Oncoplastic Variations Based on Tumor Location


Introduction

The type of reconstruction used for partial mastectomy defects depends on (1) the size of the resection, (2) the size of the breast, and (3) the location of the tumor. Tumor location on the breast and relative to the nipple–areolar complex is critically important. A recent study of 350 patients demonstrated that the maximal volume of tissue resected with lumpectomy without resulting in unacceptable aesthetic and functional outcomes of decreased quality of life were 18–19% in the upper-outer quadrant, 14–15% in the lower quadrant, 8–9% in the upper-inner quadrant, and 9–10% in the lower inner quadrant. Tumor location not only can predict the potential for a cosmetic deformity, but it also can help determine the type of reconstruction required to fill the partial mastectomy defect. Women with smaller breasts are more often amenable to flap type volume replacement reconstructions, whereas women with larger or more ptotic breasts are better candidates for volume displacement techniques. Adhering to strict algorithms is difficult because every case is different. Being familiar with the various reconstructive tools will allow reconstruction of almost any partial mastectomy defect. The oncoplastic reduction and mastopexy techniques can reconstruct a tumor in any location. Although principles are essentially the same for any breast defect, the type of pedicle and type of skin pattern might differ depending on the tumor location. Flaps can also reach any tumor location; however, some flaps are better suited for certain locations than others.

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