A management algorithm and practical oncoplastic surgical techniques for repairing partial mastectomy defects

BACKGROUND: In patients undergoing a partial mastectomy, choosing the best method with which to repair the defect is essential to optimizing outcomes and minimizing the potential for postoperative complications. METHODS: The authors present a management algorithm for repairing partial mastectomy defects based on clinically relevant parameters to allow clinicians to better select the most appropriate indications for the various reparative oncoplastic procedures. The clinicopathologic factors considered in surgical decision-making for reconstruction after partial mastectomy include timing of reconstruction in relation to radiation therapy, status of the tumor margin, extent of breast skin resection, breast size, and whether the cosmetic outcome would be better after a total mastectomy with immediate breast reconstruction, thereby avoiding the need for radiation therapy. RESULTS: Most patients with medium or large breasts will likely benefit from immediate repair, whereas some with small breasts may not. Immediate repair of partial mastectomy defects is preferred with the use of local breast tissue (local tissue rearrangement or breast reduction techniques) because of the simplicity of these approaches and because techniques using local tissue maintain the color and texture of the breast. Waiting to repair a large deformity until after whole-breast radiation therapy usually necessitates a complex transfer of a large volume of autologous tissue, which many patients who undergo breast conservation therapy are not willing to pursue. Use of lower abdominal flaps to repair partial breast defects is generally discouraged. CONCLUSION: Although the authors' management algorithm and practical oncoplastic techniques should prove useful, it is up to the multidisciplinary breast team and the patient to determine the best approach.