BACKGROUND: Tumor quadrantectomy combined with reduction mammaplasty allows resection of breast cancer with wider free margins and an improved cosmetic result. METHODS: 121 women with 125 breast cancers (114 invasive cancers, 11 high grade DCIS) underwent tumor quadrantectomy combined with a reduction mammaplasty. The oncological and cosmetic outcome is evaluated. RESULTS: Reduction mammaplasties were performed unilaterally (n = 4/121) or bilaterally (n = 117/121). Mean free surgical margins were 11.8 mm in patients with invasive cancer and 18.6 mm in patients with high grade DCIS. 3 of 125 resection specimen revealed positive margins (all were DCIS), in 2 of 125 specimens multicentric invasive cancer was found and the 5 patients underwent secondary mastectomy with immediate reconstruction. In 4 of 117 patients an occult invasive cancer was found in the histological specimen of the contralateral breast. After a median follow-up of 32 months (range 11–106 months) there were no local recurrences in the breast or axilla, three patients developed distant metastases. The postoperative cosmetic result evaluated by the patients was rated as excellent in 97 of 121 patients (80%) and good in 24 of 121 patients (20%) with no poor result. CONCLUSIONS: Tumor quadrantectomy combined with reduction mammaplasty allows wide tumor resection with adequate cosmetic result.

Background: Intraoperative frozen section examination of the sentinel node in breast cancer patients is associated with a high number of incorrect negative results with the sentinel node becoming positive in the permanent examination and necessitating a secondary axillary lymph node dissection. A reoperation of the axilla following skin-sparing mastectomy and immediate autologous tissue reconstruction may compromise the vascular pedicle of the flap and should be avoided. Methods: Eighty breast cancer patients underwent skin-sparing mastectomy with immediate autologous reconstruction and sentinel node biopsy followed by axillary lymph node dissection irrespective of the result of the frozen section of the sentinel node. The goal of the study was to identify a subgroup of patients with incorrect negative sentinel node(s) in the frozen section who may forego a secondary axillary lymph node dissection due to a low risk of positive nonsentinel nodes. Results: Frozen section examination of the sentinel node was negative in 58 patients and positive in 22 patients. Permanent histologic examination revealed tumor in 13 of 58 (22.4 percent) sentinel node(s) found negative in the frozen section. None of these 13 patients showed positive nodes in the axillary specimen, whereas nine of 22 patients with their metastases in the sentinel node found through intraoperative frozen section examination had additional positive nonsentinel node(s) (p = 0.001). Conclusions: Patients with incorrect negative sentinel node(s) found in the frozen section examination had a significantly decreased risk for additional positive nonsentinel node(s) compared with patients with sentinel node metastases found in the frozen section. However, to avoid a secondary axillary lymph node dissection, the authors suggest performing sentinel node biopsy before mastectomy under local anesthesia to have the permanent result of the senti-nel node available before a planned reconstruction.

Onkoplastische Operationstechniken kombinieren die onkologische Entfernung des Tumors mit einer sofortigen Wiederherstellung der Brustform und –symmetrie. Zunehmend werden sie auch zur brusterhaltenden Therapie (BET) zentraler Mammakarzinome angewandt, die bisher meist mit einer Mastektomie behandelt wurden.

Zielsetzung: Durch Anwendung plastisch chirurgischer Reduktionstechniken beim Mammakarzinom kann bei ungünstiger Brustgrößen – Tumorrelation die Rate an brusterhaltenden Operationen erhöht, gleichzeitig das kosmetische Ergebnis verbessert werden.