EXTENDING THE ROLE OF BREAST-CONSERVING SURGERY BY IMMEDIATE VOLUME REPLACEMENT

Background Cosmetic failure following breast-conserving surgery is com monly caused by volume loss, and the effect of immediate volume replac ement on cosmetic outcome using a latissimus dorsi miniflap (LDMF) has been investigated. The technique avoids a frontal scar and allows a w ide retromammary excision via a lateral approach. Methods Twenty patie nts who had LDMF reconstruction were compared with 38 who had wide loc al excision (WLE) without reconstruction between 1991 and 1994. Cosmet ic outcome was judged using (1) breast retraction assessment and (2) p anel assessment, recording the frequency of cosmetic failure. Results Patients who had LDMF reconstruction were younger (mean 45.1 versus 58 .6 years; P < 0.0001) with larger tumours (mean 2.5 versus 1.3 cm; P < 0.0001) and underwent wider specimen excision (57 versus 13 per cent more than 150 g; P = 0.004) with reduced margin involvement (10 versus 37 per cent positive margins; P = 0.03) compared with those who had W LE. Cosmetic failure was uncommon after immediate volume replacement ( LDMF 10 per cent versus WLE 34 per cent; P = 0.045). Conclusion LDMF r econstruction extends the role of breast-conserving surgery without co smetic penalties, and may reduce the need for mastectomy.