ONCOPLASTIC TECHNIQUES FOR LUMPS OF THE EXTERNAL AND LOWER QUADRANTS OF THE BREAST

Oncoplastic breast surgery intents to resect the breast tumor with negative histologic margins, without disturbing the contour of the breast, and multiple techniques have been suggested depending of tumor localization and size. Regarding lumps of the external quadrants, the Half-Moon lateral Crescent Zer-voudis`s Technique, can be used, making a synthesis of the submammary crescent technique and the lateral axillary incision. The purpose of this chapter is mainly to present a new oncoplastic technique for lumps localized 2.5-3 cm away from the nipple between the one and five o’clock posi-tions (left breast). This technique avoids possible cosmetic problems (deformed scars, “bird beak”, glandular defects, etc.) of other similar techniques for lateral lumps (e.g. racquet technique). During the start of the procedure, three lines are drawn. The first one (superior) starts 4 cm below the axilla in the low part of the Spence tail and finishes at six o’clock with a shape of a “S” elongated (left breast) or a “Z” elongated (right breast) following the lateral and submam-mary lines of the breast gland. The second line is drawn 1 cm above the true inframmary line and lateral line of the breast and the third one (in-ferior) is drawn 1 cm below these lines. The excision of the tumor is performed in an ellipse shape with a larger base to allow to be later filled by the lateral superior and inferior glandular flaps. The final scar is an “inverted V”. The excised specimen (lumpectomy) is oriented with different colors or with different stitches at twelve, three, six, and nine o’clock. For lower segment tumors, the final scar is “V”. Adequate and clear surgical margins are required in all cases, which are “no tumour on ink” in invasive carcinomas, ≥2 mm in ductal carcinomas in situ (DCIS), and ≥10 mm in phyllodes tumors (with narrower margins in benign cases).