Nirmala Paramanathan

Recent Progress with Breast-Conserving Volume Replacement Using Latissimus Dorsi Miniflaps in UK Patients

Significant volume loss during breast conserving surgery (BCS) can be anticipated in patients with small breast: tumor ratios, limiting the use of BCS in women with smaller breasts or larger tumors. Early experience with autogenous immediate volume replacement (IVR) at the time of BCS led to refinements in the technique, extending its role in clinical practice. The evolution of the technique has been examined, with particular reference to tumor selection, technique and modifications, histopathological findings, and cosmetic, radiological and psychological sequelae.Between 1991-1997, 62 patients underwent BCS and IVR using a latissimus dorsi (LD) miniflap. Tumors (diameter 22 [5-40] mm) were located in the upper outer quadrant (29) center (15) upper inner quadrant (17) and lower outer quadrant (1) of the breast. Operations lasted 129 (80-245) min, resecting specimens of 144 (37-345) g. Margins were positive in 8/62 specimens (13%) and local recurrence was recorded in 5/62 (8%), 4 of whom had not received radiotherapy. One local recurrence was treated by mastectomy (1.8% of whole group) and 4 were treated by re-excision and delayed radiotherapy. The cosmetic, radiological and psychological outcomes of the procedure compared favorably with BCS alone.Breast-conserving volume replacement with LD miniflaps extends the role of BCS without compromising resection, cosmesis or surveillance, and provides a further option in the surgical management of breast carcinoma.

The impact of providing an oncoplastic service on the workload of a specialist breast unit.

Abstract:  Increasing breast specialization triggered a review of our surgical activity. All 10,000 elective inpatient and day case procedures between 1998 and 2008 were grouped into six categories: oncological, primary, secondary and revisional oncoplastic, and other breast and nonbreast procedures. Overall, surgical activity increased, with a rise in breast and a fall in nonbreast procedures, as a result of a changing caseload in each category (chi‐squared for linear trend = 55.24: p < 0.00001). These included increases in oncological procedures, secondary oncoplastic, and revisional oncoplastic procedures. Increased oncoplastic activity was associated with a reduction in other breast procedures (chi‐squared for linear trend = 04.94: p < 0.00001). The impact of breast specialization reported in the 1990′s has accelerated with the introduction of oncoplastic surgery. This has major short‐term and long‐term implications when planning a modern breast service.