LOCAL ROTATIONAL FLAPS FOR BREAST-CONSERVATION THERAPY AS AN ALTERNATIVE TO MASTECTOMY

Background: An anticipated poor cosmetic result has traditionally been deemed a relative contraindication for breast conservation therapy (B CT). We sought to determine whether a local rotational flap could achi eve satisfactory cosmesis in patients who were anticipated to have a p oor cosmetic result following standard segmental mastectomy but who ne vertheless desired BCT. Methods: Within the past 3 years, nine patient s were treated with BCT using local rotational flap techniques. Their records were reviewed for patient characteristics, pre-and postoperati ve treatment, disease-free status, and patient satisfaction with cosme sis. Results: The cosmetic outcome following a segmental mastectomy wa s anticipated to be unacceptable due to the following features: a larg e previous biopsy cavity with unknown or positive margins (three patie nts); initial large primary tumors with unknown extent of residual dis ease following induction chemotherapy (five patients); and pre-existin g poor cosmesis (one patient). One patient had refused modified radica l mastectomy and had satellitosis from inadequately treated primary tu mor (excisional biopsy with positive margins and no further therapy). The median initial tumor size was 2.7 cm (range, 1.5 cm to 5.0 cm). Fi nal resection margins were negative in all patients. Postoperative rad iotherapy was given in seven patients; one patient did not receive rad iotherapy because of a pre-lupus condition and one did not require rad iotherapy because her pathologic diagnosis was Paget's disease without an invasive component. Cosmesis was judged to be good to excellent by eight of nine patients. The patient who refused mastectomy was dissat isfied with cosmesis because of mild asymmetry. With a median follow-u p of 24 months, only one patient has developed a local recurrence. Con clusion: Local rotational flaps composed of adjacent breast tissue are an acceptable method of achieving satisfactory cosmesis in selected p atients who desire BCT.