Oncoplastic Approaches to Upper Outer Quadrant Breast Cancer - a Comparative Study between Inferior Pedicle and Superomedial Pedicle Mammoplasty

Background: Oncoplastic surgery for breast cancer in large breasted patients is a new concept evolved during the last 20 years that associates breast-conserving surgery with techniques of breast reshaping. This study aims to compare the short term outcome of therapeutic reduction mammoplasty in large-breasted women with breast cancer using superomedial pedicle versus the inferior pedicle mammoplasty for tumors situated at upper outer breast quadrant. Methods: One hundred large breasted women with breast cancer underwent simultaneous bilateral reduction mammoplasty depending on either inferior (1st group) or superomedial pedicle (2nd group). Results: There was no significant difference in between the two groups regarding age (median 46 Vs 43 y) and weight (P > 0.05). In the inferior pedicle group, the size of the tumour ranged from 1 to 3.5 cm while in the superomedial group, the tumor size ranged from 1 cm to 4 cm. On follow up, wound dehiscence occurred more frequent in the inferior pedicle group (16%) than the superomedial pedicle group (8%). The cosmetic outcomes were assessed in inferior pedicle versus superomedial pedicle mammoplasty groups showing; excellent in 31 (62%) versus 32 patients (64%), good in 13 (15%) versus15 patients (30%), fair in 4 (8%) versus three patients (6%) and poor in 2(4%) versus 0% respectively. The follow-up period was 15-38 (median 24) months, with no local recurrence or systemic metastasis. Conclusion: Therapeutic reduction mammoplasty using inferior and superomedial pedicles was shown to be oncologically safer than traditional conservative surgery with more satisfactory esthetic outcome. Moreover, the superomedial pedicle mammoplasty yields a lower morbidity with better cosmetic outcome than inferior pedicle mammoplasty in large-breasted women with breast cancer.