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Oncologic and cosmetic outcome in patients with breast cancer treated with wide excision, transposition of adipose tissue with latissimus dorsi muscle, and axillary dissection followed by radiotherapy

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Abstract

We evaluated the oncologic and cosmetic outcome in patients with breast cancer treated with wide excision, transposition of adipose tissue with latissimus dorsi muscle (LDM), and axillary dissection followed by radiotherapy. In this study, a wide excision of breast tissue was performed to obtain tumor-free margins. The subsequent breast deformity was not corrected in six patients in the early phase of the study (Group 1), and in 16 patients in the late phase (Group 2) in which the breast deformity was not remarkable at the time of operation. Breast deformity was corrected by transposing adipose tissue with LDM on a vascular pedicle in the remaining 51 patients (Group 3). Five year survival was 100%. Two patients developed distant metastases. None were found to have local recurrence. Fifty percent of the Group 1 patients, 69% of the Group 2 patients, and 67% of the Group 3 patients had an excellent or good cosmetic result. However, when the cosmetic results were evaluated in patients who underwent transposition and had small breasts, the results were excellent or good in 76%, compared to 38% in the patients who had reconstructions who had large breasts. The difference was statistically significant (p = 0.0309). Therefore, it was confirmed that wide excision and axillary dissection followed by breast radiation could provide adequate local control, but frequently resulted in breast deformity. However, transposition of adipose tissue may be useful to correct the breast deformity, especially in women with small breasts.

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References

  1. Veronesi U, Banfi A, del Becchio M, Saccozzi R, Clemente C, Greco M, Luini A, Marubini E, Muscolino G, Rilke F, Sacchini V, Salvadori B, Zecchini A, Zucali R: Comparison of Halsted mastectomy with quadrantectomy, axillary dissection, and radiotherapy in early breast cancer: long-term results. Eur J Cancer Clin Oncol 22: 1085–1089, 1986

    Google Scholar 

  2. Fisher B, Redmond C, Poisson R, Margolese R, Wolmark N, Wickerham L, Fisher E, Deutsch M, Caplan R, Pilch Y, Glass A, Shibata H, Lerner H, Terz J, Sidorovich L: Eight-year results of a randomized clinical trial comparing total mastectomy and lumpectomy with or without irradiation in the treatment of breast cancer. N Engl J Med 320: 822–828, 1989

    Google Scholar 

  3. Veronesi U, Volterrani F, Luini A, Saccozzi R, Vecchio MD, Zucali R, Galimberti V, Rasponi A, Re ED, Squicciarini P, Salvadori B: Quadrantectomy versus lumpectomy for small size breast cancer. Eur J Cancer 26: 671–673, 1990

    Google Scholar 

  4. Veronesi U, Banfi A, Salvadori B, Luini A, Saccozzi R, Zucali R, Marubini E, Vecchio MD, Boracchi P, Marchini S, Merson M, Sacchini V, Riboldi G, Santoro G: Breast conservation is the treatment of choice in small breast cancer: long-term results of a randomized trial. Eur J Cancer 26: 668–670, 1990

    Google Scholar 

  5. Veronesi U, Luini A, Vecchio MD, Greco M, Galimberti V, Merson M, Rilke F, Sacchini V, Saccozzi R, Savio T, Zucali R, Zurrida S, Salvadori B: Radiotherapy after breast-conserving surgery in women with localized cancer of the breast. N Engl J Med 328: 1587–1591, 1993

    Google Scholar 

  6. Pearl RM, Wisnicki J: Breast reconstruction following lumpectomy and irradiation. Plast Reconst Surg 76: 83–86, 1985

    Google Scholar 

  7. Berrino P, Campora E, Santi P: Post-mastectomy breast deformities: classification and techniques of surgical correction. Plast Reconst Surg 79: 567–572, 1987

    Google Scholar 

  8. Noguchi M, Taniya T, Miyazaki I, Saito Y: Immediate transposition of a latissimus dorsi muscle for correcting a quadrantectomy breast deformity in Japanese patients. Int Surg 75: 166–170, 1990

    Google Scholar 

  9. Noguchi M, Saito Y, Mizukami Y, Nonomura A, Ohta N, Koyasaki N, Taniya T, Miyazaki I: Breast deformity; its correction, and assessment of breast conserving surgery. Breast Cancer Res Treat 18: 111–118, 1991

    Google Scholar 

  10. Noguchi M, Saito Y, Taniya T, Kitagawa H, Ohta N, Earashi M, Thomas M, Miyazaki I: Wide resection with latissimus dorsi muscle transposition in breast conserving surgery. Surg Oncol 1: 231–236, 1992

    Google Scholar 

  11. Union Internationale Contre le Cancer: Breast (ICD-0174). In: Harmer MD (eds) TMN Classification of Malignant Tumours, 4th edn, Springer-Verlag, Berlin, 1987, pp 93–99

    Google Scholar 

  12. Japan Breast Cancer Society: General Rules for Clinical and Pathological Record of Breast Cancer, ed. 9. Kanehara, Tokyo, 1988, pp 21–29

    Google Scholar 

  13. The World Health Organization: The World Health Organization histological typing of breast tumors - second edition. Am J Clin Pathol 78: 806–816, 1982

    Google Scholar 

  14. Veronesi U, Costa A: The role of surgery in the management of primary breast cancer. In: Baum N (ed) Clinics in Oncology 1(3). WB Saunders, London, 1982, pp 853–873

    Google Scholar 

  15. Kurtz JM: Factors influencing the risk of local recurrence in the breast. Eur J Cancer 28: 660–666, 1991

    Google Scholar 

  16. Kurtz JM, Jacquemier J, Amalric R, Brandone H, Ayme Y, Hans D, Bressac C, Roth J, Spitalier JM: Risk factors for breast recurrence in premenopausal and postmenopausal patients with ductal cancers treated by conservation therapy. Cancer 65: 1867–1878, 1990

    Google Scholar 

  17. Ghossein NA, Alpert S, Barba J, Pressman P, Stacey P, Lorenz E, Shulman M, Sadarangani GJ: Importance of adequate surgical excision prior to radiotherapy in the local control of breast cancer in patients treated conservatively. Arch Surg 127: 411–415, 1992

    Google Scholar 

  18. Fisher ER, Saas R, Fisher B, Gregorio R, Brown R, Wickerham L: Pathologic findings from the National Adjuvant Breast Project (protocol 6). II. Relation of local breast recurrence to multicentricity. Cancer 57: 1717–1724, 1986

    Google Scholar 

  19. Carter D: Margins of ‘lumpectomy’ for breast cancer. Hum Pathol 17: 330–332, 1986

    Google Scholar 

  20. Macmillan RD, Purushitham AD, Mallon E, Ramsay C, George WD: Breast-conserving surgery and tumour bed positivity in patients with breast cancer. Br J Surg 81: 56–58, 1994

    Google Scholar 

  21. Solin LJ, Fowble BL, Schultz DJ, Goodman RL: The significance of the pathology margins of the tumor excision on the outcome of patients treated with definitive irradiation for early stage breast cancer. Int J Radiat Oncol Biol Phys 21: 279–287, 1991

    Google Scholar 

  22. Harris JR, Recht A, Schnitt S, Connolly J, Silver B, Come S, Henderson IC: Current status of conservative surgery and radiotherapy as primary local treatment for early carcinoma of the breast. Breast Cancer Res Treat 5: 245–255, 1985

    Google Scholar 

  23. Zafrani B, Vielh P, Fourguet A, Mosseri V, Durand JC, Salmon RJ, Vilcoq JR: Conservative treatment of early breast cancer: prognostic value of the ductalin situ component and other pathological variables on local control and survival. Long-term results. Eur J Cancer Clin Oncol 25: 1645–1650, 1989

    Google Scholar 

  24. Schnitt SJ, Connolly JI, Harris JR, Hellman S, Cohen RB: Pathologic predictors of early local recurrence in stage I and II breast cancer treated by primary radiation therapy. Cancer 53: 1049–1057, 1984

    Google Scholar 

  25. Matory WE, Wertheimer M, Love S, Matory WE: Partial mastectomy: technical considerations in achieving cosmesis. Breast Dis 5: 225–233, 1992

    Google Scholar 

  26. Noguchi M, Miyazaki I: Breast conserving surgery and radiation in the treatment of operable breast cancer. Int Surg 79: 142–147, 1994

    Google Scholar 

  27. Hartsell WF, Kelly CA, Griem KL, Recine DC, Murthy AK, Galinsky DL: Breast conserving therapy: A boost dose of radiation therapy is not necessary when negative margins of excision are achieved. Breast Cancer Res Treat 27: 190, 1993 (Abstract)

    Google Scholar 

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Noguchi, M., Minami, M., Earashi, M. et al. Oncologic and cosmetic outcome in patients with breast cancer treated with wide excision, transposition of adipose tissue with latissimus dorsi muscle, and axillary dissection followed by radiotherapy. Breast Cancer Res Tr 35, 163–171 (1995). https://doi.org/10.1007/BF00668206

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