Breast Conservation Surgery Following Cosmetic Reduction Mammoplasty

Fig. 64.1

(a, b) Preoperative view. The breast was of medium size and has moderate ptosis. The scars after reduction mammoplasty had healed completely. The localization and size of the tumor prior to neoadjuvant chemotherapy in the upper outer quadrant of the left breast are outlined on the breast

64.2 Surgery

The incisions of the previous reduction mammoplasty were completely reopened, and mobilization was carried out subcutaneously in direction of the upper outer and upper inner quadrant. Quadrantectomy comprised the extension of the tumor after neoadjuvant chemotherapy which was marked preoperatively with a guiding wire. Sentinel lymph node biopsy revealed a macrometastatic sentinel node and an axillary dissection was done. The quadrantectomy defect in the upper outer quadrant was closed with the lateral pillar of the inferior pedicle, which was mobilized from the fascia and rotated into the defect.

64.3 Clinical and Cosmetic Outcome

The postoperative course was uneventful. Histology found a pathologically complete remission of the tumor (yT0) but 4 positive lymph nodes out of 28 removed nodes. Radiation was given to the breast and the supraclavicular nodes. The postoperative cosmetic result was rated as good with both breasts of good volume and symmetry (Fig. 64.2a, b

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