Oncoplastic techniques allow breast-conserving treatment in centrally located breast cancers

Background: Operative techniques for oncoplastic reconstruction combine oncologic extirpation of the tumor with immediate reconstruction of breast shape and symmetry. These techniques are increasingly being used for breast-conservation therapy of centrally located breast carcinomas. The goal of this study was to provide an overview of the various surgical options for oncoplastic treatment of central breast carcinomas. Methods: From September of 1998 through January of 2005, 31 women (median age, 61 years) were treated for 32 centrally located breast carcinomas by breast-conserving therapy. There were 27 invasive tumors (median size, 13.5 mm), and five patients had ductal carcinoma in situ (median size, 39.6 mm). One patient received chemotherapy preoperatively for tumor reduction. A total of 11 patients had a positive lymph-node status, and 21 patients had a free sentinel node. Results: The various surgical techniques included a central lumpectomy with direct closure (n = 6), central lumpectomy with inverted T-closure (n = 2), a circumareolar, Benelli-type closure (n = 2), a modified Grisotti-flap closure (n = 9), and a mammaplasty-type closure with an inferiorly based pedicle (n = 13). In 27 patients, a contralateral procedure was undertaken (bilateral carcinoma or symmetrizing mammaplasty). Two patients required a secondary mastectomy because of ductal carcinoma in situ with positive surgical margins in the final histology. They were treated by immediate reconstruction with an implant and a pedicled myocutaneous latissimus dorsi flap, respectively. In a median follow-up of 33.8 months, there were no local recurrences in the remaining breast or axilla, but two patients developed distant metastases. Conclusions: Breast carcinoma of small size that occurs in a central location can be safely treated oncologically by breast conservation therapy. The use of various oncoplastic techniques yields very satisfactory aesthetic results.