Abstract
Background
Oncoplastic techniques are capable of correcting or preventing morphological changes of the breast undergoing conservative surgery with the aim of improving the cosmetic outcome and therefore the quality of life. Literature reports several post-conservative surgical oncoplastic procedures using autologous or local glandular tissue.
Methods
Authors report their experience with 24 breast cancer patients (localized in upper and central quadrants). The flap used, described by Ribeiro, is a dermal–adiposal–glandular flap with an inferior pedicle prepared utilizing the lower breast pole. In the six cases, we have performed an immediate nipple reconstruction using C–V flap, sculpted with a skin island on the Ribeiro flap, and areola tattooing. The mean age was 56.3 years (range, 35 to 74 years), and mean follow-up was 26 months (12 to 40 months). The level of patient satisfaction was rated on a 1 (low) to 5 (high) scale, before and after radiotherapy (12 months).
Results
In all patients, no depression of the superior quadrants was noted, as well as no morphological change noted in the “oncological” breast contour and that of the “cosmetic” contralateral breast, with mean satisfaction score of 4.2. The degree of satisfaction symmetry, assessed at 1 year from radiotherapy, had a mean satisfaction score of 4.0.
Conclusions
The use of the Ribeiro flap as a filler in appropriate and selected indications can represent a good alternative to the many reconstructive methods available for partial breast resection.
Level of Evidence: Level IV, therapeutic study.
Similar content being viewed by others
References
Losken A, Nahabedian MY (2009) Oncoplastic breast surgery: past, present, and future directions in the United States. Plast Reconstr Surg 124(3):969–972
Veronesi U, Banfi A, Salvadori B et al (1990) Breast conservation is the treatment of choice in small breast cancer: long-term results of a randomized trial. Eur J Cancer 26:668–670
Fitoussi AD, Berry MG, Famà F, Falcou MC, Curnier A, Couturaud B, Reyal F, Salmon RJ (2010) Oncoplastic breast surgery for cancer: analysis of 540 consecutive cases [outcomes article]. Plast Reconstr Surg 125(2):454–462
Luini A, Gatti G, Zurrida S et al (2007) The evolution of the conservative approach to breast cancer. Breast 16:120–129
Chan SW, Cheung PS, Lam SH (2010) Cosmetic outcome and percentage of breast volume excision in oncoplastic breast conserving surgery. World J Surg 34(7):1447–1452
Clough KB, Kroll SS, Audretsch W (1999) An approach to the repair of partial mastectomy defects. Plast Reconstr Surg 104(2):409–420
Kronowitz SJ, Kuerer HM, Buchholz TA, Valero V, Hunt KK (2008) A management algorithm and practical oncoplastic surgical techniques for repairing partial mastectomy defects. Plast Reconstr Surg 122(6):1631–1647, Review
Spear SL (2009) Oncoplastic surgery. Plast Reconstr Surg 124(3):993–994
McCulley SJ, Schaverien MV (2009) Superior and superomedial pedicle wise-pattern reduction mammaplasty: maximizing cosmesis and minimizing complications. Ann Plast Surg 63(2):128–134
Spear SL, Pelletiere CV, Wolfe AJ, Tsangaris TN, Pennanen MF (2003) Experience with reduction mammaplasty combined with breast conservation therapy in the treatment of breast cancer. Plast Reconstr Surg 111(3):1102–1109
Munhoz AM, Montag E, Arruda EG, Aldrighi C, Gemperli R, Aldrighi JM, Ferreira MC (2006) Superomedial dermoglandular pedicle reduction mammaplasty for immediate conservative breast surgery reconstruction. Ann Plast Surg 57(5):502–508
Santanelli F, Paolini G, Campanale A, Longo B, Amanti C (2009) Modified wise pattern reduction mammaplasty, a new tool for upper quadrantectomies: a preliminary report. Ann Surg Oncol 16(5):1122–1127, Epub 2009 Feb 28
Ribeiro L (1975) A new technique for reduction mammaplasty. Plast Reconstr Surg 55(3):330–334
Ribeiro L, Accorsi A Jr, Buss A, Marcal-Pessoa M (2002) Creation and evolution of 30 years of the inferior pedicle in reduction mammaplasties. Plast Reconstr Surg 110(3):960–970
Ribeiro L, Canzi W, Buss A Jr, Accorsi A Jr (1998) Tuberous breast: a new approach. Plast Reconstr Surg 101(1):42–50, discussion 51-2
Smith GA, Schmidt GH (1979) Experience with the Ribeiro reduction mammaplasty technique. Ann Plast Surg 3(3):260–263
Patani N, Carpenter R (2010) Oncological and aesthetic considerations of conservational surgery for multifocal/multicentric breast cancer. Breast J 16(3):222–232
Regnault P (1976) Breast ptosis. Definition and treatment. Clin Plast Surg 3(2):193–203
Pitanguy I, Torres E, Salgado F, Pires Viana GA (2005) Breast pathology and reduction mammaplasty. Plast Reconstr Surg 115(3):729–734, Discussion, 735
Losken A, Schaefer TG, Newell M, Styblo TM (2009) The impact of partial breast reconstruction using reduction techniques on postoperative cancer surveillance. Plast Reconstr Surg 124(1):9–17
Oden S, Thureau S, Baron M, Hanzen C (2010) Conservative treatment for breast cancer: optimization of the tumor bed localization. Cancer Radiother 14(2):96–102, Epub 2010 Mar 4
Losken A, Pinell XA, Eskenazi B (2010) The benefits of partial versus total breast reconstruction for women with macromastia. Plast Reconstr Surg 125(4):1051–1056
Clough KB, Cuminet J, Fitoussi A, Nos C, Mosseri V (1998) Cosmetic sequelae after conservative treatment for breast cancer: classification and results of surgical treatment. Ann Plast Surg 41:471–481
D’Aniello C, Grimaldi L, Barbaro A, Bosi B, Carli A (1999) Cosmetic results in 242 patients treated by conservative surgery for breast cancer. Scand J Plast Reconstr Hand Surg 33:419–422
Clough KB, Kaufman GJ, Nos C, Buccimazza I, Sarfati IM (2010) Improving breast cancer surgery: a classification and quadrant per quadrant atlas for oncoplastic surgery. Ann Surg Oncol 17(5):1375–1391, Epub 2010 Feb 6
Munhoz AM, Montag E, Arruda E (2008) Assessment of immediate conservative breast surgery reconstruction: a classification system of defects revisited and an algorithm for selecting the appropriate technique. Plast Reconstr Surg 121:716–727
Mandrekas AD, Zambacos GJ, Anastasopoulos A, Hapsas DA (1996) Reduction mammaplasty with the inferior pedicle technique: early and late complications in 371 patients. Br J Plast Surg 49:442–446
Regaño S, Hernanz F, Ortega E, Redondo-Figuero C, Gómez-Fleitas M (2009) Oncoplastic techniques extend breast-conserving surgery to patients with neoadjuvant chemotherapy response unfit for conventional techniques. World J Surg 33(10):2082–2086
Veiga DF, Veiga-Filho J, Ribeiro LM, Archangelo I Jr, Balbino PF, Caetano LV, Novo NF, Ferreira LM (2010) Quality-of-life and self-esteem outcomes after oncoplastic breast-conserving surgery. Plast Reconstr Surg 125(3):811–817
Conflict of interest
None
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Pompei, S., Marcasciano, F., Frascino, L.F. et al. The inferior pedicle flap used as “filler” in breast conservative therapy. Eur J Plast Surg 36, 21–26 (2013). https://doi.org/10.1007/s00238-012-0760-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00238-012-0760-9