Archives of Plastic Surgery

Korean Society of Plastic and Reconstructive Surgeons (대한성형외과학회)
권호 표지
DOI QR코드

DOI QR Code

Retrospective review of 108 breast reconstructions using the round block technique after breast-conserving surgery: Indications, complications, and outcomes

  • In, Seok Kyung (Department of Plastic and Reconstructive Surgery, Kosin University Gospel Hospital) ;
  • Kim, Yoon Soo (Department of Plastic and Reconstructive Surgery, Kosin University Gospel Hospital) ;
  • Kim, Ho Sung (Department of Plastic and Reconstructive Surgery, Kosin University Gospel Hospital) ;
  • Park, Jin Hyung (Department of Plastic and Reconstructive Surgery, Kosin University Gospel Hospital) ;
  • Kim, Hong Il (Department of Plastic and Reconstructive Surgery, Kosin University Gospel Hospital) ;
  • Yi, Hyung Suk (Department of Plastic and Reconstructive Surgery, Kosin University Gospel Hospital) ;
  • Park, Jea Chun (Department of Radiology, Kosin University Gospel Hospital) ;
  • Jeon, Chang Wan (Department of Surgery, Kosin University Gospel Hospital) ;
  • Choi, Jin Hyuk (Department of Surgery, Kosin University Gospel Hospital) ;
  • Jung, Sung Ui (Department of Surgery, Kosin University Gospel Hospital) ;
  • Kim, Hyo Young (Department of Plastic and Reconstructive Surgery, Kosin University Gospel Hospital)
  • Received : 2020.03.12
  • Accepted : 2020.09.29
  • Published : 2020.11.15
Download PDF
⟨ Previous Next ⟩

Abstract

Background Several oncoplastic approaches have been implemented in recent years to enhance cosmetic results and to reduce complications. The round block technique is a volume displacement technique for breast reconstruction after breast-conserving surgery (BCS). However, its indications are currently limited according to tumor location, and its cosmetic results and complications have not been clearly established. We hypothesized that the round block technique could produce favorable cosmetic results without major complications regardless of tumor location or nipple-tumor distance, below a certain resected tumor volume and tumor-breast volume ratio. Methods All breast reconstructions using the round block technique after BCS were included in this analysis. Patients' data were reviewed retrospectively to investigate complications during follow-up, and clinical photos were used to evaluate cosmetic results. The relationships of tumor location, nipple-tumor distance, tumor volume, and the tumor-breast volume ratio with cosmetic results were investigated. Results In total, 108 breasts were reconstructed. The mean resected tumor volume was 30.2±15.0 mL. The cosmetic score was 4.5±0.6 out of 5. Tumor location, nipple-tumor distance, tumor volume, tumor-breast volume ratio, radiotherapy, and chemotherapy had no significant effects on cosmetic results or complications. There were no major complications requiring reoperation. Conclusions Breast reconstruction using the round block technique after BCS can lead to good cosmetic results without major complications regardless of the tumor location, nippletumor distance, radiotherapy, or chemotherapy. Below the maximum tumor volume (79.2 mL) and the maximum tumor-breast volume ratio (14%), favorable results were consistently obtained.

Keywords

References

  1. Fisher B, Anderson S, Bryant J, et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med 2002;347:1233-41. https://doi.org/10.1056/NEJMoa022152
  2. Song WJ, Kang SG, Kim EK, et al. Current status of and trends in post-mastectomy breast reconstruction in Korea. Arch Plast Surg 2020;47:118-25. https://doi.org/10.5999/aps.2019.01676
  3. Veronesi U, Cascinelli N, Mariani L, et al. Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med 2002;347:1227-32. https://doi.org/10.1056/NEJMoa020989
  4. Fisher B, Anderson S, Redmond CK, et al. Reanalysis and results after 12 years of follow-up in a randomized clinical trial comparing total mastectomy with lumpectomy with or without irradiation in the treatment of breast cancer. N Engl J Med 1995;333:1456-61. https://doi.org/10.1056/NEJM199511303332203
  5. Litiere S, Werutsky G, Fentiman IS, et al. Breast conserving therapy versus mastectomy for stage I-II breast cancer: 20 year follow-up of the EORTC 10801 phase 3 randomised trial. Lancet Oncol 2012;13:412-9. https://doi.org/10.1016/S1470-2045(12)70042-6
  6. Brar P, Jain S, Singh I. Complications of axillary lymph node dissection in treatment of early breast cancer: a comparison of MRM and BCS. Indian J Surg Oncol 2011;2:126-32. https://doi.org/10.1007/s13193-011-0078-2
  7. Hong KY, Son Y, Chang H, et al. Trends in breast reconstruction: implications for the National Health Insurance Service. Arch Plast Surg 2018;45:239-45. https://doi.org/10.5999/aps.2017.01417
  8. Kim MK, Kim J, Jung SP, et al. Round block technique without cerclage in breast-conserving surgery. Ann Surg Oncol 2013;20:3341-7. https://doi.org/10.1245/s10434-013-3175-3
  9. Yang JD, Lee JW, Kim WW, et al. Oncoplastic surgical techniques for personalized breast conserving surgery in breast cancer patient with small to moderate sized breast. J Breast Cancer 2011;14:253-61. https://doi.org/10.4048/jbc.2011.14.4.253
  10. Kim JB, Kim DK, Lee JW, et al. The usefulness of pedicled perforator flap in partial breast reconstruction after breast conserving surgery in Korean women. Arch Plast Surg 2018; 45:29-36. https://doi.org/10.5999/aps.2017.01200
  11. Yi HS, In SK, Kim HS, et al. Factors affecting mastectomy specimen density in direct-to-implant breast reconstruction. Arch Aesthetic Plast Surg 2019;25:137-41. https://doi.org/10.14730/aaps.2019.01774
  12. Kim S, Lee S, Lee H, et al. The safety and cosmetic effect of immediate latissimus dorsi flap reconstruction after breast conserving surgery. J Breast Cancer 2009;12:186-92. https://doi.org/10.4048/jbc.2009.12.3.186
  13. Honart JF, Reguesse AS, Struk S, et al. Indications and controversies in partial mastectomy defect reconstruction. Clin Plast Surg 2018;45:33-45. https://doi.org/10.1016/j.cps.2017.08.002
  14. Lee WY, Kim MJ, Lew DH, et al. Three-dimensional surface imaging is an effective tool for measuring breast volume: a validation study. Arch Plast Surg 2016;43:430-7. https://doi.org/10.5999/aps.2016.43.5.430
  15. Ogunleye AA, Deptula PL, Inchauste SM, et al. The utility of three-dimensional models in complex microsurgical reconstruction. Arch Plast Surg 2020;47:428-34. https://doi.org/10.5999/aps.2020.00829
  16. Yang JD, Lee JW, Cho YK, et al. Surgical techniques for personalized oncoplastic surgery in breast cancer patients with small- to moderate-sized breasts (part 2): volume replacement. J Breast Cancer 2012;15:7-14. https://doi.org/10.4048/jbc.2012.15.1.7
  17. Refaat M, Abouelnagah G, Awad AT, et al. Modified round block technique for peripherally located early cancer breast, a technique that fits for all quadrants. Breast J 2020;26:414-9. https://doi.org/10.1111/tbj.13485
  18. Haloua MH, Krekel NM, Winters HA, et al. A systematic review of oncoplastic breast-conserving surgery: current weaknesses and future prospects. Ann Surg 2013;257:609-20. https://doi.org/10.1097/SLA.0b013e3182888782
  19. Gainer SM, Lucci A. Oncoplastics: techniques for reconstruction of partial breast defects based on tumor location. J Surg Oncol 2011;103:341-7. https://doi.org/10.1002/jso.21672
  20. Gdalevitch P, Ho A, Genoway K, et al. Direct-to-implant single-stage immediate breast reconstruction with acellular dermal matrix: predictors of failure. Plast Reconstr Surg 2014;133:738e-747e. https://doi.org/10.1097/PRS.0000000000000171
  21. Molto Garcia R, Gonzalez Alonso V, Villaverde Domenech ME. Fat grafting in immediate breast reconstruction: avoiding breast sequelae. Breast Cancer 2016;23:134-40. https://doi.org/10.1007/s12282-014-0541-3
  22. Salgarello M, Visconti G, Rusciani A. Breast fat grafting with platelet-rich plasma: a comparative clinical study and current state of the art. Plast Reconstr Surg 2011;127:2176-85. https://doi.org/10.1097/PRS.0b013e3182139fe7
  23. Salzberg CA, Ashikari AY, Koch RM, et al. An 8-year experience of direct-to-implant immediate breast reconstruction using human acellular dermal matrix (AlloDerm). Plast Reconstr Surg 2011;127:514-24. https://doi.org/10.1097/PRS.0b013e318200a961
  24. Colwell AS, Damjanovic B, Zahedi B, et al. Retrospective review of 331 consecutive immediate single-stage implant reconstructions with acellular dermal matrix: indications, complications, trends, and costs. Plast Reconstr Surg 2011; 128:1170-8. https://doi.org/10.1097/PRS.0b013e318230c2f6