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

Abstract

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