Dataset Information

Combining a Chest Wall Perforator Flap and Bioabsorbable Implant to Facilitate Oncoplastic Breast-conserving Surgery.

ABSTRACT: Oncoplastic breast conservation is classically divided into two approaches: volume displacement and volume replacement (VR). These approaches are important to use when more than 20% of the breast is removed to avoid deformity. Smaller, nonptotic breasts require VR strategies from flaps based off of local chest wall perforators. When larger volumes are required, a flap based off the thoracodorsal artery can be used. Although this flap can replace larger volumes, it usually requires a position change with increased operative time, patient morbidity, and longer recovery while also exhausting a major reconstructive modality. In an effort to avoid this increased operative complexity, we have found that combining a local chest wall perforator flap and bioabsorbable implant, which has been previously shown to be safe and effective in reconstructing partial mastectomy defects, allows for a simpler VR strategy in patients who might otherwise require a more extensive thoracodorsal artery-based flap surgery or a mastectomy. Here, we present 10 cases where we combined flaps based off the lateral, anterior or medial intercostal artery perforators or lateral thoracic artery perforator with a bioabsorbable implant to successfully perform oncoplastic breast conservation in patients who might otherwise be marginal candidates for VR using a local chest wall perforator flap.

SUBMITTER: Schwartz JD

PROVIDER: S-EPMC10132726 | biostudies-literature | 2023 Apr

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Combining a Chest Wall Perforator Flap and Bioabsorbable Implant to Facilitate Oncoplastic Breast-conserving Surgery.

Schwartz Jean-Claude D JD

Plastic and reconstructive surgery. Global open 20230426 4

Oncoplastic breast conservation is classically divided into two approaches: volume displacement and volume replacement (VR). These approaches are important to use when more than 20% of the breast is removed to avoid deformity. Smaller, nonptotic breasts require VR strategies from flaps based off of local chest wall perforators. When larger volumes are required, a flap based off the thoracodorsal artery can be used. Although this flap can replace larger volumes, it usually requires a position cha ...[more]

PMID: 37124391

Similar Datasets

Project description:ObjectiveThis study aims to explore the application value of chest wall perforator flaps (CWPF) in oncoplastic breast-conserving surgery.MethodsA retrospective review was conducted on 22 early-stage breast cancer patients who underwent oncoplastic breast-conserving surgery using CWPF between January 2021 and December 2022. This included 4 cases (18.2%) utilizing lateral intercostal artery perforator (LICAP) flaps, 10 cases (45.4%) employing lateral thoracic artery perforator (LTAP) flaps, 4 cases (18.2%) combining LICAP and LTAP flaps, and 4 cases (18.2%) using anterior intercostal artery perforator (AICAP) flaps. The perforators used in this study included lateral thoracic artery perforators (LTAP), anterior intercostal artery perforators (AICAP), and lateral intercostal artery perforators (LICAP). In some cases, a combination of LICAP and LTAP was employed to ensure adequate blood supply. All flaps were supplied by dominant perforators, with some cases using multiple perforators to enhance flap perfusion and survival. Our single-center experience with CWPF, including surgical details, complications, aesthetic, and oncological outcomes, is reported.ResultsAmong all patients, tumors were located in the outer quadrant (68.2%), central quadrant (13.6%), and inner quadrant (18.2%) of the excision cavity. In the 22 patients, 15 tumors were located in the outer quadrant: 6 in the left upper outer quadrant (1-2 o'clock), 4 in the right upper outer quadrant (10-11 o'clock), and 5 in the outer quadrants (3 o'clock in 3 cases and 9 o'clock in 2 cases). Four tumors were in the lower inner quadrant: 2 in the left lower inner quadrant (7-8 o'clock) and 2 in the right lower inner quadrant (4-5 o'clock). Three tumors were in the central area extending toward the outer quadrant. All tumors were located more than 2 cm from the nipple-areola complex (NAC), and intraoperative frozen sections confirmed negative margins behind the NAC. All patients had negative surgical margins. The average operative time was 100.5 ± 10.2 min, with flap lengths ranging from 10 to 18 cm and widths from 4 to 10 cm. All flaps survived, with only one instance of surgical site infection, which improved with conservative treatment. Overall patient satisfaction was rated as excellent or good in 85.6%, and physician evaluation was 89.0% excellent or good. In addition to subjective patient and surgeon satisfaction surveys, objective aesthetic outcomes were evaluated using the BCCT.core software. This tool provided a standardized assessment of breast symmetry, contour, and cosmetic outcomes, enhancing the objectivity and reproducibility of the cosmetic evaluation in the study. The median follow-up period was 14.5 months, with one case of tumor recurrence and no patient mortality.ConclusionCWPF can be effectively used in small-to-medium volume, non-ptotic breasts for oncoplastic surgery, yielding high patient satisfaction. In the era of oncoplastic breast surgery, chest wall perforator flaps are a reliable and safe option for partial breast reconstruction with acceptable aesthetic results.

Dataset Information

Combining a Chest Wall Perforator Flap and Bioabsorbable Implant to Facilitate Oncoplastic Breast-conserving Surgery.

Publications

Combining a Chest Wall Perforator Flap and Bioabsorbable Implant to Facilitate Oncoplastic Breast-conserving Surgery.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets