Single Center Experience of Round Block Technique for Breast Surgery; Oncologic Safety and Patient Satisfaction
Abstract
Background: Round block technique (RBT) is a versatile technique for the excision of benign and malignant breast lesions with oncologic safety. Although a technically challenging procedure, it has the benefit of an inconspicuous scar and desirable aesthetic outcomes and wider exposure for tissue resection and remodelling. This study discusses the utility of RBT for the excision of different pathologies, complications, and cosmetic outcomes as it is underutilized in the developing countries.
Methods: The study was conducted at the breast surgery clinic, at Liaquat National Hospital. All patients with benign (fibroadenomas, benign phyllodes) or malignant (carcinoma, malignant phyllodes) lesions undergoing the round block technique were included. The clinical size, site, distance from the nipple, pathology, pathological size, and margin status were recorded. Early and late complications were documented during the follow-up. At the time of the final study analysis, patients were interviewed for cosmetic outcome satisfaction using the Harvard scale (4-point Likert score)
Results: Overall, 49 patients were included in the study over 2.5 years. The mean clinical tumor size was 4.72cm, of which 63% were in the upper quadrant, and the average distance from the areolar margin was 1.71cm. The pathology included 21 fibroadenomas and 18 carcinomas, with the mean size of 4.14cm. Early complications were seen in 12 cases, and late complications were observed in 2 cases which were all managed conservatively. The cosmetic outcome was found to be fair by 6.1% of the patients, good by 87%, and excellent by the 6.1% of them.
Conclusion: RBT is a technically challenging procedure but is easily adaptable. It provides good exposure for excision of both benign and malignant tumors of the breast while maintaining the oncologic safety margin and good cosmesis, especially for young patients with large lesion in the upper inner quadrant.
Full text article
References
Ogawa T. Usefulness of breast-conserving surgery using the round block technique or modified round block technique in Japanese females. Asian J Surg. 2014;37(1):8-14. doi: 10.1016/j.asjsur.2013.07.007.
Benelli L. A new periareolar mammaplasty: The “round block” technique. Aesthetic Plastic Surgery. 1990;14(1):93-100. doi: 10.1007/BF01578332.
Kim MK, Kim J, Jung SP, Bae SY, Choi MY, Lee SK, et al. Round block technique without cerclage in breast-conserving surgery. Ann Surg Oncol. 2013;20(10):3341-7. doi: 10.1245/s10434-013-3175-3.
Azzawi K, Humzah MD. Mammaplasty: the 'Modified Benelli' technique with de-epithelialisation and a double round-block suture. J Plast Reconstr Aesthet Surg. 2006;59(10):1068-72. doi: 10.1016/j.bjps.2005.11.036.
Gruber RP, Jones HW, Jr. The "donut" mastopexy: indications and complications. Plast Reconstr Surg. 1980;65(1):34-8.
Lim GH, Allen JC, Ng RP. Oncoplastic round block technique has comparable operative parameters as standard wide local excision: a matched case-control study. Gland Surg. 2017;6(4):343-9. doi: 10.21037/gs.2017.03.06.
Zeeshan S, Shaikh K, Tariq M, Vohra L. Giant Juvenile Fibroadenoma of the breast in a 13-year-old Pakistani girl with excellent cosmetic outcome after subareolar enucleation – A case report. International Journal of Surgery Case Reports. 2021;79. doi: 10.1016/j.ijscr.2021.01.094.
Daga G, Kumar R. Donut Mastopexy Lumpectomy. Indian J Surg Oncol. 2019;10(2):372-3. doi: 10.1007/s13193-018-0865-0.
Khanal S, Singh YP, Sharma R, Pandit K. Round Block Technique in Management of Breast Lesions. Kathmandu Univ Med J (KUMJ). 2019;17(67):248-50.
Refaat M, Abouelnagah G, Awad AT, Fayed HM, Abdelhady DA. Modified round block technique for peripherally located early cancer breast, a technique that fits for all quadrants. Breast J. 2020;26(3):414-9. doi: 10.1111/tbj.13485.
Giacalone PL, Dubon O, Roger P, El Gareh N, Rihaoui S, Daurés JP. Doughnut mastopexy lumpectomy versus standard lumpectomy in breast cancer surgery: a prospective study. Eur J Surg Oncol. 2007;33(3):301-6. doi: 10.1016/j.ejso.2006.09.014.
Kaviani A, Zand S, Ashraf-Ganjouei A, Younan R, Jacques Salmon R. A Novel Level I Oncoplastic Surgery Technique for Tumors Located in UIQ of the Breast Far from the Nipple: The "Cross" Technique. Plast Reconstr Surg Glob Open. 2019;7(7):e2269. doi: 10.1097/GOX.0000000000002269.
In SK, Kim YS, Kim HS, Park JH, Kim HI, Yi HS, et al. Retrospective review of 108 breast reconstructions using the round block technique after breast-conserving surgery: Indications, complications, and outcomes. Arch Plast Surg. 2020;47(6):574-82. doi: 10.5999/aps.2020.00325.
Burrah R, James K, Lund J, Vinayagam R. Breast conservation surgery by round block mammoplasty. Eur J Surg Oncol. 2020;46(2):240-4. doi: 10.1016/j.ejso.2019.10.034.
Kaviani A, Tabary M, Zand S, Araghi F, Patocskai E, Nouraie M. Oncoplastic Repair in Breast Conservation: Comprehensive Evaluation of Techniques and Oncologic Outcomes of 937 Patients. Clin Breast Cancer. 2020;20(6):511-9. doi: 10.1016/j.clbc.2020.05.016.
Lai HW, Kuo YL, Su CC, Chen CJ, Kuo SJ, Chen ST, et al. Round block technique is a useful oncoplastic procedure for multicentric fibroadenomas. Surgeon. 2016;14(1):33-7. doi: 10.1016/j.surge.2014.03.009.
Zaha H, Onomura M, Unesoko M. A new scarless oncoplastic breast-conserving surgery: modified round block technique. Breast. 2013;22(6):1184-8. doi: 10.1016/j.breast.2013.07.056.
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 Surgery. 2017;6(6):689-97. doi: 10.21037/gs.2017.06.11.
Authors
Copyright (c) 2023 Archives of Breast Cancer
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Copyright©. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non-Commercial 4.0 International License, which permits copy and redistribution of the material in any medium or format or adapt, remix, transform, and build upon the material for any purpose, except for commercial purposes.