[Contour defects after breast preserving therapy of breast carcinoma. Primary and secondary possibilities of correction].
BACKGROUND
Breast conserving treatment is increasing for primary treatment of breast carcinoma because of the importance of the cosmetic outcome.


METHODS
We examined 195 patients after breast conserving therapy which was performed between 1983 and 1992. For evaluation of the cosmetic result symmetry, contour of the breast and location of the areola were examined. Radiation effect on breast tissue was evaluated by the Lent score. 72% of the patients had been treated with quadrantectomy and 28% with lumpectomy.


RESULTS
Deformities of the contour were visible in 59% of the patients depending on the primary location of the tumor. Lumpectomy from medial quadrants caused poor results. Dislocation of the areola of more than 2 cm was detected in 32% of the patients. The dislocation depended on the primary kind of incision and resulted in 89% of the patients after a radial incision and only in 11% after curvilinear incisions. Telangiectasias were absent in 84% of the patients, the others showed telangiectasias Grade 1 to 3. In 48% of the patients no signs of fibrosis could be detected, in 49% fibrosis Grade 1 to 2 was found. 68% of the patients estimated the cosmetic result as very good or good. Only 10% of the patients estimated the result as fair or bad. The examiner estimated the results as good or very good in 28%. Examples of operative procedures for primary and secondary correction are demonstrated.


CONCLUSIONS
Our results showed an adverse effect of long radial incisions. For lumpectomy and axillary node dissection separate incisions should be used. Correction of contour deformities should be done primarily in breast conserving procedures. This is possible by using modified reduction mammaplasties, local flaps of the breast tissue or switching a latissimus dorsi muscle flap. For secondary correction of defects after breast conserving treatment a latissimus dorsi muscle can be used as well as z-plasty for scar contracture.
Deutinger
M
M
Klinische Abteilung für Plastische und Wiederherstellende Chirurgie, Universitätsklinik für Chirurgie Wien. maria.deutinger@univie.ac.at
Tairych
G
G
Resch
A
A
Biber
E
E
D001918:Brachytherapy; D001940:Breast / Q000528:radiation effects; D001943:Breast Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D003037:Cobalt Radioisotopes / Q000627:therapeutic use; D004954:Esthetics; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016462:Mammaplasty; D015412:Mastectomy, Segmental; D009558:Nipples; D017785:Photons / Q000627:therapeutic use; D011878:Radiotherapy / Q000009:adverse effects; D011879:Radiotherapy Dosage; D013524:Surgical Flaps; D013997:Time Factors
D003037:Cobalt Radioisotopes
Konturdefekte bei brusterhaltender Therapie des Mammakarzinoms. Primäre und sekundäre Möglichkeiten der Korrektur.