SUPERIOR PEDICLED ONCOPLASTY

Oncoplastic breast surgery concept is a blend of art and science to offer the safest oncologic outcome with the best aesthetic outcome, taking into consideration all treatment modalities based on a multi-disciplinary approach such as systemic treatment and radiation therapy. There are 3 crucial points to be considered when proceeding for a reduction mammoplasty surgery. First is type of skin incision to be used, second is type of selected pedicle and last is the resection volume needed according to tumor location and final aesthetic outcome. There are many options for therapeutic mammoplasty, either vertical scar, transverse mammoplasty or the most popular, inverted T (Wise pattern) mammoplasty for skin incision designs. We usually prefer the Wise pattern approach as it is easy to learn and we can select any type of pedicle according to tumor location. The best results are achieved in patients with moderate to severe degree ptosis. Pre-operative detailed medical history is required especially for diabetes, obesity, smoking, prior breast surgery for planning and selection of pedicle and technique. Proper understanding of breast and NAC anatomy is essential for pedicle selection and better intraop-erative tissue handling. In our case, we selected superior pedicle approach to suit the multifocal lower pole tumor. We do our markings while the patient is in the upright position on surgery day, we use saline-adrenaline sub-dermal injection before de-epithelialization of the superior pedicle after sharp incisions of all marked lines then we proceed for glandular excision using the diathermy guided with the tumor location. We recommend leaving metal clip in the operative bed to guide for the post opera-tive radiation therapy planning. Parenchymal closure is done with 2.0 vicryl sutures after suction drain insertion. Subcutaneous tissue closure with 2.0 vicryl sutures followed by skin closure using 4.0 subcu-ticular monocryl sutures. Soft bra is used immediately post operative and drain is removed 1 week later.