A guide algorithm for management of central quadrant breast cancer at Cairo University Hospitals

Background
Oncoplastic techniques play an important role in managing centrally located breast cancer, as it gives the opportunity for wider surgical resection, which leads to adequate margins and good oncological outcome while maintaining great cosmetic results and patient satisfaction. The objective of the current study is to assess the short-term oncological and aesthetic outcomes of oncoplastic techniques after centrally located breast tumor resection.
Patients and methods
This study comprised 35 patients with central breast cancer who were treated at Kasr Al Ainy Teaching Hospital, Faculty of Medicine, Cairo University. The decision of surgery was taken by a multidisciplinary team. According to nipple–areola complex (NAC) involvement, we classified the patients into two groups. The first group included patients with evidence of NAC involvement and required resection of the NAC. The second group included patients with no evidence of NAC involvement, and preservation of the NAC was done. In each group, we used the breast size (cup size) and the degree of breast ptosis to guide the selection of the oncoplastic technique.
Results
Our sample had a mean age of 51.2±10 years and ranged from 35 to 74 years. A total of 13 patients had a medium-sized breast with mild ptosis, hence underwent round block technique. Moreover, 11 patients had a medium-sized breast with moderate ptosis and underwent Grisotti mastopexy. In addition, in larger breasts, reduction mammoplasty was the optimal procedure, whereas in tumors that had extended to the upper pole of the breast (segment II), dome-shaped mastopexy was the best option, especially in patients with large areolar discs more than 4 cm in diameter. Regarding postoperative complications, four (11.4%) patients had a seroma formation and three cases developed wound infection, whereas only one case had a postoperative wound dehiscence and were treated conservatively.
Discussion
Preoperative radiological assessment was proved to be a very crucial element in predicting the possibility of NAC involvement, by using both MRI and mammography. The patients who had positive pathological invasion of NAC postoperatively had a smaller distance between the tumor and NAC (<1.58 cm). On the contrary, the patients who had a nipple-tumor distance more than or equal to 2.4 cm had a higher probability of negative invasion of NAC in pathological assessment. Regarding the patients’ satisfaction toward the surgical procedure done, 60% had excellent results, and it was mainly related to NAC preservation.