Histological Findings of a Local Adipofascial Flap That Was Implanted during Breast Conserving Surgery

Yuko Kijima, Heiji Yoshinaka, Munetsugu Hirata, Akihiro Nakajo, Hideo Arima, Sumiya Ishigami, Shinichi Ueno, Shoji Natsugoe

Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan.

DOI: 10.4236/mps.2013.31008                

Abstract

We report a patient with breast cancer whose breast was immediately reconstructed using a local adipofascial flap and was then subsequently resected 3 years after the original surgical procedure due to local recurrence. In order to achieve local control of the solitary recurrent lesion, we resected the remnant breast, which gave us a useful opportunity to examine the previously implanted flap histologically. A 33-year-old Japanese female was diagnosed with T2N0M0 breast cancer in the outer area of her left breast and underwent partial mastectomy with immediate reconstruction using a local adipofascial flap. The breast lesion was considered to be invasive ductal carcinoma, scirrhous carcinoma, lymphatic invasion+, venous invasion-, estrogen receptor+, progesterone receptor+, and HER2/neu-. Involvement was noted in three of the twenty-five resected axillary lymph nodes. She received adjuvant hormone therapy, but developed a solitary local recurrence of the skin forty-five months after the initial procedure, for which she received total mastectomy, systemic chemotherapy, and hormone therapy. During the histological examination of the local adipofascial flap that had been implanted into the partial breast defect, normal fatty tissue and the implanted fascia were seen at the implantation site. This is a rare report in which a local flap that was implanted during oncoplastic breast surgery was histologically examined.

Keywords

Breast Cancer; Oncoplastic Surgery; Local Adipofascial Flap; Cosmesis; Thoracodorsal Adipofascial Flap

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	J. Hoffmann and D. Wallwiener, “Classifying Breast Cancer Surgery: A Novel and Complexity-Based System for Oncological, Oncoplastic and Reconstructive Procedures, and Proof of Principle by Analysis of 1225 Operations in 1166 Patients,” BMC Cancer, Vol. 9, 2009, p. 108. doi:10.1186/1471-2407-9-108
[2]	L. H. Sobin and C. H. Wittwkind, “TNM Classification of Mlaignant Tumours,” 6th Edition, John Wiley & Sons, New York, 2002, pp. 31-41.
[3]	B. Fisher, J. Dignam, N. Wolmark, E. Manounas, J. Costantino and W. Poller, et al., “Lumpectomy and Radiation Therapy for the Treatment of Intraductal Breast Cancer: Findings from National Surgical Adjuvant Breast and Bowel Project B-17,” Journal of Clinical Oncology, Vol. 16, No. 2, 1998. pp. 441-452.
[4]	P. Berrino, E. Campora and P. Santi, “Postquadrantectomy Breast Deformities: Classification and Techniques of Surgical Correction,” Plastic Reconstructive Surgery, Vol. 79, No. 4, 1987, pp. 567-572. doi:10.1097/00006534-198704000-00010
[5]	C. Nos, A. Fitoussi, D. Bourgeois, A. Fourquet, R. J. Salmon and K. B. Clough, “Conservative Treatment Lower Pole Breast Cancers by Bilateral Mammoplasty and Radiotherapy,” European Journal of Surgical Oncology, Vol. 24, No. 6, 1998, pp. 508-514. doi:10.1016/S0748-7983(98)93356-X
[6]	Y. Kijima, H. Yoshinaka, T. Owaki, Y. Funasako and T. Aikou, “Immediate Reconstruction Using Inframammary Adipofascial Flap of the Anterior Rectus Sheath after Partial Mastectomy,” American Journal of Surgery, Vol. 193, No. 6, 2007, pp. 789-791.
[7]	Y. Kijima, H. Yoshinaka, Y. Funasako, K. Kaneko, M. Hirata and S. Ishigami, et al., “Immediate Reconstruction Using Thoracodorsal Adipofascial Flap after Partial Mastectomy,” Breast, Vol. 18, No. 2, 2009, pp. 126-129. doi:10.1016/j.breast.2009.02.006