Breast Oncoplastic Incisions

Rodrigo Arrangoiz MS, MD, FACS, FSSO
  • Disease located in the inferior hemisphere of the breast:
    • Can be easily incorporated into a Wise pattern reduction mammoplasty
Schematic representation of Wise pattern incision and various choices of pedicles. (A) Wise pattern incision. (B) Superior pedicle. (C) Superior-medial pedicle. (D) Inferior pedicle. (E) Lateral pedicle
  • Split reduction techniques:
    • Are best used for disease located in the upper inner or upper outer quadrants requiring skin excision due to the proximity of the tumor to the skin
    • With a split reduction technique:
      • The lateral (for upper outer quadrant cancers) or medial (for upper inner quadrant cancers) triangle of the Wise pattern is not positioned at the base of the breast:
        • But instead advanced up onto the breast where the area of disease was removed
  • Donut mastopexy:
    • Is best used in patients with grade 1 ptosis with the area of disease is located close to the nipple areolar complex
  • The radial ellipse lumpectomy:
    • Is useful for lateral tumors
    • With this technique a radial ellipse of skin and breast parenchyma is excised full thickness
    • This technique however does not improve significant ptosis
Radial ellipse segmentectomy. (a) Shows location of radial ellipse segmentectomy skin incision in upper outer quadrant. (b) Shows multiple “stars” indicating possible tumor locations suitable for this approach. (c) Shows resection cavity following excision of malignancy with excised specimen (inset). (d) Shows breast following closure of the skin incision.
  • References
    • Savalia NB, Silverstein MJ. Oncoplastic breast reconstruction: patient selection and surgical techniques. J Surg Oncol. 2016;113(8):875-882.
    • Silverstein MJ, Mai T, Savalia N, Vaince F, Guerra L. Oncoplastic breast conservation surgery: the new paradigm. J Surg Oncol. 2014;110(1):82-89.
    • Anderson BO, Masetti R, Silverstein MJ. Oncoplastic approaches to partial mastectomy: an overview of volume-displacement techniques. Lancet Oncol.2005;6(3):145–57.
    • Clough KB, Ihrai T, Oden S, Kaufman G, Massey E, Nos C. Oncoplastic surgery for breast cancer based on tumour location and a quadrant-per-quadrant atlas. Br J Surg. 2012;99(1):1389-1395
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Published by Rodrigo Arrangoiz MS, MD, FACS, FSSO

My name is Rodrigo Arrangoiz I am a breast surgeon/ thyroid surgeon / parathyroid surgeon / head and neck surgeon / surgical oncologist that works at Center for Advanced Surgical Oncology in Miami, Florida. I was trained as a surgeon at Michigan State University from (2005 to 2010) where I was a chief resident in 2010. My surgical oncology and head and neck training was performed at the Fox Chase Cancer Center in Philadelphia from 2010 to 2012. At the same time I underwent a masters in science (Clinical research for health professionals) at the University of Drexel. Through the International Federation of Head and Neck Societies / Memorial Sloan Kettering Cancer Center I performed a two year head and neck surgery and oncology / endocrine fellowship that ended in 2016. Mi nombre es Rodrigo Arrangoiz, soy cirujano oncólogo / cirujano de tumores de cabeza y cuello / cirujano endocrino que trabaja Center for Advanced Surgical Oncology en Miami, Florida. Fui entrenado como cirujano en Michigan State University (2005 a 2010 ) donde fui jefe de residentes en 2010. Mi formación en oncología quirúrgica y e n tumores de cabeza y cuello se realizó en el Fox Chase Cancer Center en Filadelfia de 2010 a 2012. Al mismo tiempo, me sometí a una maestría en ciencias (investigación clínica para profesionales de la salud) en la Universidad de Drexel. A través de la Federación Internacional de Sociedades de Cabeza y Cuello / Memorial Sloan Kettering Cancer Center realicé una sub especialidad en cirugía de cabeza y cuello / cirugia endocrina de dos años que terminó en 2016.

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