Application of three-pedicle reduction mammaplasty in breast cancer patients with moderate or greater breast hypertrophy and/or moderate-to-severe breast ptosis_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

FENG Yu ¹ , LI Juan ² ^△ , ZHANG Donglin ³ , ZHOU Jiao ¹ , QIN Xiangquan ¹ , LIU Xiran ¹ , QIU Mengxue ¹ , YANG Huanzuo ¹ ,  DU Zhenggui ^1,4

1. Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China;
2. Department of Breast Surgery, Sichuan Academy of Medical Sciences·Sichuan Province People’s Hospital, Chengdu Sichuan, 610072, P.R.China;
3. Department of General Surgery, the Fourth People’s Hospital of Sichuan Province, Chengdu Sichuan, 610016, P.R.China;
4. Breast Disease Research Center, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China;

Corresponding author：

DU Zhenggui, Email: docduzg@163.com

Keywords：

Breast cancer; breast hypertrophy; breast ptosis; three-pedicle technique; reduction mammoplasty

DOI：

10.7507/1002-1892.202107068

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Objective To explore the application and effectiveness of three-pedicle reduction mammoplasty in breast cancer patients with moderate or greater breast hypertrophy and/or moderate-to-severe breast ptosis. Methods The clinical data of 15 breast cancer female patients with hypertrophy and/or moderate-to-severe breast ptosis treated by three-pedicle reduction mammaplasty with inverted T incision between January 2019 and March 2021 were retrospectively analysed. The patients were aged 31-58 years, with a median age of 39 years. The disease duration ranged from 10 days to 9 months (median, 3.4 months). All patients had unifocal tumor, with a maximum diameter of primary tumor of 0.5-3.9 cm (mean, 2.0 cm), of which 12 were diagnosed with invasive carcinoma and 3 carcinoma in situ. Tumor stage: T_isN₀M₀ in 3 cases, T₁N₀M₀ in 4 cases, T₁N₂M₀ in 2 cases, T₂N₀M₀ in 4 cases, and T₂N₁M₀ in 2 cases. The preoperative cup sizes of patients were D cup in 3 cases, DD cup in 1 case, E cup in 2 cases, EE cup in 2 cases, F cup in 2 cases, FF cup in 1 case, and ≥G cup in 4 cases. The distance from nipple to inframammary fold was 8-18 cm (mean, 12.2 cm) before operation. The patients were followed up regularly after operation to evaluate the breast reduction effect and complications; Breast cancer reporting outcome scale (BREAST-Q) was used to assess patients’ satisfaction and quality of life; and ultrasound, chest and abdominal CT, whole-body bone scan were performed to assess local tumor recurrence or distant metastasis. Results The postoperative nipple position was slightly higher than inframammary fold in all patients. Postoperative cup sizes were A cup in 3 cases, B cup in 6, C cup in 4, D cup in 1, and DD cup in 1, which showing significant difference when compared with preoperative cup sizes (Z=3.420, P=0.001). The median follow-up time was 9 months (range, 6-33 months). Postoperatively, 2 cases (13.3%) had wound-site cellulitis, 1 (6.7%) had mild fat liquefaction, 2 (13.3%) had nipple and areola hypoesthesia but recovered after 3 months. No complication such as fat necrosis, papillary areola complex, or flap necrosis occurred. All patients had undergone adjuvant radiotherapy, of which 1 (6.7%) showed mild skin color change after radiotherapy, but no radiotherapy-related complication occurred in all patients. No patient was readmitted, received reoperation, or delayed to adjuvant therapy due to complications. In the BREAST-Q score, breast satisfaction and quality of life scores at 3 and 6 months after operation were significantly better than those before operation and at 1 month after operation (P<0.05); no significant difference was found between at 1 month after operation and before operation (P>0.05). Nipple satisfaction scores at 1, 3, and 6 months after operation were 15.6±2.2, 18.5±1.4, 19.3±0.7, respectively. At discharge after operation, the patient’s satisfaction with the outcome of the operation was scored 84.7±11.4. The score of adverse events of radiotherapy at 6 months after operation was 6.5±0.8. During the follow-up, patient had no local recurrence, distant metastasis, or breast cancer related death. Conclusion For breast cancer patients with moderate or greater breast hypertrophy and/or moderate-to-severe breast ptosis, three-pedicle reduction mammoplasty can not only remove the lesions, but also reduce hypertrophic breasts, accomplish the mammoplasty, reduce the radiotherapy complications, and improve the satisfaction and quality of life of patients.

Citation： FENG Yu, LI Juan, ZHANG Donglin, ZHOU Jiao, QIN Xiangquan, LIU Xiran, QIU Mengxue, YANG Huanzuo, DU Zhenggui. Application of three-pedicle reduction mammaplasty in breast cancer patients with moderate or greater breast hypertrophy and/or moderate-to-severe breast ptosis. Chinese Journal of Reparative and Reconstructive Surgery, 2021, 35(12): 1595-1602. doi: 10.7507/1002-1892.202107068 Copy

1.	金立亭, 冯尧军. 治疗性缩乳成形术在乳房肥大患者乳腺癌保留乳房手术中的应用. 中华乳腺病杂志 (电子版), 2020, 14(1): 58-61.
2.	王凯. 内侧蒂直线短瘢痕法治疗乳房肥大症的临床研究. 开封: 河南大学, 2020.
3.	Turner AJ, Dujon DG. Predicting cup size after reduction mammaplasty. Br J Plast Surg, 2005, 58(3): 290-298.
4.	Regnault P. Breast ptosis. Definition and treatment. Clin Plast Surg, 1976, 3(2): 193-203.
5.	刘敬春. “双环法”乳房整形治疗乳房肥大及乳房下垂患者的疗效研究. 基层医学论坛, 2019, 23(16): 2341, 2344.
6.	曹京, 刘晓颖, 韩思源, 等. 乳腺癌保乳术联合巨乳缩小整形技术的临床应用. 中国美容整形外科杂志, 2019, 30(3): 135-137.
7.	Hernanz F, Regaño S, Vega A, et al. Reduction mammaplasty: an advantageous option for breast conserving surgery in large-breasted patients. Surg Oncol, 2010, 19(4): e95-e102.
8.	冷永成, 俞梅瑾, 张志升. 横形双蒂法乳房缩小成形术的初步经验——兼论国人女性乳头位置的确定. 南京铁道医学院学报, 1986, 5(1): 11-13.
9.	张涤生. 实用美容外科学. 上海: 上海科学技术出版社, 1990: 160-165.
10.	韩晶, 全红, 刘君君, 等. 倒T形切口缩乳术在乳房肥大或合并乳腺癌患者中的应用. 中华乳腺病杂志 (电子版), 2019, 13(2): 75-80.
11.	Emiroglu M, Salimoglu S, Karaali C, et al. Oncoplastic reduction mammoplasty for breast cancer in women with macromastia: Oncological long-term outcomes. Asian J Surg, 2017, 40(1): 41-47.
12.	Gradishar WJ, Anderson BO, Abraham J, et al. Breast cancer, version 3. 2020, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw, 2020, 18(4): 452-478.
13.	Moody AM, Mayles WP, Bliss JM, et al. The influence of breast size on late radiation effects and association with radiotherapy dose inhomogeneity. Radiother Oncol, 1994, 33(2): 106-112.
14.	Taylor ME, Perez CA, Halverson KJ, et al. Factors influencing cosmetic results after conservation therapy for breast cancer. Int J Radiat Oncol Biol Phys, 1995, 31(4): 753-764.
15.	Back M, Guerrieri M, Wratten C, et al. Impact of radiation therapy on acute toxicity in breast conservation therapy for early breast cancer. Clin Oncol (R Coll Radiol), 2004, 16(1): 12-16.
16.	Porock D, Kristjanson L, Nikoletti S, et al. Predicting the severity of radiation skin reactions in women with breast cancer. Oncol Nurs Forum, 1998, 25(6): 1019-1029.
17.	Ikushima H, Takegawa Y, Yasuda H, et al. Radiation complications following breast conserving therapy. Breast Cancer, 1998, 5(4): 395-400.
18.	Kronowitz SJ, Feledy JA, Hunt KK, et al. Determining the optimal approach to breast reconstruction after partial mastectomy. Plast Reconstr Surg, 2006, 117(1): 1-11.
19.	Chang E, Johnson N, Webber B, et al. Bilateral reduction mammoplasty in combination with lumpectomy for treatment of breast cancer in patients with macromastia. Am J Surg, 2004, 187(5): 647-650.
20.	De La Cruz L, Blankenship SA, Chatterjee A, et al. Outcomes after oncoplastic breast-conserving surgery in breast cancer patients: A systematic literature review. Ann Surg Oncol, 2016, 23(10): 3247-3258.
21.	Brown RH, Siy R, Khan K, et al. The superomedial pedicle wise-pattern breast reduction: Reproducible, reliable, and resilient. Semin Plast Surg, 2015, 29(2): 94-101.
22.	Zhou Y, Liu Y, Wang Y, et al. Comparison of oncoplastic breast-conserving therapy and standard breast-conserving therapy in early-stage breast cancer patients. Med Sci Monit, 2021, 27: e927015.
23.	孙家明, 乔群, 赵茹, 等. 乳房神经血管解剖学研究及在乳房缩小成形术中的意义. 中华整形外科杂志, 2004, 20(4): 277-279.
24.	Lyngholm CD, Christiansen PM, Damsgaard TE, et al. Long-term follow-up of late morbidity, cosmetic outcome and body image after breast conserving therapy. A study from the Danish Breast Cancer Cooperative Group (DBCG). Acta Oncol, 2013, 52(2): 259-269.
25.	Deigni OA, Baumann DP, Adamson KA, et al. Immediate contralateral mastopexy/breast reduction for symmetry can be performed safely in oncoplastic breast-conserving surgery. Plast Reconstr Surg, 2020, 145(5): 1134-1142.
26.	Grubnik A, Benn C, Edwards G. Therapeutic mammaplasty for breast cancer: oncological and aesthetic outcomes. World J Surg, 2013, 37(1): 72-83.
27.	Goffman TE, Schneider H, Hay K, et al. Cosmesis with bilateral mammoreduction for conservative breast cancer treatment. Breast J, 2005, 11(3): 195-198.
28.	Shestak KC, Johnson RR, Greco RJ, et al. Partial mastectomy and breast reduction as a valuable treatment option for patients with macromastia and carcinoma of the breast. Surg Gynecol Obstet, 1993, 177(1): 54-56.
29.	刘安阳, 王会元, 王晓辉, 等. 乳腺癌保留乳房肿瘤整形术合并同期健侧乳房对称性整形手术10例分析. 中华乳腺病杂志 (电子版), 2015, 9(2): 127-133.
30.	Blomqvist L, Eriksson A, Brandberg Y. Reduction mammaplasty provides long-term improvement in health status and quality of life. Plast Reconstr Surg, 2000, 106(5): 991-997.
31.	Losken A, Hart AM, Broecker JS, et al. Oncoplastic breast reduction technique and outcomes: An evolution over 20 years. Plast Reconstr Surg, 2017, 139(4): 824e-833e.
32.	Rehnke RD, Groening RM, Van Buskirk ER, et al. Anatomy of the superficial fascia system of the breast: A comprehensive theory of breast fascial anatomy. Plast Reconstr Surg, 2018, 142(5): 1135-1144.
33.	Greco R, Noone B. Evidence-based medicine: Reduction mammaplasty. Plast Reconstr Surg, 2017, 139(1): 230e-239e.
34.	Silhol T, Chaouat M, Harizi R, et al. A prospective comparison of breast sensibility after reduction mammoplasty: Superior versus superomedial pedicle. J Plast Reconstr Aesthet Surg, 2019, 72(12): 1996-2001.

1. 金立亭, 冯尧军. 治疗性缩乳成形术在乳房肥大患者乳腺癌保留乳房手术中的应用. 中华乳腺病杂志 (电子版), 2020, 14(1): 58-61.
2. 王凯. 内侧蒂直线短瘢痕法治疗乳房肥大症的临床研究. 开封: 河南大学, 2020.
3. Turner AJ, Dujon DG. Predicting cup size after reduction mammaplasty. Br J Plast Surg, 2005, 58(3): 290-298.
4. Regnault P. Breast ptosis. Definition and treatment. Clin Plast Surg, 1976, 3(2): 193-203.
5. 刘敬春. “双环法”乳房整形治疗乳房肥大及乳房下垂患者的疗效研究. 基层医学论坛, 2019, 23(16): 2341, 2344.
6. 曹京, 刘晓颖, 韩思源, 等. 乳腺癌保乳术联合巨乳缩小整形技术的临床应用. 中国美容整形外科杂志, 2019, 30(3): 135-137.
7. Hernanz F, Regaño S, Vega A, et al. Reduction mammaplasty: an advantageous option for breast conserving surgery in large-breasted patients. Surg Oncol, 2010, 19(4): e95-e102.
8. 冷永成, 俞梅瑾, 张志升. 横形双蒂法乳房缩小成形术的初步经验——兼论国人女性乳头位置的确定. 南京铁道医学院学报, 1986, 5(1): 11-13.
9. 张涤生. 实用美容外科学. 上海: 上海科学技术出版社, 1990: 160-165.
10. 韩晶, 全红, 刘君君, 等. 倒T形切口缩乳术在乳房肥大或合并乳腺癌患者中的应用. 中华乳腺病杂志 (电子版), 2019, 13(2): 75-80.
11. Emiroglu M, Salimoglu S, Karaali C, et al. Oncoplastic reduction mammoplasty for breast cancer in women with macromastia: Oncological long-term outcomes. Asian J Surg, 2017, 40(1): 41-47.
12. Gradishar WJ, Anderson BO, Abraham J, et al. Breast cancer, version 3. 2020, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw, 2020, 18(4): 452-478.
13. Moody AM, Mayles WP, Bliss JM, et al. The influence of breast size on late radiation effects and association with radiotherapy dose inhomogeneity. Radiother Oncol, 1994, 33(2): 106-112.
14. Taylor ME, Perez CA, Halverson KJ, et al. Factors influencing cosmetic results after conservation therapy for breast cancer. Int J Radiat Oncol Biol Phys, 1995, 31(4): 753-764.
15. Back M, Guerrieri M, Wratten C, et al. Impact of radiation therapy on acute toxicity in breast conservation therapy for early breast cancer. Clin Oncol (R Coll Radiol), 2004, 16(1): 12-16.
16. Porock D, Kristjanson L, Nikoletti S, et al. Predicting the severity of radiation skin reactions in women with breast cancer. Oncol Nurs Forum, 1998, 25(6): 1019-1029.
17. Ikushima H, Takegawa Y, Yasuda H, et al. Radiation complications following breast conserving therapy. Breast Cancer, 1998, 5(4): 395-400.
18. Kronowitz SJ, Feledy JA, Hunt KK, et al. Determining the optimal approach to breast reconstruction after partial mastectomy. Plast Reconstr Surg, 2006, 117(1): 1-11.
19. Chang E, Johnson N, Webber B, et al. Bilateral reduction mammoplasty in combination with lumpectomy for treatment of breast cancer in patients with macromastia. Am J Surg, 2004, 187(5): 647-650.
20. De La Cruz L, Blankenship SA, Chatterjee A, et al. Outcomes after oncoplastic breast-conserving surgery in breast cancer patients: A systematic literature review. Ann Surg Oncol, 2016, 23(10): 3247-3258.
21. Brown RH, Siy R, Khan K, et al. The superomedial pedicle wise-pattern breast reduction: Reproducible, reliable, and resilient. Semin Plast Surg, 2015, 29(2): 94-101.
22. Zhou Y, Liu Y, Wang Y, et al. Comparison of oncoplastic breast-conserving therapy and standard breast-conserving therapy in early-stage breast cancer patients. Med Sci Monit, 2021, 27: e927015.
23. 孙家明, 乔群, 赵茹, 等. 乳房神经血管解剖学研究及在乳房缩小成形术中的意义. 中华整形外科杂志, 2004, 20(4): 277-279.
24. Lyngholm CD, Christiansen PM, Damsgaard TE, et al. Long-term follow-up of late morbidity, cosmetic outcome and body image after breast conserving therapy. A study from the Danish Breast Cancer Cooperative Group (DBCG). Acta Oncol, 2013, 52(2): 259-269.
25. Deigni OA, Baumann DP, Adamson KA, et al. Immediate contralateral mastopexy/breast reduction for symmetry can be performed safely in oncoplastic breast-conserving surgery. Plast Reconstr Surg, 2020, 145(5): 1134-1142.
26. Grubnik A, Benn C, Edwards G. Therapeutic mammaplasty for breast cancer: oncological and aesthetic outcomes. World J Surg, 2013, 37(1): 72-83.
27. Goffman TE, Schneider H, Hay K, et al. Cosmesis with bilateral mammoreduction for conservative breast cancer treatment. Breast J, 2005, 11(3): 195-198.
28. Shestak KC, Johnson RR, Greco RJ, et al. Partial mastectomy and breast reduction as a valuable treatment option for patients with macromastia and carcinoma of the breast. Surg Gynecol Obstet, 1993, 177(1): 54-56.
29. 刘安阳, 王会元, 王晓辉, 等. 乳腺癌保留乳房肿瘤整形术合并同期健侧乳房对称性整形手术10例分析. 中华乳腺病杂志 (电子版), 2015, 9(2): 127-133.
30. Blomqvist L, Eriksson A, Brandberg Y. Reduction mammaplasty provides long-term improvement in health status and quality of life. Plast Reconstr Surg, 2000, 106(5): 991-997.
31. Losken A, Hart AM, Broecker JS, et al. Oncoplastic breast reduction technique and outcomes: An evolution over 20 years. Plast Reconstr Surg, 2017, 139(4): 824e-833e.
32. Rehnke RD, Groening RM, Van Buskirk ER, et al. Anatomy of the superficial fascia system of the breast: A comprehensive theory of breast fascial anatomy. Plast Reconstr Surg, 2018, 142(5): 1135-1144.
33. Greco R, Noone B. Evidence-based medicine: Reduction mammaplasty. Plast Reconstr Surg, 2017, 139(1): 230e-239e.
34. Silhol T, Chaouat M, Harizi R, et al. A prospective comparison of breast sensibility after reduction mammoplasty: Superior versus superomedial pedicle. J Plast Reconstr Aesthet Surg, 2019, 72(12): 1996-2001.

Chinese Journal of Reparative and Reconstructive Surgery

Application of three-pedicle reduction mammaplasty in breast cancer patients with moderate or greater breast hypertrophy and/or moderate-to-severe breast ptosis

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