Assessment of immediate conservative breast surgery reconstruction: a classification system of defects revisited and an algorithm for selecting the appropriate technique.
BACKGROUND
Although various techniques have been used for breast conservation surgery reconstruction, there are few studies describing a logical approach to reconstruction of these defects. The objectives of this study were to establish a classification system for partial breast defects and to develop a reconstructive algorithm.


METHODS
The authors reviewed a 7-year experience with 209 immediate breast conservation surgery reconstructions. Mean follow-up was 31 months. Type I defects include tissue resection in smaller breasts (bra size A/B), including type IA, which involves minimal defects that do not cause distortion; type IB, which involves moderate defects that cause moderate distortion; and type IC, which involves large defects that cause significant deformities. Type II includes tissue resection in medium-sized breasts with or without ptosis (bra size C), and type III includes tissue resection in large breasts with ptosis (bra size D).


RESULTS
Eighteen percent of patients presented type I, where a lateral thoracodorsal flap and a latissimus dorsi flap were performed in 68 percent. Forty-five percent presented type II defects, where bilateral mastopexy was performed in 52 percent. Thirty-seven percent of patients presented type III distortion, where bilateral reduction mammaplasty was performed in 67 percent. Thirty-five percent of patients presented complications, and most were minor.


CONCLUSIONS
An algorithm based on breast size in relation to tumor location and extension of resection can be followed to determine the best approach to reconstruction. The authors' results have demonstrated that the complications were similar to those in other clinical series. Success depends on patient selection, coordinated planning with the oncologic surgeon, and careful intraoperative management.
Munhoz
Alexandre Mendonça
AM
São Paulo, Brazil From the Division of Plastic Surgery, University of São Paulo School of Medicine, and Hospital Sírio-Libanês.
Montag
Eduardo
E
Arruda
Eduardo
E
Pellarin
Leandro
L
Filassi
José Roberto
JR
Piato
José Roberto
JR
de Barros
Alfredo Carlos
AC
Prado
Luis Carlos
LC
Fonseca
Alexandre
A
Baracat
Edmund
E
Ferreira
Marcus Castro
MC
D000328:Adult; D000465:Algorithms; D001943:Breast Neoplasms / Q000601:surgery*; D018270:Carcinoma, Ductal, Breast / Q000601:surgery*; D005260:Female; D006801:Humans; D016462:Mammaplasty; D015412:Mastectomy, Segmental / Q000009:adverse effects*; D008875:Middle Aged; D013524:Surgical Flaps; D014947:Wounds and Injuries / Q000145:classification* / Q000209:etiology