Cross Oncoplastic Breast Surgery Technique; A Good Choice for Tumors Located Far From Nipple Areola Complex

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Ahmad Kaviani
Amir Ashraf Ganjuei
Sanaz Zand
Ahmad Elahi
Mahtab Vasigh
Hamid Ahmadi
Marzieh Kord Zanganeh
Remy Salmon
Samira Rahmani


Oncoplastic breast surgery, Cross technique, Breast tumor, Far from NAC


Background: Although various Oncoplastic Breast Surgery (OBS) techniques have been introduced for varied sizes of the breast and locations of tumors , surgeons are still faced with serious challenges for tumors which have developed in special anatomic part of the breast. A good instance of these challenges is the tumors located far from Nipple Areola Complex (NAC) especially in the upper inner quadrant. We aimed to assess the application of newly introduced OBS technique (Cross Technique) in these situations.
Methods: The data of 95 patients who suffered from breast cancer and operated with Cross method were assessed in this prospective survey. Data was gathered regarding demographic variables, the size, location, and pathologic characteristics of tumors, patients' BMI and breast circumference and cup size. The patients were recruited to the study according to inclusion and exclusion criteria and the study protocol which was approved by the research deputy of department of surgery, Tehran University of Medical Sciences. Data was presented in a descriptive method.
Results: Nighty-five patients underwent oncoplastic breast surgery using the Cross method from November 2015 to May 2018. Patients had a mean age of 48.2 ranging from 25 to 70 years. The patients had a wide range of breast circumference and cup size (70 to 95 for the breast circumference and A to E for the cup size).
Clear surgical margin was obtained in 93 cases according to the permanent pathology reports. The complications were seen in 5 patients all managed conservatively (2 slight hematoma and three ischemic skin flaps). The most common histologic type was insitu and invasive ductal carcinoma (DCIS-IDC). Mean tumor size was 22.7 mm with standard deviation of 9.2mm, most of which were positive for estrogen receptor (ER)/progesterone receptor (PR). As the surgery of axilla, six lymph nodes were excised on average and 22 patients had axillary lymph node involvement.
Conclusion: The Cross method is not only a reliable choice for tumors located in the UIQ, but it can also be applied safely for tumors in UOQ and upper central part of the breast, although the best application for the technique is the tumors located far from nipple areola complex.

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