Study cohort and data sources. All consecutive patients who underwent a traditional “J” mammoplasty or a “Crescent” technique at our Institution between July 2016 and December 2021 were analyzed for this retrospective study with a level IV of evidence. An informed consent was obtained from all women. Data were collected from computerized patient’s records.
The inclusion criteria for both techniques were:
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Patients with early breast cancer (T1) of LQ, LIQ and LOQ requiring a BCS. Feasibility for T2 breast cancer were evaluated individually in according to favourable tumor size/breast size ratio;
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Small (cup A/B) or medium (cup C) sized breast.
The exclusion criteria for both techniques were:
The exclusion criteria for “Crescent” technique were:
Fifty-eight patients were enrolled in the study and divided into two groups: twenty-nine patients underwent the “Crescent” technique and twenty-nine underwent the “J” mammoplasty technique. The study focused on oncological safety and surgical complications, which were divided into minor and major complications. Minor complications included: wound infection which only required antibiotic therapy, marginal skin necrosis/partial Nipple Areola Complex (NAC) necrosis managed without further surgery, fat necrosis, ecchymosis and seromas. Major complications involved: complete and partial NAC necrosis which required surgery, wound dehiscence and haematoma. Furthermore, aesthetic results were evaluated at least six months after radiotherapy (RT). Cosmetic outcomes were assessed by two senior breast surgeons, independently, evaluating the following criteria: volume symmetry, breast shape, nipple-areola complex symmetry, scars and overall appearance of the breast and NAC (excellent, good, fair, poor, bad) as described by Clough et al [10]. In conclusion, we developed an algorithm to allow an effective pre-operative surgical strategy for the treatment of lower breast cancer in medium/small size breasts.
SURGICAL TECHNIQUE: The Crescent technique described by Nos et al. [11] is characterized by a fasciocutaneous flap taken from the fatty area below the inframammary fold. The “Crescent” flap is designed by drawing the following two lines: the first one is situated 0.5 cm above the inframammary fold and the second one 1 cm below it, corresponding to the width of the flap. The skin and the subcutaneous tissue are incised along the upper line with electrocautery up to the pectoralis major muscle. Breast parenchyma is raised from the muscle following the pectoralis fascia to allow a wide resection of the tumor. Subsequently de-epithelialization of the skin area situated between the incision and the inferior line below the inframammary fold is performed. In order to realize the “Crescent” fasciocutaneous flap, the inferior line is incised laterally and medially to a central zone which is left attached to the thoracic wall. No preset flap thickness was used. After checking the flap volume and its perfusion, the two edges of the “Crescent” flap are stitched together and pulled up to fill the breast defect. In case of lateral or medial defect a hemiflap can be easily raised through the incision of the inferior line only in the lateral or medial part of the attached area realizing the so called “Emicrescent” technique.
The lower quadrants J mammoplasty technique is performed to resect tumors situated into inferior quadrants, with a predilection for those located in the LOQ. It allows the excision of a larger portion of breast parenchyma when compared to both “Crescent” and “Emicrescent” techniques. The tumor, the overlying skin and the adjacent glandular tissue are removed thanks to a wide incision shaped like a “J” starting from the NAC and descending down to the inframammary fold inward or outward depending on the tumor location. The NAC is subsequently recentralized through the de-epithelialization of an upper outer/inner periareolar skin crescent directly opposite from the initial tumor position. This technique leaves a “J” scar formed by the radial, inframammary and periareolar incisions.
STATISTICAL ANALYSIS: Quantitative variables were analyzed using the Student’s T test to detect differences between the two groups. Categorical variables were analyzed using the Chi square test and the Fisher’s exact test. A p value of 0.05 or less was considered statistically significant. All the analyses were performed using SPSS 22 software package (SPSS, Inc., Chicago, IL).