As the inclusion criteria for breast conservation therapy (BCT) has continued to evolve to include lower quadrant tumors, very large breasts, and central tumors, the potential for significant disfigurement after BCT has also increased. This has led some centers to develop coordinated oncology – plastic surgery approaches to insure both adequate cancer resection and aesthetic appearance to the breasts. The authors applied this principal to a specific group of breast cancer patients – women with macromastia who would benefit from reduction mammaplasty. Eleven women were identified from the senior author’s reconstructive practice who underwent BCT followed by breast reconfiguration and bilateral reduction mammaplasty. Preoperative brassiere sizes ranged from 34D-46B. All women had immediate reduction after frozen sections from the lumpectomy/partial mastectomy margins were determined to be negative. A total of twenty-two reduction mammaplasties were performed (8 free nipple grafts, 5 inferior pedicle, 7 superomedial pedicle, and 2 superolateral) and an average of 1085g was removed per breast. All patients underwent XRT post-operatively. There were 8 minor complications in 6 patients (1 hematoma, 1 keloid, 1 radiation burn, 2 nipple hypopigmentation, and 3 fat necrosis). After an average of 20 months follow-up, there were no local recurrences and one death from distant metastasis. Seven of the eleven patients were available and agreed to rate their aesthetic satisfaction based on a scale of 1 to 4, 4 being the best. The mean satisfaction score was 3.3. Aesthetic outcomes pre-XRT and post-XRT were evaluated by a panel of plastic surgery residents blinded to the purpose of the study. Using a scale of 1 to 4, the pre-XRT aesthetic mean was 2.9 and the post-XRT aesthetic mean was 3.03. By combining breast conservation therapy with breast reconfiguration or reduction in large breasted women, multiple benefits are derived. Larger segmental or partial mastectomies can be performed without disfigurement risk, ensuring adequate surgical margins. Immediate reconfiguration of the breast with reduction of the contralateral side creates symmetrical, aesthetically pleasing breasts, allows contralateral breast tissue to be evaluated, and spares women from undergoing a second operative procedure. Such a coordinated program gives women an important boost, both physically and psychologically, during their management of breast cancer.
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