Therapeutic reduction mammoplasty techniques in management of breast cancer in large-breasted females – a comparative study between inferior and superior pedicle reduction mammoplasty

Background
Oncoplastic surgery for breast cancer in patients with macromastia is a new concept that has evolved to associate breast conserving surgery with techniques of breast reshaping. This study aims to compare the outcomes of therapeutic reduction mammoplasty in medium-sized to large-breasted females with breast cancer using superior pedicle versus the inferior pedicle mammoplasty for early stages of breast cancer.
Patients and methods
From January 2013 to January 2017, 50 females patients with medium-sized to large-sized breasts diagnosed with early breast cancer and suitable for breast conservation underwent reduction mammoplasty depending on either inferior pedicle (group 1) or superior pedicle (group 2). Patients with central breast cancer and inability to obtain free resection margin after excision were excluded from the study. Surgical outcomes, oncologic safety, and cosmetic result were assessed and compared between both techniques.
Results
There was no significant difference between the two groups regarding age and weight of the patients (median: 42 vs 40 years) (>0.05). Most cases had a mass in the upper outer quadrant of the breast (60%). On follow-up, wound dehiscence occurred more frequent in the inferior pedicle group, which occurred in four (16%) cases, than in the superior pedicle group, which occurred in two (8%) cases. The cosmetic outcomes were assessed in inferior pedicle versus superior pedicle mammoplasty groups, showing excellent results in 15 (60%) cases versus 16 (64%) patients, respectively. In a median follow-up of 24 months, no cases showed local recurrence.
Conclusion
Therapeutic reduction mammoplasty using inferior and superior pedicles was shown to be oncologically safer than traditional conservative surgery with more satisfactory esthetic outcome. Moreover, the superior pedicle mammoplasty yields a lower morbidity with better cosmetic outcome than inferior pedicle mammoplasty in large-breasted women with breast cancer.