Reconstruction of large volume breast excision area with volume replacement after using V mammoplasty technique
Öz
The main goal in breast cancer surgery should be to perform safe surgery within the framework of oncological principles and to achieve the ideal cosmetic appearance that will not impair the person's quality of life. With this aspect, oncoplastic breast cancer surgery, which was developed for the solution of situations where classical breast-conserving surgery methods are insufficient, is being applied at increasing rates today. The cosmetic success of breast-conserving surgery can be understood after radiotherapy is given. The tissue gap formed in a lumpectomy is closed by the organization of the tissue fluid accumulated in the excision area over time. Fibrosis, which will develop during the natural wound-healing process, increases significantly after radiotherapy and may cause a change in appearance. In oncoplastic techniques, the defect is closed primarily by shifting the breast tissue, thus preserving the cosmetic.
As an example, our study aimed to present the V mammoplasty technique applied to a premenopausal patient in the fourth decade with atypical ductal hyperplasia covering the entire inner half of one breast, with moderate ptosis and macromastia.
Today, breast cancer is accepted as a chronic disease and multidisciplinary teamwork is required for effective treatment. General surgeons play an important role in this team in terms of the interventional treatment of the disease and the preservation of the patient's quality of life. For this purpose, it is necessary for them to know and be able to apply most of the low and high-difficulty levels of oncoplastic techniques.
Anahtar Kelimeler
Breast cancer oncoplastic surgery breast concerving therapy mammaplasty cosmesis
Kaynakça
- Strach MC, Prassanna T, Kirova YM, et al. Optimise not compromise: the importance of a multidisciplinary breast cancer patient pathway in the era of oncoplastic and reconstructive surgery. Crit Rev Oncol Hematol. 2019;134:10–21.
- Macmillan RD, McCulley SJ. Oncoplastic breast surgery: what, when and for whom? Curr Breast Cancer Rep. 2016; 8:112–7.
- Losken A, Dugal CS, Styblo TM, et al. A meta-analysis comparing breast conservation therapy alone to the oncoplastic technique. Ann Plast Surg. 2014;72(2):145–9.
- Kopkash K, Clark P. Basic oncoplastic surgery for breast conservation: tips and techniques. Ann Surg Oncol. 2018;25(10):2823–8.
- Rietjens M, Urban CA, Rey PC, et al. Long-term oncological results of breast conservative treatment with oncoplastic surgery. Breast. 2007;16(4):387–95.
- Clough KB, Lewis JS, Couturaud B, et al. Oncoplastic techniques allow extensive resections for breast-conserving therapy of breast carcinomas. Ann Surg. 2003;237(1):26–34.
- Carter SA, Lyons GA, Kuerer HM, et al. Operative and oncologic outcomes in 9861 patients with operable breast cancer: singleinstitution analysis of breast conservation with oncoplastic reconstruction. Ann Surg Oncol. 2016;23(10):3190–8.
- Losken A, Hart AM, Chatterjee A. Updated evidence on the oncoplastic approach to breast conservation therapy. Plast Reconstr Surg. 2017;140(5S Advances in Breast Reconstruction):14S–22S.
- Scomacao I, AlHilli Z, Schwarz G. The Role of Oncoplastic Surgery for Breast Cancer. Curr Treat Options Oncol. 2020;21(12):94.
- Patel K, Bloom J, Nardello S, et al. An oncoplastic surgery primer: common indications, techniques, and complications in level 1 and 2 volume displacement oncoplastic surgery. Ann Surg Oncol. 2019;26(10):3063–70.
- Chatterjee A, Gass J, Patel K, et al. A consensus definition and classification system of oncoplastic surgery developed by the American Society of Breast Surgeons. Ann Surg Oncol. 2019;26(11):3436–44.
- Clough KB, Gouveia PF, Benyahi D, et al. Positive margins after oncoplastic surgery for breast cancer. Ann Surg Oncol. 2015;22(13):4247–53.
- Blankensteijn LL, Crystal DT, Egeler SA, et al. The influence of surgical specialty on oncoplastic breast reconstruction. Plast Reconstr Surg Glob Open. 2019;7(5): e2248.
- Santos G, Urban C, Edelweiss MI, et al. Long-term comparison of aesthetical outcomes after oncoplastic surgery and lumpectomy in breast cancer patients. Ann Surg Oncol. 2015;22.2500–8.
- Kaufman CS. Increasing Role of Oncoplastic Surgery for Breast Cancer. Curr Oncol Rep. 2019;21(12):111.
Geniş hacimli meme eksizyon alanının V mamoplasti tekniği kullanımı sonrası volüm replasmanı ile rekonstruksiyonu
Öz
Meme kanseri cerrahisinde temel hedef, onkolojik prensipler çerçevesinde güvenli cerrahi girişim yapmak ve kişinin hayat kalitesini bozmayacak ideal kozmetik görünüme ulaşmak olmalıdır. Bu yönüyle klasik meme koruyucu cerrahi yöntemlerinin yetersiz kaldığı durumların çözümüne yönelik geliştirilmiş olan onkoplastik meme kanseri cerrahisi günümüzde artan oranlarda uygulanmaktadır. Çok sayıda çalışma ile başarılı sonuçları gösterilmektedir. Yeterli seviyede yapılabilmesi, ayrı bir eğitim gerektirmektedir. Meme koruyucu cerrahinin kozmetik başarısı, verilecek olan radyoterapiden sonra anlaşılabilmektedir. Lumpektomide oluşan doku boşluğu, eksizyon alanında biriken doku sıvısının zamanla organize olmasıyla kapanmaktadır. Doğal yara iyileşmesi sürecinde gelişecek olan fibrozis, radyoterapiden sonra belirgin olarak artmakta ve görünümün değişmesine sebebiyet verebilmektedir. Onkoplastik tekniklerde, defekt meme dokusunun kaydırılması ile primer kapatılmakta ve böylece kozmesiz korunmaktadır.
Buna örnek olması açısından çalışmamızda, dördüncü dekatta bulunan, tek memenin iç yarısının tamamını kaplayan atipik duktal hiperplazi alanına sahip, orta derecede pitozisi ve makromastisi bulunan premenapozal olguya yapılan V mamoplasti tekniğinin sunulması amaçlandı. Hastanın talebi üzerine simetrizasyon cerrahisi tedavinin sonuna bırakıldı ve ciddi komplikasyon yaşanmadan kabul edilebilir kozmetik başarı elde edilebildi.
Günümüzde meme kanseri kronik hastalık olarak kabul edilmekte ve tedavisinin etkin yapılabilmesi için multidisipliner takım çalışması gerekmektedir. Genel cerrahi uzmanları bu takımın içerisinde hastalığın girişimsel tedavisi ve hastanın hayat kalitesinin korunması bakımından önemli bir rol üstlenmektedir. Onkoplastik tekniklerin alt ve üst zorluk derecesinde olanlarının çoğunu bilmeleri ve uygulayabilmeleri bu amaç için gereklidir.
Anahtar Kelimeler
Meme kanseri Onkoplastik cerrahi Meme koruyucu cerrahi Mamoplasti Kozmezis
Kaynakça
- Strach MC, Prassanna T, Kirova YM, et al. Optimise not compromise: the importance of a multidisciplinary breast cancer patient pathway in the era of oncoplastic and reconstructive surgery. Crit Rev Oncol Hematol. 2019;134:10–21.
- Macmillan RD, McCulley SJ. Oncoplastic breast surgery: what, when and for whom? Curr Breast Cancer Rep. 2016; 8:112–7.
- Losken A, Dugal CS, Styblo TM, et al. A meta-analysis comparing breast conservation therapy alone to the oncoplastic technique. Ann Plast Surg. 2014;72(2):145–9.
- Kopkash K, Clark P. Basic oncoplastic surgery for breast conservation: tips and techniques. Ann Surg Oncol. 2018;25(10):2823–8.
- Rietjens M, Urban CA, Rey PC, et al. Long-term oncological results of breast conservative treatment with oncoplastic surgery. Breast. 2007;16(4):387–95.
- Clough KB, Lewis JS, Couturaud B, et al. Oncoplastic techniques allow extensive resections for breast-conserving therapy of breast carcinomas. Ann Surg. 2003;237(1):26–34.
- Carter SA, Lyons GA, Kuerer HM, et al. Operative and oncologic outcomes in 9861 patients with operable breast cancer: singleinstitution analysis of breast conservation with oncoplastic reconstruction. Ann Surg Oncol. 2016;23(10):3190–8.
- Losken A, Hart AM, Chatterjee A. Updated evidence on the oncoplastic approach to breast conservation therapy. Plast Reconstr Surg. 2017;140(5S Advances in Breast Reconstruction):14S–22S.
- Scomacao I, AlHilli Z, Schwarz G. The Role of Oncoplastic Surgery for Breast Cancer. Curr Treat Options Oncol. 2020;21(12):94.
- Patel K, Bloom J, Nardello S, et al. An oncoplastic surgery primer: common indications, techniques, and complications in level 1 and 2 volume displacement oncoplastic surgery. Ann Surg Oncol. 2019;26(10):3063–70.
- Chatterjee A, Gass J, Patel K, et al. A consensus definition and classification system of oncoplastic surgery developed by the American Society of Breast Surgeons. Ann Surg Oncol. 2019;26(11):3436–44.
- Clough KB, Gouveia PF, Benyahi D, et al. Positive margins after oncoplastic surgery for breast cancer. Ann Surg Oncol. 2015;22(13):4247–53.
- Blankensteijn LL, Crystal DT, Egeler SA, et al. The influence of surgical specialty on oncoplastic breast reconstruction. Plast Reconstr Surg Glob Open. 2019;7(5): e2248.
- Santos G, Urban C, Edelweiss MI, et al. Long-term comparison of aesthetical outcomes after oncoplastic surgery and lumpectomy in breast cancer patients. Ann Surg Oncol. 2015;22.2500–8.
- Kaufman CS. Increasing Role of Oncoplastic Surgery for Breast Cancer. Curr Oncol Rep. 2019;21(12):111.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Cerrahi |
| Bölüm | Olgu Sunumu/Olgu Serisi |
| Yazarlar | |
| Yayımlanma Tarihi | 21 Ağustos 2023 |
| Gönderilme Tarihi | 19 Aralık 2022 |
| Yayımlandığı Sayı | Yıl 2023 Cilt: 3 Sayı: 2 |
e-ISSN: 2791-9935