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Annals of Surgical Oncology

, Volume 12, Issue 7, pp 539–545 | Cite as

Comparative Study of Surgical Margins in Oncoplastic Surgery and Quadrantectomy in Breast Cancer

  • Navneet Kaur
  • Jean-Yves Petit
  • Mario Rietjens
  • Fausto Maffini
  • Alberto Luini
  • Giovanna Gatti
  • Pier Carlo Rey
  • Cicero Urban
  • Francesca De Lorenzi
Original Article

Abstract

Background

Oncoplastic surgery for breast cancer is a novel concept that combines a plastic surgical procedure with breast-conserving treatment to improve the final cosmetic results. The aim of this study was to evaluate the oncological safety of oncoplastic procedures by studying the status of the surgical margins of the excised tumor specimen in comparison with standard quadrantectomies.

Methods

Thirty consecutive breast cancer patients undergoing oncoplastic surgery (group 1) and 30 patients undergoing standard quadrantectomy (group 2) were prospectively studied with regard to the stage of breast cancer, the surgical procedures performed, the volume of breast tissue excised, and the histopathology of the tumor specimen, with specific details on surgical margins.

Results

Patients who underwent oncoplastic surgery (group 1) were younger (mean age, 48.73 years) than patients who had a classic quadrantectomy (group 2; mean age, 55.76 years; P = .022). The mean volume of the excised specimen in group 1 was 200.18 cm3, compared with 117.55 cm3 in group 2 (P = .016). Surgical margins were negative in 25 cases out of 30 in group 1 and 17 out of 30 in group 2 (P = .05). The average length of the surgical margin was 8.5 mm in group 1 and 6.5 mm in group 2, but the difference was not statistically significant (P = .074).

Conclusions

Oncoplastic surgery adds to the oncological safety of breast-conserving treatment because a larger volume of breast tissue can be excised and a wider negative margin can be obtained. It is especially indicated for large tumors, for which standard breast-conserving treatment has a high probability of leaving positive margins.

Keywords

Oncoplastic surgery Quadrantectomy Surgical margins Breast cancer Plastic surgery 

References

  1. 1.
    Jakesz, R, Samonigg, H, Gnant, M,  et al. 2003Significant increase in breast conservation in 16 years of trials conducted by the Austrian Breast and Colorectal Cancer Study GroupAnn Surg23755664CrossRefPubMedGoogle Scholar
  2. 2.
    Fisher, B, Dignam, J, Wolmark, N,  et al. 1998Lumpectomy and radiation therapy for the treatment of intraductal breast cancer: findings from National Surgical Adjuvant Breast and Bowel ProjectJ Clin Oncol1644152PubMedGoogle Scholar
  3. 3.
    Schwartz, GF, Birchansky, CA, Komarnicky, LT,  et al. 1994Induction chemotherapy followed by breast conservation for locally advanced carcinoma of the breastCancer733629Google Scholar
  4. 4.
    Doridot, V, Nos, C, Aucouturier, JS, Sigal-Zafrani, B, Fourquet, A, Clough, KB 2004Breast-conserving therapy of breast cancerCancer Radiother8218PubMedGoogle Scholar
  5. 5.
    Clough, KB, Lewis, JS, Couturand, B, Fitoussi, A, Nac, S, Falcou, MC 2003Oncoplastic techniques allow extensive resections for breast-conserving therapy of breast carcinomasAnn Surg2372634PubMedGoogle Scholar
  6. 6.
    Audretsch, W, Rezai, M, Kolotas, C,  et al. 1998Tumor-specific immediate reconstruction in breast cancer patientsPerspect Plast Surg1171100Google Scholar
  7. 7.
    Rainsbury, RM 2003Training and skills for breast surgeons in the new millenniumANZ J Surg735116PubMedGoogle Scholar
  8. 8.
    Baildam, AD 2002Oncoplastic surgery of the breastBr J Surg895323PubMedGoogle Scholar
  9. 9.
    Rew, DA 2003Towards a scientific basis for oncoplastic breast surgeryEur J Surg Oncol291056CrossRefPubMedGoogle Scholar
  10. 10.
    Noguchi, M, Saito, Y, Mizukami, Y,  et al. 1991Breast deformity, its correction and assessment of breast-conserving surgeryBreast Cancer Res Treat181118PubMedGoogle Scholar
  11. 11.
    Raja, MAK, Straker, VF, Rainsbury, RM 1997Extending the role of breast-conserving surgery by immediate volume replacementBr J Surg841015CrossRefPubMedGoogle Scholar
  12. 12.
    Rainsbury, RM, Paramanathan, N 1998Recent progress with breast conserving volume replacement using latissimus dorsi miniflaps in UK patientsBreast Cancer513947PubMedGoogle Scholar
  13. 13.
    Dixon, JM, Venizelos, B, Chan, P 2002Latissimus dorsi miniflap: a new technique for extending breast conservationBreast115865PubMedGoogle Scholar
  14. 14.
    Clough, KB, Kroll, SS, Audretsch, W 1999An approach to the repair of partial mastectomy defectsPlast Reconstr Surg10440920PubMedGoogle Scholar
  15. 15.
    Nos, C, Fitoussi, A, Bourgeois, D, Fourquet, A, Salmon, RJ, Klough, KB 1998Conservative treatment of lower pole breast cancers by bilateral mammoplasty and radiotherapyEur J Surg Oncol2450814PubMedGoogle Scholar
  16. 16.
    Petit, JY, Garusi, C, Greuse, M,  et al. 2002One hundred and eleven cases of breast conservation treatment with simultaneous reconstruction at the European Institute of Oncology (Milan)Tumori88417PubMedGoogle Scholar
  17. 17.
    Silverstein, MJ, Lagios, MD, Groshen, S,  et al. 1999The influence of margin width on local control of ductal carcinoma in situ of the breastN Engl J Med340145561PubMedGoogle Scholar
  18. 18.
    Veronesi, U, Volteranni, F, Luini, A,  et al. 1990Quadrantectomy versus lumpectomy for small size breast cancerEur J Cancer266713PubMedGoogle Scholar
  19. 19.
    Schnitt, SJ, Abner, A, Gelman, R, Connelly, JL 1994The relationship between microscopic margins of resection and the risk of local recurrence in patients treated with breast conserving surgery and radiation therapyCancer74174651Google Scholar
  20. 20.
    Meric, F, Mirza, NQ, Vlastos, G 2003Positive surgical margins and ipsilateral breast tumor recurrence predict disease-specific survival after breast conserving therapyCancer9792633Google Scholar
  21. 21.
    Mokbel, K, Ahmed, M, Nash, A, Sacks, N 1995Re-excision operations in non palpable breast cancerJ Surg Oncol582258PubMedGoogle Scholar
  22. 22.
    Clarke, K, Le, MG, Sarrazin, D,  et al. 1985Analysis of loco-regional relapses in patients with early breast cancer treated by excision and radiotherapy: experience of the Institute Gustave-RoussyInt J Radiat Oncol Biol Phys1113745PubMedGoogle Scholar
  23. 23.
    Singletary, SE 2002Surgical margins in patients with early stage breast cancer treated with breast conservation therapyAm J Surg18438393CrossRefPubMedGoogle Scholar
  24. 24.
    Graham, RA, Homer, MJ, Katz Judith, K, Rothschild, J, Safaii, H, Supram, S 2002The pancake phenomenon contributes to the inaccuracy of margin assessment in patients with breast cancerAm J Surg1848993PubMedGoogle Scholar
  25. 25.
    Mustonen, P, Harma, M 2002Viewpoints on oncoplastic surgery in invasive breast cancerScand J Surg91255258–62PubMedGoogle Scholar
  26. 26.
    Veronesi, U, Cascinelli, N, Mariani, L,  et al. 2003Twenty-year follow-up of a randomized study comparing breast conserving surgery with radical mastectomy for early breast cancerN Engl J Med347122732CrossRefGoogle Scholar
  27. 27.
    Gerber, B, Krause, A, Reimer, T,  et al. 2003Skin-sparing mastectomy with conservation of the nipple-areola complex and autologous reconstruction is an oncologically safe procedureAnn Surg2381207PubMedGoogle Scholar
  28. 28.
    Benelli, L 1990A new periareolar mammoplasty: round block techniqueAesthetic Plast Surg1499106CrossRefGoogle Scholar
  29. 29.
    Galimberti, V, Zurrida, S, Zanini, V,  et al. 1993Central small size breast cancer: how to overcome the problem of nipple and areola involvement?Eur J Cancer2910936Google Scholar
  30. 30.
    Raja, MAK, Straker, VE, Rainsbury, RM 1997Extending the role of breast-conserving surgery by immediate volume replacementBr J Surg841015CrossRefPubMedGoogle Scholar
  31. 31.
    Asgeirsson, KS, McCulley, SJ, Pinder, SE, Macmillan, RD 2003Size of invasive breast cancer and risk of local recurrence after breast-conservation therapyEur J Cancer3924629Google Scholar
  32. 32.
    Silverstein, MJ, Gierson, ED, Colburn, WJ,  et al. 1994Can intraductal breast carcinoma be excised completely by local excision? Clinical and pathologic predictorsCancer7329859Google Scholar
  33. 33.
    Vicini, FA, Kestin, LL, Goldstein, NS,  et al. 2001Relationship between excision volume, margin status, and tumor size with the development of local recurrence in patients with ductal carcinoma in situ treated with breast conserving therapyJ Surg Oncol7624554PubMedGoogle Scholar
  34. 34.
    Bonadonna, G, Veronesi, U, Brumbilla, C,  et al. 1990Primary chemotherapy to avoid mastectomy in tumors with diameters of three centimeters or moreJ Natl Cancer Inst82153945PubMedGoogle Scholar
  35. 35.
    Rietjens, M, Petit, JY, Contesso, G 1997The role of reduction mammoplasty in oncologyEur J Plast Surg2024650CrossRefGoogle Scholar
  36. 36.
    Gray, JR, McCormick, B, Cox, L, Yahalom, J 1991Primary breast irradiation in large-breasted or heavy women: analysis of cosmetic outcomeInt J Radiat Oncol Biol Phys2134754PubMedGoogle Scholar
  37. 37.
    Moody, AM, Mayles, WP, Bliss, JM,  et al. 1994The influence of breast size on late radiation effects and association with radiotherapy dose inhomogeneityRadiother Oncol3310612PubMedGoogle Scholar

Copyright information

© The Society of Surgical Oncology, Inc. 2005

Authors and Affiliations

  • Navneet Kaur
    • 1
  • Jean-Yves Petit
    • 1
  • Mario Rietjens
    • 1
  • Fausto Maffini
    • 2
  • Alberto Luini
    • 3
  • Giovanna Gatti
    • 3
  • Pier Carlo Rey
    • 1
  • Cicero Urban
    • 1
  • Francesca De Lorenzi
    • 1
  1. 1.Department of Plastic and Reconstructive SurgeryEuropean Institute of OncologyMilanItaly
  2. 2.Pathology DivisionEuropean Institute of OncologyMilanItaly
  3. 3.Breast DivisionEuropean Institute of OncologyMilanItaly

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