Preventing Bird’s Beak Deformity: A narrative review of Innovations in Oncoplastic Surgery Preventing beak's deformity

Masakuni Noguchi (1), Masafumi Inokuchi (2), Miki Yokoi-Noguchi (3), Emi Morioka (4), Yusuke Haba (5)
(1) Department of Breast and Endocrine Surgery, Breast Center, Kanazawa Medical University Hospital, Uchinada, Ishikawa, Japan, Japan,
(2) Department of Breast and Endocrine Surgery, Breast Center, Kanazawa Medical University Hospital, Uchinada, Ishikawa, Japan, Japan,
(3) Department of Breast and Endocrine Surgery, Breast Center, Kanazawa Medical University Hospital, Uchinada, Ishikawa, Japan, Japan,
(4) Department of Breast and Endocrine Surgery, Breast Center, Kanazawa Medical University Hospital, Uchinada, Ishikawa, Japan, Japan,
(5) Department of Breast and Endocrine Surgery, Breast Center, Kanazawa Medical University Hospital, Uchinada, Ishikawa, Japan, Japan

Abstract

Background: In the field of breast surgery, breast conserving surgery (BCS) is widely valued for its ability to preserve the breast while also achieving cosmetically acceptable outcomes and an overall survival rate comparable to that of total mastectomy. However, BCS has not always managed to achieved satisfactory cosmetic results. Among its challenges is the “bird’s beak” deformity, which is characterized by skin retraction and a downward deviation of the nipple areolar complex due to tissue excision from the lower pole of the breast.


Methods: Various forms of oncoplastic surgery (OPS) have been developed to prevent bird’s beak deformity. These include volume displacement operations (such as superior pedicle mammoplasty, rotation technique and downward-mobilization procedure), as well as volume replacement techniques, including the latissimus dorsi mini-flap, thoracodorsal artery perforator flap, lateral intercostal artery perforator flap, anterior intercostal artery perforator flap, inframammary adipofascial flap and lipofilling.


Conclusion: Choosing the most suitable approach for OPS requires careful consideration of various factors, notably the defect’s size and location, the size of the breast, and the thickness of subcutaneous fatty tissue. Further studies are required to firmly position these forms of OPS techniques in an evidence-based framework.

Full text article

Generated from XML file

References

Clough KB, Cuminet J, Fitoussi A, Nos C, Mosseri V. Cosmetic sequelae after conservative treatment for breast cancer: classification and results of surgical correction. Ann Plast Surg 1998; 41(5):471-481. doi: 10.1097/00000637-199811000-00004

Gass J, Mitchell S, Hanna M. The psychosocial impact of surgical scars in survivorship: findings form a nationwide survey of women breast cancer survivors [abstract]. In: proceddings of the 2017 San Antonio Breast Cancer Symposium; 5-9 Dec 2017; San Antonio. TX.

Pearl RM, Wisnicki J. Breast reconstruction following lumpectomy and irradiation. Plast Recontr Surg 1985; 76(1):83-86. doi: 10.1097/00006534-198507000-00014

Cochrane RA, Valasiadou P, Wilson ARM, AI-Ghazal SK, Macmillan RD. Cosmesis and satisfaction after breast-conserving surgery correlates with the percentage of breast volume excised. Br J Surg 2003; 90:1505-1509. doi: 10.1002/bjs.4344

Bulstrode NW, Shrotria S. Prediction of cosmetic outcome following conservative breast surgery using breast volume measurements. Breast 2001; 10(2):124-126. doi: 10.1054/brst.2000.0197

Clough KB, Kaufman GJ, Nos C, Buccimazza I, Sarfati IM. Improving breast cancer surgery: a classification and quadrant per quadrant atlas for oncoplastic surgery. Ann Surg Oncol 2010; 17(5):1375-1391. doi: 10.1245/s10434-009-0792-y.

Clough KB, Nos C, Salmon RJ, Soussaline M, Durand JC. Conservative treatment of breast cancers by mammoplasty and irradiation: a new approach to lower quadrant tumors. Plast Reconstr Surg 1995; 96(2):363-370. doi: 10.1097/00006534^199508000-00015

Clough KB, Soussaline M, Campana F, Salmon RJ. Mammoplasty combined with irradiation: conservative treatment of breast cancer localized in the lower quadrant. Ann Chir Plast Esthet 1990; 35(2):117-122 [in French].

Audretsch W, Kolotas Ch, Rezai M, Schmitt G, Zamboglou N. Oncoplastic surgery in breast conserving therapy and flap supported operability In: Presented at the Annual Symposium on Breast Surgery and Body Contouring. Santa Fe, New Mexico 1993.

Noguchi M, Yokoi-Noguchi M, Ohno Y, Morioka E, Nakano Y, Kosaka T, Kurita T. Oncoplastic breast conserving surgery: volume replacement vs. volume displacement. Eur J Surg Oncol 2016; 42:926-934. http://dx.doi.org/10.1016/j.ejso.2016.02.248

Silverstein MJ, Savalia N, Khan S, Ryan J. Extreme oncoplasty: Breast conservation for patients who need mastectomy. Breast J 2015; 21:52-59. doi. 10.1111/tbj.12356

Chatterjee A, Gass J, Patel K, Holmes D, Kopkash K, Peiris L, et al. A consensus definition and classification system of oncoplastic surgery developed by the American Society of Breast Surgeons. Ann Surg Oncol 2019; 26:3436-3444. https://doi.org/10.1245/s10434-019-07345-4

Noguchi M, Taniya T, Miyazaki I, Saito Y. Immediate transposition of a latissimus dorsi muscle for correcting a postquadrantectomy breast deformity in Japanese patients. Int Surg 1990; 75(3):166-170

Noguchi M, Saito Y, Mizukami Y, Nonomura A, Koyasaki N, Taniya T, Miyazaki I. Breast deformity, its correction, and assessment of breast conserving surgery. Breast Cancer Res Treat 1991; 18:111-118.

Clough KB, Ihrai T, Oden S, Kaufman G, Massey E, Nos C. Oncoplastic surgery for breast cancer based on tumor location and a quadrant-per-quadrant atlas. Brit J Surg 2012; 99:1389-1395. doi: 10.1002/bjs.8877

Clough KB, Lewis JS, Couturaud B, Fitoussi A, Nos C, Falcou M-C. Oncoplastic techniques allow extensive resections for breast-conserving therapy of breast carcinomas. Ann Surg 2003; 237(1):26-34.

Kronowitz SJ, Hunt KK, Kuerer HM, Strom EA, Buchholz TA, Ensor JE, Koutz CA, Robb GL. Practical guidelines for repair of partial mastectomy defects using the breast reduction technique in patients undergoing breast conservation therapy. Plast Reconstr Surg 2007; 120(7):1755-1768. doi: 10.1097/01.prs.0000287130.77835.f6

Clough KB, Kroll SS, Audretsch W. An approach to the repair of partial mastectomy defects. Plast Reconstr Surg 1999; 104(2):409-420. doi: 10.1097/00006534-199908000-00014

Colombo P-E, Lefevre M, Delmond L, Traore D, Jacot W, Mourregot A, Gutowski M, Bertrand MM, Rouanet P. Oncoplastic resection of breast cancers located in the lower-inner or lower-outer quadrant with the modified McKissock Mammaplasty technique. Ann Surg Oncol 2015; 22:S486-S494. doi.10.1245/s10434-015-4727-5

Kim J, Yoo J, Lee J, Chang E, Suh K. Oncoplastic reconstruction with superior based lateral breast rotation flap after lower quadrant tumor resection. J Breast Cancer http://dx.doi.org/10.4048/jbc.2012.15.3.350

Miyake T, Kagara N, Shimada M, Tabuchi Y, Motomura K, Tanei T, BNaoi Y, Shimazu K, Kim SJ, Noguchi S. Aeshetic utility of addition of nipple-areola recentralization to rotation flap according to nipple tumor distance for patients with lower-outer or upper-inner located breast cancer. J Plast Recontr Aesthe Surg 2021; 74:1629-1632. https://doi.org/10.1016/j.bjps.2021.03.051

Noguchi M, Ohno Y, Morioka E, Noguchi M, Nakano Y, Kosaka T, Shimada K. A novel oncoplastic technique for breast cancer localized in the lower pole of the breast. J Surg Oncol 2018; 117:137-141. doi: 10.1002/jso.24824

Noguchi M, Morioka E, Yokoi-Noguchi M, Haba Y, Inokuchi M, Hisano M. Oncoplastic breast surgery to prevent “Bird’s beak” deformity in the breast: a comparative retrospective study. Surgery Today. 2024; 54:14-22. https://doi.org/10.1007/s00595-023-02690-0

Noguchi M, Taniya T, Kobayashi N, et al. Immediate mammoplasty for the breast deformity after quadrantectomy. Operation 1989; 43:1521-1524 [in Japanese]

Noguchi M, Saito Y, Taniya T, Kitagawa H, Ohta N, Earashi M, Thomas M, Miyazaki I, Nonomura A, Mizukami Y, Nakamura S, Michigishi T. Wide resection with latissimus dorsi muscle transposition in breast conserving surgery. Surg Oncol 1992; 1: 231-236.

Raja MAK, Straker VF, Rainsbury RM. Extending the role of breast-conserving surgery by immediate volume replacement. Br J Surg 1997; 84:101-105.

Rainsbury RM, Paramanthan N. Recent progress with breast-conserving volume replacement using latissimus dorsi miniflaps in UK patients. Breast Cancer 1998; 5(2):139-147. doi: 10.1007/BF02966686

Rainsbury RM. Breast-sparing reconstruction with latissimus dorsi miniflaps. Eur J Surg Oncol 2002; 28:891-895. doi: 10.1053/ejso.2002.1350.

Rainsbury RM. Surgery insight: oncoplastic breast-conserving reconstruction -indications, benefits, choices and outcomes. Nat Clin Prac Oncol.2007; 4(11):657-664. doi: 10.1038/ncpono0957

Hemanz F, Regano S, Redondo-Figuero C, Orallo V, Erasun F, Gomez-Fleitas M. Oncoplastic breast-conserving surgery: analysis of quadrantectomy and immediate reconstruction with latissimus dorsi flap. World J Surg 2007; 31(10):1934-1940. Doi: 10.1007/s00268-007-9196-y

Nano MT, Gill PG, Kollias J, Bochner MA. Breast volume replacement using the latissimus dorsi miniflap. ANZ J Surg 2004 74:98-104.

De Lorenzi F, Borelli F, Alessandri-Bonetti M, Marchetti A, Dias LPN, Invento A, Rossi EMC, Loschi P, Veronesi P. A new level II oncoplastic technique for inferior pole defects: The three-petal glandular reconstruction (3-pR). Aesth Plast Surg. https://doi.org/10.1007/s00266-022-03119-8

Hojvig JH, Henriksen M, Bartholdy CR, Bonde CT. Donor-site morbidity following breast reconstruction with a latissimus dorsi flap -A prospective study. J Plast Aesthet Surg 2022; 75:2205-2210. doi: 10.1016/j.bjps.2022.01.036.

Hamdi M, Van Landuyt K, Monstrey S, Blondeel P. Pedicled perforator flaps in breast reconstruction: a new concept. Br J Plast Surg 2004; 57:531-539. doi:10.1016/j.bjps.2004.04.015

Mangialardi ML, Baldelli I, Salgarello M, Raposio E. Thoracodorsal artery perforator flap in partial breast reconstruction: a systemic review. Plast Reconstr Surg Glob Open 2020; 8:e3104; doi:10.1097/GOX.0000000000003104

Denning M, Hayes P, Tsang F, Leff D, Thiruchelvam P, Hadjiminas D. The modified crescenteric anterior intercostal perforator flap. Plast Recontr Surg Glob Open 2020; 8:e2785. doi: 10.1097/GOX.0000000000002785.

Quinn EM, Burrah R, O’Ceallaigh S, Highton L, Murphy J. Six-year experience of oncoplastic volume replacement using local perforator flaps. J Plast Reconstr Aesthet Surg 2021; 74:2184-2193. doi: 10.1016/j.bjps.2020.12.083.

Kim JB, Kim DK, Lee JW, Choi KY, Chung HY, Cho BC, Park HY, Lee JY, Yang JD. The usefulness of pedicled perforator flap in partial breast reconstruction after breast conserving surgery in Korean women. Arch Plast Surg 2018; 45:29-36. https://doi.org/10.5999/aps.2017.01200

Abdelrahman EM, Nawar AM, Balbaa MA, Shoulah AA, Shora AA, Kharoub MS. Oncoplastic volume replacement for breast cancer: Latissimus dorsi flap versus thoracodorsal artery perforator flap. Plast Reconstr Surg Glob Open 2019; 7:e2476; doi: 10.1097/GOX.0000000000002476

Sakai S, Suzuki I, Izawa H. Adipofascial (anterior rectus sheath) flaps for breast reconstruction. Ann Plast Surg 1992; 29:173-177.

Ogawa T, Hanamura N, Yamashita M, Ri Y, Kuriyama N, Isaji S. Usefulness of breast-volume replacement using an inframammary adipofascial flap after breast-conserving therapy. Am J Surg 2007; 193:514-518. doi: 10.1016/j.amjsurg.2006.07.018

Kijima Y, Yoshinaka H, Owaki T, Funasako Y, Aikou T. Immediate reconstruction using inframammary adipofascial flap of the anterior rectus sheath after partial mastectomy. Am J Surg 2007; 193:789-791. Doi: 10.1016/j.amjsurg.2006.06.052

Kijima Y, Yoshinaka H, Hirata M, Arima H, Nakajo A, Shinden Y, Uenosono Y, Okumura H, Ishigami S, Natsugoe S. Oncoplastic surgery combining partial mastectomy and immediate volume replacement using a thoracodorsal adipofascial cutaneous flap with a crescent-shaped dermis. Surg Today 2014; 44:2098-2105. doi: 10.1007/s00595-013-0812-1

Otsuka S, Watanabe N, Sasaki Y, Shimojima R. Postoperative courses of breast reconstruction using inferior adipofascial tissue repair. Breast Cancer 2015; 22(6):570-577. doi: 10.1007/s12282-014-0522-6

Nakada H, Inoue M, Furuya K, Watanabe H, Ikegame K, Nakayama Y, Ohmori M, Nakagomi H. Fat necrosis after breast-conserving oncoplastic surgery. Breast Cancer 2019; 26:125-130. https://doi.org/10.1007/s12282-018-0901-5

Cohen S, Sekigami Y, Schwartz T, Losken A, Margenthaler J, Chatterjee A. Lipofilling after breast conserving surgery: a comprehensive literature review investigating its oncologic safety. Gland Surg 2019; 8(5):569-580. http://dx.doi.org/10.21037/gs.2019.09.09

Garcia RM, Alonso VG, Domenech MEV. Fat grafting in immediate breast reconstruction. Avoiding breast sequelae. Breast Cancer 2016; 23:134-140. doi 10.1007/s12282-014-0541-3

Stumpf CC, Zucatto AE, Cavalheiro JAC, de Melo MP, Cericato R, Damin APS, Biazus JV. Oncologic safety of immediate autologous fat grafting for reconstruction in breast-conserving surgery. Breast Cancer Res Treat 2020; 180:301-309. https://doi.org/10.1007/s10549-020-05554-0

Authors

Masakuni Noguchi
nogumasa@kanazawa-med.ac.jp (Primary Contact)
Masafumi Inokuchi
Miki Yokoi-Noguchi
Emi Morioka
Yusuke Haba
1.
Noguchi M, Inokuchi M, Yokoi-Noguchi M, Morioka E, Haba Y. Preventing Bird’s Beak Deformity: A narrative review of Innovations in Oncoplastic Surgery : Preventing beak’s deformity. Arch Breast Cancer [Internet]. 2024 Oct. 25 [cited 2024 Nov. 14];11(4). Available from: https://archbreastcancer.com/index.php/abc/article/view/981

Article Details

Most read articles by the same author(s)