Article Abstract

Rotation advancement flap—a novel technique for breast conserving surgery in tumors of the upper lateral breast quadrant

Authors: Andrii Zhygulin, Valentyn Palytsia, Dmytro Unukovych


Background: Focus on patient’s quality of life has dramatically changed the paradigm of surgical treatment of breast cancer. Contemporary breast surgery has to provide not only with good margins, but also with the best aesthetic result possible.
Methods: A novel modification of an oncoplastic technique for breast tumors located in the upper-lateral quadrant is proposed and is based on two principles—flap rotation and advancement. Rotation advancement flap is a combination of wide rotation parenchymatous flap from the lateral part of the breast with a tissue complex from the axillary region. The point of rotation is the nipple-areolar complex (NAC).
Results: Between 2013 and 2017, 33 procedures with the described technique were performed. The mean age of the patients was 49 years (range, 33–69 years), mean specimen weight 113.5 g (range, 36–268 g), tumor size—26 mm (range, 10–50 mm). Six patients (18.2%) received neoadjuvant chemotherapy. Sentinel lymph node biopsy (SLNB) was performed in 25 (75.8%) and axillary lymph node dissection (ALND) in 12 (36.4%) patients. Complications occurred in 7 (21.2%) patients: hematoma (n=2, including one revision), cellulitis (n=3, conservative treatment), and wound edge necrosis (n=2, revised). We followed up 32 (97%) patients during 29 (range, 6–48) months postoperatively. No loco-regional recurrence was registered, whereas distant metastases were revealed in 2 (6.1%) patients; 1 (3%) of the patients succumbed to breast cancer.
Conclusions: We have proposed a novel technique of the rotation advancement flap in breast conserving surgery. This technique is reliable and allows for correcting potential deformities and significant volume loss. It may provide with an excellent aesthetic result and is considered a safe alternative to more complex operations.