Evaluation of Central Quadrantectomy and Immediate Reconstruction in Patients with Retroareolar Breast Cancer

Abstract

Background: Centrally located breast cancer represents 5–20 % of all breast cancer cases. Oncoplastic breast surgery combines oncological principles with plastic surgical techniques; it requires knowledge of anatomy, and appreciation of symmetry, esthetics and breast function. Aim of the Work: The aim of the current study is to present and assess multiple techniques of surgical outcome of oncoplastic techniques following the resection of centrally located breast cancer. Patients and Methods: This prospective study comprised of 24 female patients with central breast cancer from November 2018 to Feb 2020 at the department of surgery Ain-Shams University Hospitals. Patients were followed up every 3 months for at least 12 months. Informed consent was obtained from the patients, and this study was approved by Al. Demerdash Hospital ethics committee. Results: In our study, statistics shows to some extent, when NAC is not involved Flierl and Hanker [11] reported satisfactory results with central quadrentectomy and immediate reconstruction in patients with retroareolar breast cancer. The mean age was 49.83 ± 7.6 years (range; 39 to 60). 13/24 patients (54.16%) were premenopausal while 11/24 (45.83%) patients were postmenopausal. 5 patients had diabetes mellitus and the rest of patients were non diabetic. Four patients (16.6%) had positive family history of breast cancer. Six patients had nipple retraction (25%). The mean tumour size was 2.52 ± 0.64 cm (0.9-2.8 cm). The spectrum of safety margin ranged from (1.9-2.8cm) the mean safety margin in our study is 2.19±0.32, the overall percentage of complications was 5/24 (20.8%). Pathological nipple infiltration was found in 12 cases (50%) showed clinical and/or radiological evidence of nipple involvement and underwent resection of the NAC (Grissoti and Melon slice techniques). 14 patients (58.33%) had positive axillary lymph nodes, all staged as pN1; while the other 10 patients (41.66%) where staged as pN0. There is significant statistical difference between the two groups; Patient dissatisfaction is due to presence of scar, breast shape asymmetry and absence of NAC as in Grisotti and Melon slice groups or asymmetry as in Inferior pedicle group. Conclusion: Multiple oncoplastic breast surgery techniques used in treatment of CLBC with good cosmetic and oncological outcome but need more training to have good results.