How are lumpectomy defects managed in breast reconstruction?

Updated: Jan 10, 2020
  • Author: Mark F Deutsch, MD; Chief Editor: James Neal Long, MD, FACS  more...
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Answer

Answer

Lumpectomy has gained popularity with oncologic surgeons, [16] more patients are referred for evaluation of postoperative breast deformities. Large breasts can easily camouflage a lumpectomy defect with minimal cosmetic deformity, while small breasts need volume replacement. Postlumpectomy deformities can be managed in several ways. If the opposite breast is excessively large, it can be reduced while the lumpectomy deformity can be incorporated into a Wise pattern, and a small reduction can be performed to achieve symmetry.

Conversely, a small implant often can solve the problem. If the patient is opposed to prosthetic material, a latissimus flap can fill in a defect on any quadrant. The flap may use a small skin paddle to replace needed skin, or it can be de-epithelialized and buried to provide more projection. A TRAM flap seldom is needed for this purpose, because it involves too much wasted tissue and precludes a mastectomy reconstruction should the patient develop a recurrence.


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