REDUCTION MAMMAPLASTY - ITS ROLE IN BREAST-CONSERVATION SURGERY FOR EARLY-STAGE BREAST-CANCER

Segmental resection and radiotherapy is an accepted alternative over m astectomy for small, staged breast malignancies. However, women with l arge, pendulous breasts have been documented to have poorer cosmetic o utcomes when undergoing irradiation after breast conservative surgery compared with women with small- or medium-size breasts, thought to be caused by dose inhomogeneity. The purpose of this study was to evaluat e the efficacy of combining reduction mammaplasty with breast conserva tive surgery to facilitate postoperative irradiation. Between 1988 and 1996, 10 women have undergone bilateral reduction mammaplasty for bre ast malignancy followed by radiation therapy at our center. All women wished to avoid mastectomy (average age, 59 years). All lesions were d etected preoperatively on mammography. The average amount of tissue re moved was 945 g per breast. A variety of reduction techniques were emp loyed to include the malignant lesions. All patients received 50 Gy of radiation therapy delivered in 25 fractions following reduction mamma plasty during a fi-week period. Radiation therapy was usually initiate d within 4 weeks following surgery. Follow-up is currently 37 months, with all patients being followed for at least 8 months. No patients ha ve had complications from the surgery or radiation therapy. No local r ecurrent malignancies have been detected. Cosmesis has been good to ex cellent in all patients. Despite equivalent survival outcomes for mast ectomy for early-stage breast cancer, certain women are not good candi dates for breast conservation and radiation therapy. An alternative fo r women with large, pendulous breasts that combines breast conservatio n therapy and concurrent bilateral reduction mammaplasty should be con sidered. This combination, in selected women, provides good functional and cosmetic results, and at the same time minimizes the potential di fficulties of radiation therapy.