TUMOUR-ADAPTED BREAST REDUCTION PLASTY

The removal of the tumour from a healthy breast and an aesthetically good long-term result are both key objectives of breast conservation. An understanding of the corresponding surgical options for aesthetic reconstruction after extensive tumour removal is therefore a vital pre-condition for good therapy and operation planning.
In comparison with standard procedures for tumour excision or quadrantectomy, good oncological as well as aesthetic results in breast conservation have been achieved with oncoplasty techniques, even for the removal of large tumours. Rotation flap plasty from the breast region itself or from the breast wall region has proved beneficial, in particular in covering defects in the nipple-areola complex and in the two lower quadrants.
In the case of more extensive defects in the two upper quadrants or the inclusion of two quadrants, tumour-adapted reduction mammoplasty is to be regarded as an accepted option today in the over all concept of breast conservation therapy. This method is particularly suitable for the pre-condition of macromasty, where, in addition to generous in sano resection, a significant reduction in the target volume for radiotherapy can be achieved. As the mammilla-areola complex can be pedicled in a cranial, caudal, lateral and medial direction for adequate blood circulation, this technique is suitable for almost any tumour localisation. All known classical reduction techniques, including the various scar-sparing procedures, can be individually adapted for this.
With the exception of an increased rate of necroses of fatty tissue after radiotherapy, the complications following tumour-adapted reduction mammoplasty are comparable with the complications following aesthetic medically indicated reduction plasty. In order to prevent an increased rate of fatty tissue necrosis, postoperative radiotherapy treatment should not be carried out postoperative until four weeks have passed and healing is complete. The question of whether contralateral reduction mammoplasty should be carried out simultaneously or only after definitive therapy of the diseased side – particularly after completed radiotherapy – must be discussed with the individual patient.