Advertisement

Outcomes in volume replacement and volume displacement techniques in oncoplastic breast conserving surgery: A systematic review

      Summary

      Introduction

      Volume Replacement (VR-OBCS) and Volume Displacement Oncoplastic Breast Conserving Surgery (VD-OBCS) are commonly used in the management of breast cancer. Many studies summarize the individual postoperative outcomes of these two procedures; however, there is a lack of research that compares outcomes of these approaches. This review summarizes the available VR and VD-OBCS literature in terms of oncological, cosmetic, and clinical outcomes.

      Methods

      An online literature search (MEDLINE, EMBASE, PubMed, and CINAHL) was performed. Studies were included if they were written in English, had more than 10 adult (18+) female patients who underwent VR-OBCS or VD-OBCS, and reported at least one well-described oncological, clinical, or cosmetic outcome

      Results

      Thirty-three studies (26 VR-OBCS and 7 VD-OBCS) were included in this review; VR-OBCS studies were separated based on the use of latissimus dorsi (LD) flaps. Studies utilizing VR-OBCS with LD flaps reported the highest rate of all oncological outcomes; VR-OBCS studies without LD flaps reported the lowest. Rates of hematoma, seroma, and wound dehiscence were highest in VR-OBCS with LD flaps; partial flap loss and fat necrosis were highest in VR-OBCS without LD flaps and infection was highest in VD-OBCS studies. Inconsistencies in methodology (cosmetic outcome measures, outcome definitions, and time horizons) were found in all procedural groups.

      Conclusion

      Differences in outcomes for both OBCS procedures may be due to the heterogeneity of patient populations. “Doers” and “Users” of breast oncoplastic research should consider tumor size, laterality of tumor, breast size, measurement scales, and defensible time horizons before the application of a study's conclusions.

      Keywords

      To read this article in full you will need to make a payment

      References

        • Panchal H.
        • Matros E.
        Current trends in postmatectomy breast reconstruction.
        Plast. Reconstr. Surg. 2017; 140: 7S-13S
        • Murawa P.
        • Murawa D.
        • Adamczyk B.
        • Połom K.
        Breast cancer: actual methods of treatment and future trends.
        Rep Pract Oncol Radiother. 2014; 19: 165-172https://doi.org/10.1016/j.rpor.2013.12.003
        • Noguchi M.
        • Yokoi-Noguchi M.
        • Ohno Y.
        • et al.
        *Oncoplastic breast conserving surgery: volume replacement vs. volume displacement.
        EJSO. 2016; 42: 926-934
        • Onitilo A.A.
        • Engel J.M.
        • Stankowski R.V.
        • Doi S.A.R.
        Survival comparisons for breast conserving surgery and mastectomy revisited: community experience and the role of radiation therapy.
        Clin Med Res. 2015; 13: 65-73https://doi.org/10.3121/cmr.2014.1245
        • Behluli I.
        • Le Renard P.-.E.
        • Rozwag K.
        • Oppelt P.
        • Kaufmann A.
        • Schneider A
        Oncoplastic breast surgery versus conventional breast-conserving surgery: a comparative retrospective study.
        ANZ J Surg. 2019; 89: 1236-1241https://doi.org/10.1111/ans.15245
        • Bertozzi N.
        • Pesce M.
        • Santi P.L.
        • Raposio E.
        Oncolplastic breast surgery: comprehensive reivew.
        Eur Rev Med Pharmacol Sci. 2017; 21: 2572-2585
        • Hamdi M.
        • Sinove Y.
        • DePypere H.
        • et al.
        The role of Oncoplastic surgery in breast cancer.
        Acta Chir Belg. 2008; 108: 666-672
        • Chatterjee A.
        • Gass J.
        • Patel K.
        • et al.
        A consensus definition and classification system of oncoplastic surgery developed by the American Society of Breast Surgeons.
        Ann. Surg. Oncol. 2019; 26: 3436-3444https://doi.org/10.1245/s10434-019-07345-4
        • Clough K.B.
        • Kaufman G.J.
        • Nos C.
        • Buccimazza I.
        • Sarfati I.M.
        Improving breast cancer surgery: a classification and quadrant per quadrant atlas for oncoplastic surgery.
        Ann. Surg. Oncol. 2010; 17: 1375-1391
        • Patel K.
        • Bloom J.
        • Nardello S.
        • Cohen S.
        • Reiland J.
        • Chatterjee A.
        An oncoplastic surgery primer: common indications, techniques and complications in Lelve 1 and 2 Volume Displacement oncoplastic surgery.
        Ann. Surg. Oncol. 2019; 26: 3063-3070
        • Schaverien M.V.
        • Kuerer H.M.
        • Caudle A.S.
        • Smith B.D.
        • Hwang R.R.
        • Robb G.L.
        Outcomes of volume replacement oncoplastic breast-conserving surgery using chest wall perforator flaps: comparison with volume displacement oncoplastic surgery and total breast reconstruction.
        Plast. Reconstr. Surg. 2020; 146: 14-27
        • Arnaout A.
        • Ross D.
        • Khayat E.
        • et al.
        Position statement on defining and standardizing an oncoplastic approach to breast-conserving surgery in Canada.
        Curr Oncol. 2019; 26: e405-e409https://doi.org/10.3747/co.26.4195
        • Berrino P.
        • Campora E.
        • Santi P.
        Postquadrantectmy breast deformities: classification and techniques of surgical correction.
        Plast. Reconstr. Surg. 1987; 79: 567-572
        • Rainsbury R.
        Breast sparing reconstruction with latissimus dorsi miniflaps.
        European Journal of Surgical Oncology. 2002; 28: 891-895
        • Dixon J.
        • Venizelos B.
        • Chan P.
        Latissimus dorsi mini-flap: a technqieu for extending breast conservation.
        Breast. 2002; 11: 58-65
        • Soumian S.
        • Parmeshwar R.
        • Chandarana M.
        • Marla S.
        • Narayanan S.
        • Shetty G.
        Chest wall perforator flaps for partial breast reconstruction: surgical outcomes from a multicenter study.
        Arch Plast Surg. 2020; 47: 153-159
        • Adams W.P.J.
        • Lipschitz A.H.
        • Ansari M.
        • Kenkel J.M.
        • Rohrich R.J.
        Functional Donor site morbidity following latissimus dorsi muscle flap transfer.
        Ann Plast Surg. 2004; 53: 6-11
        • Lee K.
        • Mun G.
        A systematic review of functional donorsite morbidity after latissimus dorsi muscle transfer.
        Plast. Reconstr. Surg. 2014; 143: 303-314
        • Smith J.L.
        Sir Arbuthnot Lane, chronic intestinal stasis, and autointoxication.
        Ann. Intern. Med. 1982; 96: 365-369
        • Hamdi M.
        • Van Landuyt K.
        • Monstrey S.
        • Blondeel P.
        Pedicled perforator flaps in breast reconstruction: a new concept.
        Br Assoc Plast Surg. 2004; 57: 531-539
        • Hamdi M.
        • Van Landuyt K.
        • Hijjawi J.B.
        • Roche N.
        • Blondeel P.
        • Monstrey S
        Surgical technique in pedicled thoracodorsal artery perfortor flaps: a clinical experience with 99 patients.
        Plast. Reconstr. Surg. 2008; 121: 1632-1641
        • Hamdi M.
        • Van Landuyt K.
        • de Frene B.
        • Roche N.
        • Blondeel P.
        • Monstrey S.
        The versatility of the inter-costal artery perforator (ICAP) flaps.
        J Plast, Reconstr Aesthet Surg. 2006; 59: 644-652
        • Hamdi M.
        • Spano A.
        • Van Landuyt K.
        • D'Herde K.
        • Biondeel P.
        • Monstrey S
        The lateral intercostal artery perforators: anatomical study and clinical application in breast surgery.
        Plast. Reconstr. Surg. 2008; 121: 389-396
        • Kimball C.C.
        • Nichols C.I.
        • Vose J.G.
        • Peled A.W.
        Trends in Lumpectomy and Oncoplastic Breast-Conserving Surgery in the US, 2011–2016.
        Ann Surg Oncol. 2018; 25: 3867-3873https://doi.org/10.1245/s10434-018-6760-7
        • Kim J.
        • Yoo J.
        • Lee J.
        • Chang E.
        • Suh K.
        Oncoplastic Reconstruction with Superior Based Lateral Breast Rotation Flap after Lower Quadrant Tumor Resection.
        J Breast Cancer. 2012; 15: 350-355https://doi.org/10.4048/jbc.2012.15.3.350
        • Kaviani A.
        • Zand S.
        • Ashraf-Ganjouei A.
        • Younan R.
        • Jacques Salmon R
        A Novel Level I Oncoplastic Surgery Technique for Tumors Located in UIQ of the Breast Far from the Nipple: the “Cross” Technique.
        Plast Reconstr Surg Glob Open. 2019; 7: e2269
        • Campbell E.J.
        • Romics L.
        Oncologiacl safety and cosmetic outcomes in oncoplastic breast conservation surgery, a review of the best level of evidence literature.
        Breast Cance (Dove Med Press). 2017; 9: 521-530
        • Haloua M.H.
        • Krekel N.M.A.
        • Winters H.A.H.
        • et al.
        A systematic review of oncoplastic breast-conserving surgery: current weaknesses and future prospects.
        Ann. Surg. 2013; 257: 609https://doi.org/10.1097/SLA.0b013e3182888782
      1. Covidence - Better systematic review management. Accessed May 27, 2020. https://www.covidence.org/home

        • Hernanz F.
        • Sánchez S.
        • Cerdeira M.P.
        • Figuero C.R.
        Long-term results of breast conservation and immediate volume replacement with myocutaneous latissimus dorsi flap.
        World J Surg Oncol. 2011; 9: 159https://doi.org/10.1186/1477-7819-9-159
        • Kijima Y.
        • Yoshinaka H.
        • Hirata M.
        • et al.
        Oncoplastic surgery combining partial mastectomy and immediate volume replacement using a thoracodorsal adipofascial cutaneous flap with a crescent-shaped dermis.
        Surg Today. 2014; 44: 2098-2105https://doi.org/10.1007/s00595-013-0812-1
        • Hu J.
        • Cuffolo G.
        • Parulekar V.
        • Chan V.
        • Tenovici A.
        • Roy P.G.
        The results of surveillance imaging after breast conservation surgery and partial breast reconstruction with chest wall perforator flaps; a qualitative analysis compared with standard breast-conserving surgery for breast cancer.
        Clin. Breast Cancer. 2019; 19: e422-e427https://doi.org/10.1016/j.clbc.2019.01.010
        • Moher D.
        • Shamseer L.
        • Clarke M.
        • et al.
        Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.
        Syst Rev. 2015; 4: 1-9
        • Burgić M.
        • Bruant-Rodier C.
        • Wilk A.
        • et al.
        Complications following autologous latissimus flap breast reconstruction.
        Bosn J Basic Med Sci. 2010; 10: 65-67
        • Farahat A.M.
        • Hashim T.
        • Soliman H.O.
        • Manie T.M.
        • Soliman O.M.
        Skin sparing mastectomy: technique and suggested methods of reconstruction.
        J Egypt Natl Canc Inst. 2014; 26: 153-159https://doi.org/10.1016/j.jnci.2014.05.004
        • Lee J.
        • Jung J.H.
        • Kim W.W.
        • et al.
        Oncologic outcomes of volume replacement technique after partial mastectomy for breast cancer: a single center analysis.
        Surg Oncol. 2015; 24: 35-40https://doi.org/10.1016/j.suronc.2014.12.001
        • El-Marakby H.H.
        • Kotb M.H.
        Oncoplastic volume replacement with latissimus dorsi myocutaneous flap in patients with large ptotic breasts. Is it feasible?.
        J Egypt Natl Canc Inst. 2011; 23: 163-169https://doi.org/10.1016/j.jnci.2011.11.002
        • Zhou L.
        • Wang Y.
        • Cai R.
        • et al.
        Pedicled descending branch latissimus dorsi mini-flap in repairing partial mastectomy defect: shoulder functional and esthetic outcomes.
        J Surg Oncol. 2019; 120: 518-526https://doi.org/10.1002/jso.25524
        • De Biasio F.
        • Zingaretti N.
        • Marchesi A.
        • Vaienti L.
        • Almesberger D.
        • Parodi P.C.
        A Simple and Effective Technique of Breast Remodelling After Conserving Surgery for Lower Quadrants Breast Cancer.
        Aesth Plast Surg. 2016; 40: 887-895https://doi.org/10.1007/s00266-016-0709-7
        • Mele S.
        • Wright D.
        • Paramanathan N.
        • Laws S.
        • Peiris L.
        • Rainsbury R.
        Long-term effect of oncoplastic breast-conserving surgery using latissimus dorsi miniflaps on mammographic surveillance and the detection of local recurrence.
        J Plast, Reconstr Aesthet Surg. 2017; 70: 1203-1209https://doi.org/10.1016/j.bjps.2017.06.030
        • Yang C.E.
        • Roh T.S.
        • Yun I.S.
        • Kim Y.S.
        • Lew D.H.
        Immediate partial breast reconstruction with endoscopic Latissimus Dorsi muscle flap harvest.
        Arch Plast Surg. 2014; 41: 513-519https://doi.org/10.5999/aps.2014.41.5.513
        • Ho W.
        • Stallard S.
        • Doughty J.
        • Mallon E.
        • Romics L.
        Oncological outcomes and complications after volume replacement oncoplastic breast conservations—the glasgow experience.
        Breast Cancer (Auckl). 2016; 10: 223-228https://doi.org/10.4137/BCBCR.S41017
        • Fujimoto H.
        • Shiina N.
        • Nagashima T.
        • et al.
        Oncoplastic breast-conserving surgery using chest wall perforator flaps: three-dimensional quantitative analysis of the percentage of breast volume excised and changes over time in flap volume.
        J Surg Oncol. 2020; 121: 216-223https://doi.org/10.1002/jso.25809
        • Thekkinkattil D.K.
        • Salhab M.
        • McManus P.L.
        Feasibility of Autologous fat transfer for replacement of implant volume in complicated implant-assisted Latissimus Dorsi Flap Breast Reconstruction:.
        Ann Plast Surg. 2015; 74: 397-402https://doi.org/10.1097/SAP.0b013e3182a6adfc
        • Kelemen P.
        • Pukancsik D.
        • Újhelyi M.
        • et al.
        Evaluation of the central pedicled, modified Wise-pattern technique as a standard level II oncoplastic breast-conserving surgery: a retrospective clinicopathological study of 190 breast cancer patients.
        Breast J. 2019; 25: 922-926https://doi.org/10.1111/tbj.13371
        • Kelemen P.
        • Pukancsik D.
        • Újhelyi M.
        • et al.
        Comparison of clinicopathologic, cosmetic and quality of life outcomes in 700 oncoplastic and conventional breast-conserving surgery cases: a single-centre retrospective study.
        Eur J Surg Oncol. 2019; 45: 118-124https://doi.org/10.1016/j.ejso.2018.09.006
        • Lee J.
        • Jung J.H.
        • Kim W.W.
        • et al.
        Five-year oncologic outcomes of volume displacement procedures after partial mastectomy for breast cancer.
        Clin. Breast Cancer. 2017; 17: 70-75https://doi.org/10.1016/j.clbc.2016.06.018
        • Gurleyik G.
        • Karagulle H.
        • Eris E.
        • Aker F.
        • Ustaalioglu B.O.
        Oncoplastic surgery; volume displacement techniques for breast conserving surgery in patients with breast cancer.
        Acta Chir Belg. 2017; 117: 169-175https://doi.org/10.1080/00015458.2016.1272916
        • Yang J.D.
        • Bae S.G.
        • Chung H.Y.
        • Cho B.C.
        • Park H.Y.
        • Jung J.H.
        The Usefulness of Oncoplastic Volume displacement techniques in the superiorly located breast cancers for korean patients with small to moderate-sized breasts:.
        Ann Plast Surg. 2011; 67: 474-480https://doi.org/10.1097/SAP.0b013e318201fdf4
        • Clough K.B.
        • van la Parra R.F.D.
        • Thygesen H.H.
        • et al.
        Long-term results after oncoplastic surgery for breast cancer: a 10-year follow-up.
        Ann. Surg. 2018; 268: 165-171https://doi.org/10.1097/SLA.0000000000002255
        • Yang J.D.
        • Kim M.C.
        • Lee J.W.
        • et al.
        Usefulness of Oncoplastic volume replacement techniques after breast conserving surgery in small to moderate-sized breasts.
        Arch Plast Surg. 2012; 39: 489-496https://doi.org/10.5999/aps.2012.39.5.489
        • Abdelrahman E.M.
        • Nawar A.M.
        • Balbaa M.A.
        • Shoulah A.A.
        • Shora A.A.
        • Kharoub M.S.
        Oncoplastic Volume Replacement for Breast Cancer: latissimus Dorsi Flap versus Thoracodorsal Artery Perforator Flap.
        Plastic and Reconstructive Surgery – Global Open. 2019; 7: e2476https://doi.org/10.1097/GOX.0000000000002476
        • Amin A.A.
        • Rifaat M.
        • Farahat A.
        • Hashem T.
        The role of thoracodorsal artery perforator flap in oncoplastic breast surgery.
        J Egypt Natl Canc Inst. 2017; 29: 83-87https://doi.org/10.1016/j.jnci.2017.01.004
        • Dogan L.
        • Gulcelik M.A.
        • Karaman N.
        • Camlibel M.
        • Serdar G.K.
        • Ozaslan C.
        Intraglandular flap technique for tumors located in the upper outer quadrant of the breast.
        Clin. Breast Cancer. 2012; 12: 194-198https://doi.org/10.1016/j.clbc.2012.03.010
        • Kijima Y.
        • Koriyama C.
        • Fujii T.
        • et al.
        Immediate breast volume replacement using a free dermal fat graft after breast cancer surgery: multi-institutional joint research of short-term outcomes in 262 Japanese patients.
        Gland Surg. 2015; 4: 179-194https://doi.org/10.3978/j.issn.2227-684X.2015.01.06
        • Lee J.W.
        • Kim M.C.
        • Park H.Y.
        • Yang J.D.
        Oncoplastic volume replacement techniques according to the excised volume and tumor location in small- to moderate-sized breasts.
        Gland Surg. 2014; 3: 14-21https://doi.org/10.3978/j.issn.2227-684X.2014.02.02
        • Sarkar D.K.
        • Maji A.
        • Saha S.
        • Biswas J.K.
        Oncoplastic Breast Surgery - Our Experiences in the Breast Clinic, IPGME&R, Kolkata.
        Indian J Surg Oncol. 2011; 2: 112-117https://doi.org/10.1007/s13193-011-0065-7
        • Tanaka S.
        • Sato N.
        • Fujioka H.
        • et al.
        Breast conserving surgery using volume replacement with oxidized regenerated cellulose: a cosmetic outcome analysis.
        Breast J. 2014; 20: 154-158https://doi.org/10.1111/tbj.12229
        • Klinger M.
        • Giannasi S.
        • Klinger F.
        • et al.
        Periareolar approach in oncoplastic breast conservative surgery.
        Breast J. 2016; 22: 431-436https://doi.org/10.1111/tbj.12590
        • van Huizum M.A.
        • Hage J.J.
        • Oldenburg H.A.
        • Hoornweg M.J.
        Internal mammary artery perforator flap for immediate volume replacement following wide local excision of breast cancer.
        Arch Plast Surg. 2017; 44: 502-508https://doi.org/10.5999/aps.2016.00458
        • Hakakian C.S.
        • Lockhart R.A.
        • Kulber D.A.
        • Aronowitz J.A.
        Lateral intercostal artery perforator flap in breast reconstruction: a simplified pedicle permits an expanded role.
        Ann Plast Surg. 2016; 76: S184-S190https://doi.org/10.1097/SAP.0000000000000752
        • McCulley S.J.
        • Schaverien M.V.
        • Tan V.K.M.
        • Macmillan R.D.
        Lateral Thoracic Artery Perforator (LTAP) flap in partial breast reconstruction.
        J Plast Reconstr Aesthet Surg. 2015; 68: 686-691https://doi.org/10.1016/j.bjps.2015.01.008
        • Gardfjell A.
        • Dahlbäck C.
        • Åhsberg K.
        Patient satisfaction after unilateral oncoplastic volume displacement surgery for breast cancer, evaluated with the BREAST-Q™.
        World J Surg Oncol. 2019; 17: 96https://doi.org/10.1186/s12957-019-1640-6
        • Lee S.
        • Lee J.
        • Lee S.
        • Bae Y.
        Oncoplastic breast surgery with Latissimus Dorsi myocutaneous flap for large defect in patients with Ptotic breasts: is it feasible when combined with local flaps?.
        World J Surg Oncol. 2014; 12: 65https://doi.org/10.1186/1477-7819-12-65
        • Schaverien M.V.
        • Kuerer H.M.
        • Caudle A.S.
        • Smith B.D.
        • Hwang R.F.
        • Robb G.L.
        Outcomes of Volume Replacement Oncoplastic Breast-Conserving Surgery Using Chest Wall Perforator Flaps: comparison with Volume Displacement Oncoplastic Surgery and Total Breast Reconstruction.
        Plast. Reconstr. Surg. 2020; 146: 14-27https://doi.org/10.1097/PRS.0000000000006911
        • Thoma A.
        • Murphy J.
        • Voineskos S.
        • Coroneos C.
        • Goldsmith C.
        Improving science in surgery.
        Accept Plast Reconstr Surg. December 2020; (Published online)
        • Williamson P.R.
        • Altman D.G.
        • Bagley H.
        • et al.
        The COMET Handbook: version 1.0.
        Trials. 2017; 18
      2. The COSMIN Initiative. About the COSMIN Initiative. COSMIN. Published NA. Accessed June 30, 2020. https://www.cosmin.nl/.

        • Mowakket S.
        • Karpinski M.
        • Gallo L.
        • et al.
        Reporting Time Horizons in RCTs in plastic surgery: a systematic review.
        Plast. Reconstr. Surg. 2018; 142: 947e-957e

      Further reading

        • Kim J.
        • Eom J.
        • Lee J.
        • Lee J.
        • Park H.
        • Yang J.
        Utility of two surgical techniques using a lateral intercostal artery perforator flap after breast-conserving surgery: a single-center retrospective study.
        Plast. Reconstr. Surg. 2019; 143https://doi.org/10.1097/PRS.0000000000005374
        • Lee J.W.
        • Kim M.C.
        • Park H.Y.
        • Yang J.D.
        Oncoplastic volume replacement techniques according to the excised volume and tumor location in small- to moderate-sized breasts.
        Gland Surg. 2014; 3: 14-21https://doi.org/10.3978/j.issn.2227-684X.2014.02.02