Breast Cancer

, Volume 23, Issue 6, pp 932–938 | Cite as

Oncoplastic surgery combining abdominal advancement flaps with volume displacement techniques to breast-conserving surgery for small- to medium-sized breasts

  • Tomoko OgawaEmail author
  • Noriko Hanamura
Original Article



An abdominal advancement flap (AAF) is a flap that pulls the elevated abdominal skin up, creating the shape of the inferior portion of the breast by making a neo-inframammary fold. We used an AAF combined with volume displacement techniques to fill the defect left after breast-conserving surgery (BCS).


Forty-one small- to medium-sized breast patients whose resection area included the lower portion of the breast underwent this procedure from October 2010 to December 2014. We evaluated efficacy of this procedure.


The excision volume ranged from 10 to 35 %. Complications after surgery were observed in two patients (partial necrosis of the nipple-areola complex and partial necrosis of the breast skin in one patient each). There was no fat necrosis of the flap in any of the patients. The cosmetic results were found to be excellent in 7 cases, good in 23, fair in 9 and poor in 2. In 11 cases with an unacceptable outcome, 9 cases were in the inner portion. In patients with the tumor in the inner portion, the proportion of unacceptable cases was 50 %. In the cases other than the inner portion, the proportion of unacceptable cases was 8.7 % (p < 0.01). In the cases with larger breasts, unacceptable cases were more frequently observed (p < 0.05).


We believe that an AAF combined with volume displacement techniques may be useful following BCS in the lower portion of a small- to medium-sized breast, except in cases where the tumors is located in the inner potion.


Breast-conserving surgery Breast reconstruction Reconstructive surgical procedures 


Compliance of ethical standards


Conflict of interest

The authors declare that they have no competing interests in association with this srudy.


  1. 1.
    Iwuchukwu OC, Harvey JR, Dordea M, Critchley AC, Drew PJ. The role of oncoplastic therapeutic mammoplasty in breast cancer surgery- a review. Surg Oncol. 2012;21:133–41.CrossRefPubMedGoogle Scholar
  2. 2.
    Kronowitz SJ, Kuerer HM, Buchholz TA, Valero V, Hunt KK. A management algorithm and practical oncoplastic surgical techniques for repairing partial mastectomy defects. Plast Reconstr Surg. 2008;122:1631–47.CrossRefPubMedGoogle Scholar
  3. 3.
    Yang JD, Lee JW, Cho YK, Kim WW, Hwang SO, Jung JH, et al. Surgical techniques for personalized oncoplastic surgery in breast cancer patients with small- to moderate-sized breasts (Part 2): volume replacement. J Breast Cancer. 2012;15:7–14.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Yang JD, Kim MC, Lee JW, Cho YK, Choi KY, Chung HY, et al. Usefulness of oncoplastic volume replacement techniques after breast conserving surgery in small to moderate-sized breasts. Arch Plast Surg. 2012;39:489–96.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Rainsbury RM. Breast-sparing reconstruction with latissimus doesi miniflaps. Eur J Surg Oncol. 2002;28:891–5.CrossRefPubMedGoogle Scholar
  6. 6.
    Hamdi M. Oncoplastic and reconstructive surgery of the breast. Breast. 2013;22:S100–5.CrossRefGoogle Scholar
  7. 7.
    Ogawa T, Hanamura N, Yamashita M, Ito M, Kimura H, Nakamura T, et al. Abdominal advancement flap as oncoplastic breast conservation: report of seven cases and their cosmetic results. J Breast Cancer. 2013;16:236–43.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Harris JR, Levene MB, Svensson G, Hellman S. Analysis of cosmetic results following primary radiation therapy for stages I and II carcinoma of the breast. Int J Radiat Oncol Biol Phys. 1979;5:257–61.CrossRefPubMedGoogle Scholar
  9. 9.
    Ogawa T, Hanamura N, Yamashita M, Kimura H, Kashikura Y. Breast-volume displacement using an extended glandular flap for small dense breasts. Plastic Surgery Int. 2011;2011:359842. doi: 10.1155/2011/359842.CrossRefGoogle Scholar
  10. 10.
    Ogawa T. Usefulness of breast-conserving surgery using the round block technique or modified round block technique in Japanese females. Asian J Surg. 2014;37:8–14.CrossRefPubMedGoogle Scholar
  11. 11.
    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.CrossRefPubMedGoogle Scholar
  12. 12.
    Bulstrode NW, Shrotria S. Prediction of cosmetic outcome following conservative breast surgery using breast volume measurements. Breast. 2001;10:124–6.CrossRefGoogle Scholar
  13. 13.
    Macmillan RD, James R, Gale KL, McCulley SJ. Therapeutic mammaplasty. J Surg Oncol. 2014;110:90–5.CrossRefPubMedGoogle Scholar
  14. 14.
    Ogawa T, Hanamura N, Yamashita M, Ri Y, Kuriyama N, Isaji S. Usefulness of breast-volume replacement using an inframammary adipofascial flap after breast-conservation therapy. Am J Surg. 2007;193:514–8.CrossRefPubMedGoogle Scholar
  15. 15.
    Ogawa T, Hanamura N, Yamashita M, Kimura H, Kashikura Y. Long-term results of breast volume replacement using an inframammary adipofascial flap after breast-conserving surgery. Breast Cancer. 2014;21:635–40.CrossRefPubMedGoogle Scholar
  16. 16.
    Ogawa T, Hanamura N, Yamashita M, Kimura H, Ito M, Nakamura T, et al. Oncoplastic technique combining an adipofascial flap with an extended glandular flap for the breast-conserving reconstruction of small dense breasts. J Breast Cancer. 2012;15:1–6.CrossRefGoogle Scholar
  17. 17.
    Lewis JR Jr. Use of a sliding flap from the abdomen to provide cover in breast reconstructions. Plast Reconstr Surg. 1979;64:491–7.CrossRefPubMedGoogle Scholar
  18. 18.
    Ryan JJ. A lower thoracic advancement flap in breast reconstruction after mastectomy. Plast Reconstr Surg. 1982;70:153–60.CrossRefPubMedGoogle Scholar
  19. 19.
    Delay E, Jorquera F, Pasi P, Gratadour AC. Autologous latissimus breast reconstruction in association with the abdominal advancement flap: a new refinement in breast reconstruction. Ann Plast Surg. 1999;42:67–75.CrossRefPubMedGoogle Scholar

Copyright information

© The Japanese Breast Cancer Society 2016

Authors and Affiliations

  1. 1.Department of Breast SurgeryMie University Graduate School of MedicineTsuJapan

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