Immediate Breast Reconstruction after Quadrandectomy and Axillary Dissection with a Rhomboid Flap.
 
Manoel Pereira da Silva Neto, MD; Julio Hochberg, MD; Marcos F. Ardenghy, MD;
Roberto Gonzalez-Cruz, MD; James C Yuen, MD
 
In the treatment of breast cancer, quadrandectomy followed by axillary dissection and radiotherapy has demonstrated similar results when compared with modified radical mastectomy. After quadrandectomy three deformities are common: (1) Lack of skin and mammary gland, (2) Deviation or distortion of the nipple-areola complex and
(3) Breast retraction. The immediate reconstmction in such cases involves the use of latissimus dorsi muscle or myocutaneous flaps and local flaps.1,2,3,4,5,6
 
The rhomboid flap constitutes a new approach for immediate reconstruction of the quadrantectomy defects. The authors present their experience between June of 1997 and June of 1999, a total of 62 patients were operated with median age of 52.5 years. There were 90% ductal invasive carcinoma and 10% of other types of carcinoma. Sixty five percent of the patients showed node involvement. Complications occurred in 7% of the patients and consisted of wound healing problems, epidermolysis being the most common one. There were no major postoperative complications. Sentinel lymph node mapping/biopsy was performed in all cases.
 
The flap used was the rhomboid flap with skin and subcutaneous tissue and in 23 cases included breast tissue. After marking the extension of the tumor, the rhomboid flap was designed without compromising the safety margins and with the pedicle turned to the breast. Quadrantectomy and axillary dissection were performed. The flap was harvested up to the muscle to facilitate rotation. A drain was kept in place for 8 days.
 
The Rhomboid flap is a versatile flap to maintain the breast shape, avoiding a dorsal scar or mobilization of a muscle. It minimizes secondary deformities of the breast, making it a reliable alternative in breast reconstruction.
                  758_Fig1b  
   758_Fig1a     
  
Fig. 1a. Carcinoma of the right breast
     
Fig. 1b. Defect after quadrantectomy and axillary node dissection
 
   758_Fig1c         758_Fig1d    
  
Fig. 1c. Immediate result after reconstruction with rhomboid flap
       
Fig 1d. Result at 1 month
  
   758_Fig2a     758_Fig2b  
 
Fig. 2a. Ductal carcinoma of the left breast. Planning the quadrantectomy and flap
                    
     
Fig. 2b. Specimen
 
                      758_Fig2d     
    758_Fig2c            
                    
Fig. 2d. Immediate result after reconstruction
    
  
Fig. 2c. Result after quadrantectomy and axillary dissection
         
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               758_Fig3a      
    
Fig. 2e. Result at 2 months
          
Fig. 3a. Carcinoma of the right breast
     
       758_Fig3b                758_Fig3c       
     
Fig. 3b. & Fig. 3c. Immediate result after reconstruction with rhomboid flap
      
                         758_Fig4b       
       758_Fig4a                     
      
Fig. 4a. Carcinoma left breast at the upper pole
             
Fig. 4b. Resulting defect after quadrantectomy
      
         758_Fig3b          
         
Fig. 4c. Immediate result
        
        758_Fig5a   758_Fig5b        
                 
Fig. 5b. Immediate result after rhomboid flap reconstruction
       
       
Fig. 5a. Local invasive carcinoma left breast
        
 
References
 
1. Berrino P, Campora F, Santi P- Postquadrantectomy breast deformities: Classification and techniques of surgical correction. Plast Reconstr Surg 79:567, 1987
 
2. Cooperman AM, Dinner M- The rhomboid flap and partial mastectomy. Surg Clin North Am 58:869, 1978
 
3. Grisotti A, Veronesi J- Reconstruction of the radiated partial mastectomy defect with autogenous tissues (discussion). Plast Reconstr Surg 90: 866, 1985
 
4. Pearl RM, Wisnicki J- Breast reconstruction following lumpectomy and irradiation. Plast Reconstr Surg 76:83, 1985
 
5. Sacchini V, Nava M, Tana S et al: Quantitative and qualitative cosmetic evaluation after conservative treatment for breast cancer. Eu J Cancer 27:1395, 1991
 
6. Slavin SA, Love SM , Padosky L- Reconstruction of the radiated partial mastectomy defect with autogenous tissues. Plast Reconstr Surg 90: 854, 1992