A Universal Level II Oncoplasty Technique in Difficult Situation

Oncoplastic breast surgery was introduced over 25 years ago with the integration of plastic surgery and breast cancer surgery. It follows two goals: the first one is the improvement of disease outcomes and local control, and the second one is the improvement of the quality of life. In some situations, oncoplastic breast surgery faces challenges, such as large tumors, skin involvements, and certain tumor locations, like the inner or central parts.
In this paper, we aim to describe a technique that was an old-fashioned technique, firstly used for reduction mammoplasty, and how the surgeon can use it as a universal level two oncoplastic breast surgery in complex situations. Therefore, the authors would recommend it to be applied whenever the other classic OBS techniques are not feasible. This technique can be adopted and applied to remove the tumors located in any part of the breast but the central part.
The technique starts with a classic incision of reduction mammoplasty. The skin flaps are made liberally over the tumor and can be extended to most parts of the breast except for the central part. The thickness of the flap is considered identical to the mastectomy flap to have the safest oncologic operation. After the skin flap preparation over the tumor site and tumor resection with respect to the central posterior vessels to the nipple, rotational pedicles of breast tissue fill the tumor site, and the skin is closed in a routine form mammoplasty.
Although this technique can be used in most complex situations, the best indication is in patients whose breasts are significantly ptotic who desire to rectify it and make the contralateral breast symmetric. The importance of this technique would be clearer when routine mammoplasty techniques (superomedial and inferior) cannot be adopted because of insufficient tissue to fill up the resection cavity or the risk of compromise on the vascular pedicles.