Quadrant by Quadrant Preoperative Planning for Oncoplastic Resections

Abstract

Several groups have published clinical algorithms for the use of various oncoplastic breast conserving surgery techniques. Some favor to select the reconstruction choice primarily based on tumor location by quadrant, others first consider the size and shape of the breast; however, all oncoplastic surgeons use all of these criteria when finalizing their treatment plan. One of the oldest and most commonly used techniques is round block mammoplasty, which works well in most situations. It is technically one of the least demanding procedures when applied to smaller tumors in any location other than the lower pole. However, the level of technical complexity of partial breast reconstruction is increased for peripheral large tumors due to limited exposure. Even though this technique reliably prevents deformities and nipple deviations, the final aesthetic result is limited by the lack of reshaping and loss of projection of the breast. The oncoplastic breast reduction mammoplasty can be used in patients with large breasts for tumors in all quadrants. This technique allows optimal oncological and aesthetic results even for large tumors at the cost of increased duration of surgery and risk of complications. The triangle excision is a straightforward alternative for tumors close to the inframammary fold. For tumors in the lower inner quadrant, the V-mammoplasty allows safe partial breast reconstruction at the expense of longer incisions. Further mastopexy techniques include hemi-batwing mammoplasty, which works well for tumors in the outer quadrants of the breast, and crescent mammoplasty for tumors close to the skin in the supra-areolar region. For retromamillary tumors, Grisotti mammoplasty – also known as the B-technique – can be used in virtually all patients with small adjustments based on the size and shape of the breast.