Skip to main content
SpringerLink
Log in

Recent progress with breast-conserving volume replacement using latissimus dorsi miniflaps in UK patients

  • Original Article
  • Published:
Breast Cancer Aims and scope Submit manuscript

Abstract

Significant volume loss during breast conserving surgery (BCS) can be anticipated in patients with small breast: tumor ratios, limiting the use of BCS in women with smaller breasts or larger tumors. Early experience with autogenous immediate volume replacement (IVR) at the time of BCS led to refinements in the technique, extending its role in clinical practice. The evolution of the technique has been examined, with particular reference to tumor selection, technique and modifications, histopathological findings, and cosmetic, radiological and psychological sequelae.

Between 1991-1997, 62 patients underwent BCS and IVR using a latissimus dorsi (LD) miniflap. Tumors (diameter 22 [5-40] mm) were located in the upper outer quadrant (29) center (15) upper inner quadrant (17) and lower outer quadrant (1) of the breast. Operations lasted 129 (80-245) min, resecting specimens of 144 (37-345) g. Margins were positive in 8/62 specimens (13%) and local recurrence was recorded in 5/62 (8%), 4 of whom had not received radiotherapy. One local recurrence was treated by mastectomy (1.8% of whole group) and 4 were treated by re-excision and delayed radiotherapy. The cosmetic, radiological and psychological outcomes of the procedure compared favorably with BCS alone.

Breast-conserving volume replacement with LD miniflaps extends the role of BCS without compromising resection, cosmesis or surveillance, and provides a further option in the surgical management of breast carcinoma.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Abbreviations

BCS:

Breast conserving surgery

IVR:

Immediate volume replacement

LD:

Latissimus dorsi

WLE:

Wide local excision

SA:

Serratus anterior

References

  1. Gazet JC, Rainsbury R, Ford H,et al: Survey of treatment for primary breast cancer in Great Britain.Br Med J 290:1793–1795, 1985.

    Article  CAS  Google Scholar 

  2. Morris J, Royle GT, TaylorI: Changes in the surgical management of early breast cancer in England.J R Soc Med 82:12–14, 1989.

    PubMed  CAS  Google Scholar 

  3. Harries SA, Lawrence RN, ScrivenerR,et al: A survey of the management of breast cancer in England and Wales.Ann R Coll Surg Engl 78:197–202, 1996.

    PubMed  CAS  Google Scholar 

  4. Veronesi U, Volterrani F, LuiniA,et al: Quadran- tectomy versus lumpectomy for small sized breast cancer.EurJ Cancer 26:671–673, 1990.

    Article  CAS  Google Scholar 

  5. Olivotto I, Rose M, Osteen RT,et al: Late cosmetic outcome after conservative surgery and radiotherapy; Analysis of causes of cosmetic failure.Int J Radiat Oncol Biol Phys 17:747–753, 1989.

    PubMed  CAS  Google Scholar 

  6. Noguchi M, Taniya T, Miyasaki I,et al: Immediate transposition of a latissimus dorsi muscle for correcting a postquadrantectomy breast deformity in Japanese patients.Int Surg 75:166–170, 1990.

    PubMed  CAS  Google Scholar 

  7. Slavin SA, Love SM, Sadowsky NL: Reconstruction of the irradiated partial mastectomy defect with autogenous tissues.Plast Reconstr Surg 90:854–865, 1992.

    Article  PubMed  CAS  Google Scholar 

  8. Gaillard Thomas T: On the removal of benign tumours of the mamma without mutilation of the organ.N. York Medical Journal and Obstetrical Review 35:337–340, 1882.

    Google Scholar 

  9. Lee RPF, Vincenti A, BuchananR,et al: Selective radiotherapy following wide local excision of breast cancer; Early results of randomised trial.Eur J Surg Oncol 21:113–114 (abstract), 1995.

    Google Scholar 

  10. Raja MAK, Straker VF, Rainsbury RM: Extending the role of breast-conserving surgery by immediate volume replacement.Br J Surg 84:101–105, 1997.

    Article  PubMed  CAS  Google Scholar 

  11. Pesner R, Patterson M, HillL,et al: Breast retraction assessment; Multiple variable analysis of factors responsible for cosmetic retraction in patients treated conservatively for stage 1 or 2 breast carcinoma.Acta Radiol Oncol 24:327–330, 1985.

    Article  Google Scholar 

  12. Peyser PM, Rainsbur RM: Early experience of ultra- conservative skin saving mastectomy and immediate breast and areolar reconstruction.Eur J Surg Oncol 23:584 (abstract), 1997.

    Google Scholar 

  13. O’Brien W, Hasselgren P-O, Hummel RP,et al:Comparison of postoperative wound complications and early cancer recurrence between patients undergoing mastectomy with or without immediate breast reconstruction.Am J Surg 116:1–5, 1993.

    Article  Google Scholar 

  14. Eberlein TJ, Crespo LD, Smith BL,et al: Prospective evaluation of immediate reconstruction after mastectomy.Ann Surg 218:29–36, 1993.

    Article  PubMed  CAS  Google Scholar 

  15. Elkowitz A, Colen S, SlavinS,et al: Various methods of breast reconstruction after mastectomy; An economic comparison.Plast Reconstr Surg 92:77–83, 1993.

    Article  PubMed  CAS  Google Scholar 

  16. Dean C, Chetty U, Forrest APM: Effect of immediate breast reconstruction on psychosocial morbidity after mastectomy.Lancet 1:459–462, 1983.

    Article  PubMed  CAS  Google Scholar 

  17. Veronesi U, Luini A, Vecchio MD,et al: Radiotherapy after breast-conserving surgery in women with localised cancer of the breast.N Engl J Med 328:1587–1591, 1993.

    Article  PubMed  CAS  Google Scholar 

  18. Noguchi M, Saito Y, MizukamiY,et al: Breast deformity, its correction, and assessment of breast conserving surgery.Breast Cancer Res Treat 18:111- 118, 1991.

    Article  PubMed  CAS  Google Scholar 

  19. Tsouskas LI, Fentiman IS: Breast compliance; A new method for evaluation of cosmetic outcome after conservative treatment of early treatment of early breast cancer.Breast Cancer Res Treat 15:185–190, 1990.

    Article  PubMed  CAS  Google Scholar 

  20. Solen LJ, Fowble BL, MartzK,et al: Results of re- excisional biopsy of the primary tumour in preparation for definitive irradiation of patients with early stage breast cancer.Int Radiat Oncol Biol Phys 12:721–725, 1986.

    Google Scholar 

  21. McCormick B, Kinney D, PetrekJ,et al: Limited resection for breast cancer; A study of inked speci-men margins before radiotherapy.Int J Radiat Oncol Biol Phys 13:1667–1671,1987.

    PubMed  CAS  Google Scholar 

  22. Schnitt SJ, Abner A, GelmanR,et al: The relation-ship between microscopic margins of resection and the risk of local recurrence in patients with breast cancer treated by breast-conserving surgery and radiation therapy.Cancer 74:1746–1751, 1994.

    Article  PubMed  CAS  Google Scholar 

  23. NIH Consensus Conference: Treatment of early-stage breast cancer.JAMA 265:391–395,1991.

    Article  Google Scholar 

  24. Eaves FF, Bostwick J, NahaiF,et al: Endoscopic techniques in aesthetic breast surgery.Clin Plast Surg 22:683–695, 1995.

    PubMed  Google Scholar 

  25. Wellisch DK, Schain WS, Noone RB,et al: Psychosocial correlates of immediate versus delayed reconstruction of the breast.Plast Reconstr Surg 76:713–718, 1985.

    Article  PubMed  CAS  Google Scholar 

  26. Noguchi M, Minami M, EarashiM,et al: Oncologic and cosmetic outcome in patients with breast cancer treated by wide excision, transposition of adipose tissue with latissimus dorsi muscle, and axillary dissection followed by radiotherapy.Breast Cancer Res Treat 35:163–171, 1995.

    Article  PubMed  CAS  Google Scholar 

  27. Tohno E, Cosgrove DO, Sloane JP: Malignant disease-primary carcinoma-ductal carcinomain situ. In: Ultrasound Diagnosis of Breast Disease, Churchill Livingstone, New York, ppl78–179,1994.

    Google Scholar 

  28. Gilles R, Guinebretiere J-M: Magnetic resonance imaging. In: Ductal CarcinomaIn Situ of the Breast, William & Wilkins, Baltimore, pp159–166, 1997.

    Google Scholar 

  29. Holland R, Veling SH, MravunacM,et al: Histologic multi-focality of Tis, T1-2 breast carcinomas; Implications for clinical trials of breast-conserving surgery.Cancer 56:979–790, 1985.

    Article  PubMed  CAS  Google Scholar 

  30. Bass LS, Karp NS, BenacquistaT,et al: Endoscopic harvest of the rectus abdominus free flap; balloon dissection in the fascial plane.Ann Plast Surg 34:274–279, 1995.

    Article  PubMed  CAS  Google Scholar 

  31. Van BuskarkER, Krehnke RD, Montgomery RL,et al: Endoscopie harvest of the latissimus dorsi muscle using the balloon dissection technique.Plast Reconstr Surg 99:899–903, 1997.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. The Breast Unit, Royal Hampshire County Hospital, Winchester, UK

    Richard M. Rainsbury & Nirmala Paramanathan

Authors
  1. Richard M. Rainsbury
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nirmala Paramanathan
    View author publications

    You can also search for this author in PubMed Google Scholar

About this article

Cite this article

Rainsbury, R.M., Paramanathan, N. Recent progress with breast-conserving volume replacement using latissimus dorsi miniflaps in UK patients. Breast Cancer 5, 139–147 (1998). https://doi.org/10.1007/BF02966686

Download citation

  • Received:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02966686

Key words

Search

Navigation