Burow’s triangle advancement flap

a reliable tool on oncoplastic breast-conserving surger

Authors

Keywords:

breast neoplasms, surgical flaps, mastectomy, segmental, mammaplasty

Abstract

Oncoplastic techniques in breast cancer treatment allow increasing indications of breast-conserving surgery and improving cosmetic results. Breast tumors located at the superior edge of the upper quadrant or at the upper inner quadrant represent a challenge for conservative surgery due to insufficient breast thickness and risk of skin involvement. We present a modified Burow’s triangle advancement flap for breast-conserving surgery in patients with breast tumors at these locations. This retrospective observational study analyzed 8 out of 213 patients submitted to major oncoplastic breast procedures, who underwent breast-conserving surgery with matrix rotation mammaplasty, using a modified Burow’s triangle advancement flap. All patients were treated in public and private health systems in Santiago, Chile. The median age at diagnosis was 47 years. The average initial tumor size was 5.9 cm, and the mean excised breast weight was 117 g. Patients required neither symmetrization nor displacement of the nipple-areola complex. Only one patient had a minor complication (wound dehiscence). During follow-up, no local recurrences were reported. We conclude that the modified Burow’s triangle advancement flap is a safe and effective technique to manage tumors at this complex location. It provides adequate oncological margins, good cosmetic results, and contralateral symmetry, with complication rates similar to those of standard conservative surgery.

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Author Biographies

Jaime Letzkus, University of Chile Medical School

Breast Surgery Department, Obstetrics and Gynecology Service, San Borja Arriarán Clinical Hospital – Santiago, Chile. Academic Obstetrics and Gynecology Department, University of Chile Medical School, Santiago, Chile. Private practice breast surgeon – Santiago, Chile

Maria José Del Río, University of Chile Medical School

Breast Surgery Department, Obstetrics and Gynecology Service, San Borja Arriarán Clinical Hospital – Santiago, Chile. Academic Obstetrics and Gynecology Department, University of Chile Medical School, Santiago, Chile.

Carlos Rencoret

Private practice breast surgeon.

Alejandro Belmar, San Borja Arriarán Clinical Hospital

Breast Surgery Department, Obstetrics and Gynecology Service, San Borja Arriarán Clinical Hospital – Santiago, Chile.

Galina Ivanova, University of Chile Medical School

Breast Surgery Department, Obstetrics and Gynecology Service, San Borja Arriarán Clinical Hospital – Santiago, Chile. Academic Obstetrics and Gynecology Department, University of Chile Medical School, Santiago, Chile

Daniela Hidalgo, San Borja Arriarán Clinical Hospital

Breast Surgery Department, Obstetrics and Gynecology Service, San Borja Arriarán Clinical Hospital – Santiago, Chile.

Jorge Gamboa, University of Chile Medical School

Breast Surgery Department, Obstetrics and Gynecology Service, San Borja Arriarán Clinical Hospital – Santiago, Chile. Academic Obstetrics and Gynecology Department, University of Chile Medical School, Santiago, Chile

References

Fisher B, Anderson S, Bryant J, Margolese RG, Deutsch M, Fisher ER, et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med. 2002;347(16):1233-41. https://doi.org/10.1056/NEJMoa022152

Veronesi U, Cascinelli N, Mariani L, Greco M, Saccozzi R, Luini A, Aguilar M, et al. Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med. 2002;347(16):1227-32. https://doi.org/10.1056/NEJMoa020989

Clough KB, Lewis JS, Couturaud B, Fitoussi A, Nos C, Falcou M-C. Oncoplastic techniques allow extensive resections for breast-conserving therapy of breast carcinomas. Ann Surg. 2003;237(1):26-34. https://doi.org/10.1097/00000658-200301000-00005

Munhoz AM, Montag E, Gemperli R. Oncoplastic breast surgery: indications, techniques and perspectives. Gland Surg. 2013;2(3):143-57. https://doi.org/10.3978/j.issn.2227-684X.2013.08.02

Chatterjee A, Gass J, Patel K, Holmes D, Kopkash K, Peiris L, et al. A Consensus Definition and Classification System of Oncoplastic Surgery Developed by the American Society of Breast Surgeons. Ann Surg Oncol. 2019;26(11):3436-44. https://doi.org/10.1245/s10434-019-07345-4

Youssif S, Hassan Y, Tohamy A, Eld S, Ashour T, Malahias M, et al. Pedicled local flaps: a reliable reconstructive tool for partial breast defects. Gland Surg. 2019;8(5):527-36. https://doi. org/10.21037/gs.2019.09.06

Clough KB, Kaufman GJ, Nos C, Buccimazza I, Sarfati IM. Improving breast cancer surgery: a classification and quadrant per quadrant atlas for oncoplastic surgery. Ann Surg Oncol. 2010;17(5):1375-91. https://doi.org/10.1245/s10434-009-0792-y

Kronowitz SJ, Kuerer HM, Buchholz TA, Valero V, Hunt K. A management algorithm and practical oncoplastic surgical techniques for repairing partial mastectomy defects. Plast Reconstr Surg. 2008;122(6):1631-47. https://doi.org/10.1097/PRS.0b013e31818cbf1b

Petit J-Y, Rietjens M, Lohsiriwat V, Rey P, Garusi C, Lorenzi F, et al. Update on breast reconstruction techniques and indications. World J Surg. 2012;36(7):1486-97. https://doi. org/10.1007/s00268-012-1486-3

Kramer S, Darsow M, Kummel S, Kimmig R, Rezai M. Breast-conserving treatment of breast cancer--oncological and reconstructive aspects. Gynakol Geburtshilfliche Rundsch. 2008;48(2):56-62. https://doi.org/10.1159/000118932

Lin J, Chen D-R, Wang Y-F, Lai H-W. Oncoplastic Surgery for Upper/Upper Inner Quadrant Breast Cancer. PLoS One. 2016;11(12):e0168434. https://doi.org/10.1371/journal.pone.0168434

Gormley DE. A Brief Analysis of the Burow’s Wedge/Triangle Principle. The Journal of Dermatologic Surgery and Oncology. 1985;11(2):121-3. https://doi.org/10.1111/j.1524-4725.1985.tb02978.x

Quatrano NA, Samie FH. Modification of Burow’s Advancement Flap. JAMA. 2014;16(5):364-6. https://doi.org/10.1001/jamafacial.2014.427

Krishnan R, Garman M, Nunez-Gussman J, Orengo I. Advancement flaps: a basic theme with many variations. Dermatol Surg. 2005;31(S2):986-94. https://doi.org/10.1111/j.1524-4725.2005.31823

Quatrano NA, Dawli TB, Park AJ, Samie FH. Simplifying Forehead Reconstruction: A Review of More Than 200 Cases. Facial Plast Surg. 2016;32(3):309-14. https://doi.org/10.1055/s-0036-1579780

Wang SQ, Goldberg LH. Burow’s Wedge Advancement Flap for Lateral Forehead Defects. Dermatol Surg. 2006;32(12):1505-8. https://doi.org/10.1111/j.1524-4725.2006.32363.x

Zivony D, Siegle RJ. Burowʼs Wedge Advancement Flaps for Reconstruction of Adjacent Surgical Defects. Dermatol Surg. 2002;28(12):1162-4. https://doi.org/10.1097/00042728-200212000-00013

Boggio P, Gattoni M, Zanetta R, Leigheb G. Burowʼs Triangle Advancement Flaps for Excision of Two Closely Approximated Skin Lesions. Dermatol Surg. 1999;25(8):622-5. https://doi.org/10.1046/j.1524-4725.1999.99053.x

Pilewskie M, Morrow M. Margins in breast cancer: How much is enough? Cancer. 2018;124(7):1335-41. https://doi.org/10.1002/cncr.31221

Harris J, Levene M, Svensson G, Hellman S. Analysis of cosmetic results following primary radiation therapy for stages I and II carcinoma of the breast. Int J Radiation Oncology Biol Phys. 1979;5(2):257-61. https://doi.org/10.1016/0360-3016(79)90729-6

Munhoz AM, Montag E, Arruda E, Aldrighi C, Filassi JR, Barros AC, et al. Reliability of inferior dermoglandular pedicle reduction mammaplasty in reconstruction of partial mastectomy defects: surgical planning and outcome. Breast. 2007;16(6):577-89. https://doi.org/10.1016/j.breast.2007.04.008

Bramhall RJ, Lee J, Concepcion M, Westbroek D, Huf S, Mohammed K, et al. Central round block repair of large breast resection defects: oncologic and aesthetic outcomes. Gland Surg. 2017;6(6):689-97. https://doi.org/10.21037/gs.2017.06.11

Dogan L, Gulcelik MA, Karaman N, Camlibel M, Serdar GK, Ozaslan C. Intraglandular flap technique for tumors located in the upper outer quadrant of the breast. Clin Breast Cancer. 2012;12(3):194-8. https://doi.org/10.1016/j.clbc.2012.03.010

Anderson BO, Masetti R, Silverstein MJ. Oncoplastic approaches to partial mastectomy: an overview of volume-displacement techniques. Lancet Oncol. 2005;6(3):145-57. https://doi.org/10.1016/S1470-2045(05)01765-1

Grisotti A, Calabrese C. Conservative treatment of breast cancer: reconstructive Issues. In: Spear SL, Willey SC, editors. Surgery of the Breast: Principles and Art. 2ª ed. Lippincott: Williams & Wilkins; 2006. p.147-8.

Munhoz AM, Montag E, Fels KW, Arruda EG, Sturtz G, Aldrighi C, et al. Outcome analysis of breast-conservation surgery and immediate latissimus dorsi flap reconstruction in patients with T1 to T2 breast cancer. Plast Reconstr Surg. 2005;116(3):741-52. https://doi.org/10.1097/01.prs.0000176251.15140.36

Stumpf CC, Zucatto ÂE, Cavalheiro JAC, Melo MP, Cericato R, Damin APS, et al. Oncologic safety of immediate autologous fat grafting for reconstruction in breast-conserving surgery. Vol. 180, Breast Cancer Research and Treatment. 2020;180:301-9. https://doi.org/10.1007/s10549-020-05554-0

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Published

2021-04-05

How to Cite

Letzkus, J., Del Río, M. J., Rencoret, C., Belmar, A., Ivanova, G., Hidalgo, D., & Gamboa, J. (2021). Burow’s triangle advancement flap: a reliable tool on oncoplastic breast-conserving surger. Mastology, 31, 1–8. Retrieved from https://revistamastology.emnuvens.com.br/revista/article/view/300

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Original Articles