole-breast irradiation in stages I and II invasive breast cancer. Int J Radiat Oncol Biol Phys 2014;88:553-64.

Rainsbury RM. Surgery insight: Oncoplastic breast-conserving reconstruction - indications, benefits, choices and outcomes.Nat Clin Pract Onc 2007;4:657-64.

Palsdottir EP, Lund SHL, Asgeirsson KSA. Oncoplastic breastconserving surgery in Iceland: a population-based study. Scand J Surg 2018;107: 224–9.

Niinikoski L, Leidenius MHK, 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. EurJ Surg Oncol 2019;45: 976–82.

De La Cruz L, Blankenship SA, Chatterjee A, Geha R,Nocera N,Czerniecki BJ, et al. Outcomes after oncoplastic breast-conserving surgery in breast cancer patients: a systematic literature review. Ann Surg Oncol 2016;23:3247–58.

Chen JY, Huang YJ, Zhang LL, Yang CQ, Wang K. Comparison of oncoplastic breast-conserving surgery and breast-conserving surgery alone: a meta-analysis. J Breast Cancer 2018;21: 321–9.

Rageth CJ, Tausch C. Intramammarian flap reconstruction (IFR) technique in breast conserving surgery.Breast 2009;18:387–92.

Sabel MS. Principles of Breast Reconstruction. In: MS S, editor.Essentials of breast surgery. 1st ed.Philadelphia: Mosby; 2009.

Dixon MJ. Breast-Conserving Surgery. In: Fischer J, editor. Fischer’s Mastery of Surgery. 7th ed. Philadelphia:Lippincott Williams & Wilkins; 2019.

Luini A, Rososchansky J, Gatti G, Zurrida S, Caldarella P, Viale G, et al. The surgical margin status after breast-conserving surgery: discussion of an open issue. Breast Cancer Res Treat 2009;113:397-402.

Kurniawan ED, Wong MH, Windle I, Rose A, Mou A, Buchanan M,et al. Predictors of surgical margin status in breast conserving surgery within a breast screening program. Ann Surg Oncol 2008;15:2542–9.

Houvenaeghel G, Tallet A, Jalaguier-Coudray A, Cohen M, Bannier M, Jauffret-Fara C, et al. Is breast conservative surgery a reasonable option in multifocal or multicentric tumors? World J Clin Oncol 2016;7:234-42.

Esbona K, Li Z, Wilke LG. Intraoperative imprint cytology and frozen section pathology for margin assessment in breast conservation surgery: A systematic review. Ann Surg Oncol 2012;19:3236–45.

Nowikiewicz T, Srutek E, Głowacka-Mrotek I, Tarkowska M, Zyromska A, Zegarski W. Clinical outcomes of an intraoperative surgical margin assessment using the fresh frozen section method in patients with invasive breast cancer undergoing breast-conserving surgery – a single center analysis. Sci Rep 2019;9:13441.

National Comprehensive Cancer Network. Breast Cancer (Version 4.2020).[Internet]. [Available from:https://www.nccn.org/professionals/physician_gls/pdf/breast.pdf.

Published

18-06-2021

How to Cite

1.
Sornthom ว. Intramammarian Flap Reconstruction Technique in Breast Conserving Surgery: a Case Report. j dept med ser [Internet]. 2021 Jun. 18 [cited 2022 Aug. 14];46(1):270-8. Available from: https://he02.tci-thaijo.org/index.php/JDMS/article/view/251915