Extreme oncoplasty for centrally located breast cancer in small non-ptotic breasts: extending the indications of chest wall perforator flaps with areolar reconstruction

Shashank Nigam; Andrew Eichholz; Madhu Bhattacharyya; Vaishali Parulekar; Pankaj Gupta Roy

doi:10.3332/ecancer.2021.1311

Extreme oncoplasty for centrally located breast cancer in small non-ptotic breasts: extending the indications of chest wall perforator flaps with areolar reconstruction

Ecancermedicalscience. 2021 Nov 1:15:1311. doi: 10.3332/ecancer.2021.1311. eCollection 2021.

Authors

Shashank Nigam^{1

2}, Andrew Eichholz³, Madhu Bhattacharyya⁴, Vaishali Parulekar⁴, Pankaj Gupta Roy¹

Affiliations

¹ Department of Breast Surgery, Oxford University Hospitals NHS Foundation Trust, Oxfordshire OX3 7LF, UK.
² Private Oncology Clinic, Lucknow, UP 226021, India.
³ Department of Oncology, Oxford University Hospitals NHS Foundation Trust, Oxfordshire OX3 7LF, UK.
⁴ Oxford Breast Imaging Centre, Oxford University Hospitals NHS Foundation Trust, Oxfordshire OX3 7LF, UK.

Abstract

Background: Breast cancers located centrally require excision of nipple-areola complex. A simple central wide excision is a safe option but results in suboptimal aesthetic outcome. An oncoplastic option involves therapeutic mammoplasty with or without areolar reconstruction, limited to moderate and large ptotic breasts. For small non-ptotic breasts, most surgeons would resort to mastectomy with/without reconstruction.

Methods: Lateral chest wall perforator flap (CWPF) is an option for partial breast reconstruction in small to moderate sized, non-ptotic breasts for laterally located tumours. We have extended the application of CWPF for central tumours to avoid mastectomy in selected patients.

Results: We here present a case series of four patients with small to medium-sized non-ptotic breasts, who had centrally located breast cancer or ductal carcinoma in-situ (DCIS). Three patients had single stage CWPF reconstruction, and one had central excision with immediate reconstruction following a failed attempt at therapeutic mammoplasty. All had the areola reconstructed using flap skin; one patient had simultaneous nipple reconstruction.

Conclusions: CWPF is an option for treatment of centrally located breast cancers/DCIS needing nipple-areola complex excision for patients wishing to avoid mastectomy. Patients with small to medium-sized non-ptotic breasts are suitable, and need to be carefully selected.

Keywords: central excision; centrally located breast cancer; chest wall perforator flap; extreme oncoplasty; partial breast reconstruction; volume replacement oncoplastic breast surgery.