Breast Conserving and Reconstructive Techniques

Where excision volumes are more than 10% of total breast volume with medial lesions and more than 20% with lateral or outer lesions, an unsatisfactory aesthetic outcome is probable. Tumours that are located centrally in the breast and require nipple excision also often result in visible asymmetry and distortion.

Breast conserving and reconstructive techniques may not be suitable for patients who smoke, have diabetes, are obese, or have connective tissue disorders that may make them more prone to wound complications. A patient will need to be suitable for a standard wide local excision procedure with approximately 1 cm of surrounding tissue, relative to breast size, to ensure the tumour can be removed with an appropriate margin.

Level 1 breast conserving techniques are used when less than 20% of breast volume is to be excised. This involves selecting the most appropriate placement of the incision, excising the cancer with adequate margins, and mobilising the breast tissue, skin and nipple to achieve the best possible aesthetic result. Level 2 breast conserving and reconstructive techniques are used when 20–50% of breast volume is to be excised.

These surgical techniques are classified into two types: volume displacement techniques and volume replacement techniques, indicated below as VDT and VRT. Volume displacement involves using the remaining breast tissue to fill the area previously occupied by the tumour. Displacement techniques reshape the breast and may result in a smaller breast volume. Volume replacement techniques involve using the patient’s own skin and tissue grafts (autologous) through myocutaneous or subcutaneous flap procedures. The disadvantage of volume replacement techniques is that they involve more extensive surgery and may limit the use of certain flaps for future whole breast reconstruction surgery.