Retrospective review of 108 breast reconstructions using the round block technique after breast-conserving surgery: Indications, complications, and outcomes

Background Several oncoplastic approaches have been implemented in recent years to enhance cosmetic results and to reduce complications. The round block technique is a volume displacement technique for breast reconstruction after breast-conserving surgery (BCS). However, its indications are currently limited according to tumor location, and its cosmetic results and complications have not been clearly established. We hypothesized that the round block technique could produce favorable cosmetic results without major complications regardless of tumor location or nipple-tumor distance, below a certain resected tumor volume and tumor-breast volume ratio.

Methods All breast reconstructions using the round block technique after BCS were included in this analysis. Patients’ data were reviewed retrospectively to investigate complications during follow-up, and clinical photos were used to evaluate cosmetic results. The relationships of tumor location, nipple-tumor distance, tumor volume, and the tumor-breast volume ratio with cosmetic results were investigated.

Results In total, 108 breasts were reconstructed. The mean resected tumor volume was 30.2±15.0 mL. The cosmetic score was 4.5±0.6 out of 5. Tumor location, nipple-tumor distance, tumor volume, tumor-breast volume ratio, radiotherapy, and chemotherapy had no significant effects on cosmetic results or complications. There were no major complications requiring reoperation.

Conclusions Breast reconstruction using the round block technique after BCS can lead to good cosmetic results without major complications regardless of the tumor location, nipple-tumor distance, radiotherapy, or chemotherapy. Below the maximum tumor volume (79.2 mL) and the maximum tumor-breast volume ratio (14%), favorable results were consistently obtained.

Keywords

Breast reconstruction - Breast-conserving surgery - Surgical flap

This study was supported by a grant from Kosin University College of Medicine (Kosin-19-06).

Publication History

Received: 12 March 2020

Accepted: 29 September 2020

Article published online:
25 March 2022

• REFERENCES

• 1 Fisher B, Anderson S, Bryant J. et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med 2002; 347: 1233-41
• 2 Song WJ, Kang SG, Kim EK. et al. Current status of and trends in post-mastectomy breast reconstruction in Korea. Arch Plast Surg 2020; 47: 118-25
• 3 Veronesi U, Cascinelli N, Mariani L. et al. Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med 2002; 347: 1227-32
• 4 Fisher B, Anderson S, Redmond CK. et al. Reanalysis and results after 12 years of follow-up in a randomized clinical trial comparing total mastectomy with lumpectomy with or without irradiation in the treatment of breast cancer. N Engl J Med 1995; 333: 1456-61
• 5 Litiere S, Werutsky G, Fentiman IS. et al. Breast conserving therapy versus mastectomy for stage I-II breast cancer: 20 year follow-up of the EORTC 10801 phase 3 randomised trial. Lancet Oncol 2012; 13: 412-9
• 6 Brar P, Jain S, Singh I. Complications of axillary lymph node dissection in treatment of early breast cancer: a comparison of MRM and BCS. Indian J Surg Oncol 2011; 2: 126-32
• 7 Hong KY, Son Y, Chang H. et al. Trends in breast reconstruction: implications for the National Health Insurance Service. Arch Plast Surg 2018; 45: 239-45
• 8 Kim MK, Kim J, Jung SP. et al. Round block technique without cerclage in breast-conserving surgery. Ann Surg Oncol 2013; 20: 3341-7
• 9 Yang JD, Lee JW, Kim WW. et al. Oncoplastic surgical techniques for personalized breast conserving surgery in breast cancer patient with small to moderate sized breast. J Breast Cancer 2011; 14: 253-61
• 10 Kim JB, Kim DK, Lee JW. et al. The usefulness of pedicled perforator flap in partial breast reconstruction after breast conserving surgery in Korean women. Arch Plast Surg 2018; 45: 29-36
• 11 Yi HS, In SK, Kim HS. et al. Factors affecting mastectomy specimen density in direct-to-implant breast reconstruction. Arch Aesthetic Plast Surg 2019; 25: 137-41
• 12 Kim S, Lee S, Lee H. et al. The safety and cosmetic effect of immediate latissimus dorsi flap reconstruction after breast conserving surgery. J Breast Cancer 2009; 12: 186-92
• 13 Honart JF, Reguesse AS, Struk S. et al. Indications and controversies in partial mastectomy defect reconstruction. Clin Plast Surg 2018; 45: 33-45
• 14 Lee WY, Kim MJ, Lew DH. et al. Three-dimensional surface imaging is an effective tool for measuring breast volume: a validation study. Arch Plast Surg 2016; 43: 430-7
• 15 Ogunleye AA, Deptula PL, Inchauste SM. et al. The utility of three-dimensional models in complex microsurgical reconstruction. Arch Plast Surg 2020; 47: 428-34
• 16 Yang JD, Lee JW, Cho YK. et al. Surgical techniques for personalized oncoplastic surgery in breast cancer patients with small- to moderate-sized breasts (part 2): volume replacement. J Breast Cancer 2012; 15: 7-14
• 17 Refaat M, Abouelnagah G, Awad AT. et al. Modified round block technique for peripherally located early cancer breast, a technique that fits for all quadrants. Breast J 2020; 26: 414-9
• 18 Haloua MH, Krekel NM, Winters HA. et al. A systematic review of oncoplastic breast-conserving surgery: current weaknesses and future prospects. Ann Surg 2013; 257: 609-20
• 19 Gainer SM, Lucci A. Oncoplastics: techniques for reconstruction of partial breast defects based on tumor location. J Surg Oncol 2011; 103: 341-7
• 20 Gdalevitch P, Ho A, Genoway K. et al. Direct-to-implant single-stage immediate breast reconstruction with acellular dermal matrix: predictors of failure. Plast Reconstr Surg 2014; 133: 738e-747e
• 21 Molto Garcia R, Gonzalez Alonso V, Villaverde Domenech ME. Fat grafting in immediate breast reconstruction: avoiding breast sequelae. Breast Cancer 2016; 23: 134-40
• 22 Salgarello M, Visconti G, Rusciani A. Breast fat grafting with platelet-rich plasma: a comparative clinical study and current state of the art. Plast Reconstr Surg 2011; 127: 2176-85
• 23 Salzberg CA, Ashikari AY, Koch RM. et al. An 8-year experience of direct-to-implant immediate breast reconstruction using human acellular dermal matrix (AlloDerm). Plast Reconstr Surg 2011; 127: 514-24
• 24 Colwell AS, Damjanovic B, Zahedi B. et al. Retrospective review of 331 consecutive immediate single-stage implant reconstructions with acellular dermal matrix: indications, complications, trends, and costs. Plast Reconstr Surg 2011; 128: 1170-8