Deformities of contour after breast conserving therapy and the possibilities of correction

Background: Breast conserving treatment is increasing for primary treatment of breast carcinoma because of the importance of the cosmetic outcome. Patients and Method: We examined 195 patients after breast conserving thera py which was performed between 1983 and 1992. For evaluation of the cosmeti c result symmetry, contour of the breast and location of the areola were ex amined. Radiation effect on breast tissue was evaluated by the Lent score. 72% of the patients had been treated with quadrantectomy and 28% with lumpe ctomy. Results: Deformities of the contour were visible in 59% of the patients dep ending on the primary location of the tumor. Lumpectomy from medial quadran ts caused poor results. Dislocation of the areola of more than 2 cm was det ected in 32% of the patients. The dislocation depended on the primary kind of incision and resulted in 89% of the patients after a radial incision and only in 11% after curvilinear incisions. Telangiectasies were absent in 84 % of the patients, the others showed telangiectasies Grade 1 to 3. In 48% o f the patients no signs of fibrosis could be detected, in 49% fibrosis Grad e 1 to 2 was found. 68% of the patients estimated the cosmetic result as ve ry good or good. Only 10% of the patients estimated the result as fair or b ad. The examiner estimated the results as good or very good in 28%. Example s of operative procedures for primary and secondary correction are demonstr ated. Conclusions: Our results showed an adverse effect of long radial incisions. For lumpectomy and axillary node dissection separate incisions should be u sed. Correction of contour deformities should be done primarily in breast c onserving procedures. This is possible by using modified reduction mammapla sties, local flaps of the breast tissue or switching a latissimus dorsi mus cle flap. For secondary correction of defects after breast conserving treat ment a latissimus dorsi muscle can be used as well as z-plasty for scar con tracture.