by Zhygulin, Andrii; Fedosov, Artem; Palytsia, Valentyn
Plastic and Reconstructive Surgery: December 2021
- Volume 148 - Issue 6 - p 1209-1213
The authors believe that oncoplastic breast surgery has to
achieve the best possible aesthetic results. In this article, they propose the
concept of “invisible surgery.” This is a combination of certain oncoplastic
techniques that allows for restoration of the original appearance of the breast
without obvious scars on the breast. Further, the authors classify the
techniques as follows: the “level 1 technique,” with contour approach; the
“from inside” technique; the lateral parenchymal flap; the axillary subcutaneous
adipofascial flap; the rotational lateral thoracic flap; regional island
perforator flaps (lateral intercostal artery perforator, lateral thoracic
artery perforator, anterior intercostal artery perforator, and medial
intercostal artery perforator flaps); and the nipple-sparing mastectomy with
immediate expander reconstruction. These techniques were combined by internal
logic—one can move from one to another according to the preoperative planning
and margins status during the operation. They call their approach the “scenario
strategy.” The authors have performed 138 operations in 137 patients using this
approach. Most of them involved the “from inside” technique and perforator
flaps. The average tumor size was 2.4 cm, and the average specimen weight was
43.2 g. The total rate of complications was 14.6 percent. According to this
concept, the surgery should be performed in such way that breast appearance
will not change. It should be planned as one would plan a staged procedure,
taking into account possible changes in the scenario during the operation to
achieve the best possible aesthetic result.
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