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Shaping the Breast in Aesthetic and Reconstructive Breast Surgery: An Easy Three-Step Principle. Part III-Reconstruction following Breast Conservative Treatment

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Abstract
Of the relatively few studies that exist regarding the cosmetic satisfaction of patients following breast conservation therapy, several indicate significant dissatisfaction in many patients. Breast conservation often results in some of the most challenging and complex reconstructive problems. Indeed, even defining the problem or analyzing the defect can be difficult for the junior surgeon. For the more seasoned reconstructive surgeon, analyzing the problem and applying solutions may be less difficult, but clearly communicating the defects typically seen after an aggressive lumpectomy and radiotherapy can be difficult, especially with trainees or junior surgeons. The goal of this article, the third in a four-part series, is to provide a template for the analysis and surgical reconstruction of defects resulting from breast conservation therapy utilizing a systematic three-step method. Part I of this series described the three main anatomical features of the breast-the footprint, the conus of the breast, and the skin envelope-and how they interact. By systematically analyzing the breast with this three-step method, a "problem list" based in specific anatomic traits of the breast can be generated, allowing the surgeon to then generate an appropriate surgical plan for reconstruction. Surgical approaches based on the percentage of breast parenchyma resected are suggested, with a focus on glandular rearrangement, breast reduction techniques, and locoregional flaps. The three-step method of breast analysis, evaluating the anatomical deformation of the breast footprint, conus, and skin envelope, remains the fundamental "fall-back" principle of this approach.
Keywords
THERAPY, IRRADIATION, PARTIAL MASTECTOMY DEFECTS, CANCER, LATERAL THORACODORSAL FLAP

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MLA
Blondeel, Phillip et al. “Shaping the Breast in Aesthetic and Reconstructive Breast Surgery: An Easy Three-Step Principle. Part III-Reconstruction Following Breast Conservative Treatment.” PLASTIC AND RECONSTRUCTIVE SURGERY 124.1 (2009): 28–38. Print.
APA
Blondeel, P., Hijjawi, J., Depypere, H., Roche, N., & Van Landuyt, K. (2009). Shaping the Breast in Aesthetic and Reconstructive Breast Surgery: An Easy Three-Step Principle. Part III-Reconstruction following Breast Conservative Treatment. PLASTIC AND RECONSTRUCTIVE SURGERY, 124(1), 28–38.
Chicago author-date
Blondeel, Phillip, John Hijjawi, Herman Depypere, Nathalie Roche, and Koenraad Van Landuyt. 2009. “Shaping the Breast in Aesthetic and Reconstructive Breast Surgery: An Easy Three-Step Principle. Part III-Reconstruction Following Breast Conservative Treatment.” Plastic and Reconstructive Surgery 124 (1): 28–38.
Chicago author-date (all authors)
Blondeel, Phillip, John Hijjawi, Herman Depypere, Nathalie Roche, and Koenraad Van Landuyt. 2009. “Shaping the Breast in Aesthetic and Reconstructive Breast Surgery: An Easy Three-Step Principle. Part III-Reconstruction Following Breast Conservative Treatment.” Plastic and Reconstructive Surgery 124 (1): 28–38.
Vancouver
1.
Blondeel P, Hijjawi J, Depypere H, Roche N, Van Landuyt K. Shaping the Breast in Aesthetic and Reconstructive Breast Surgery: An Easy Three-Step Principle. Part III-Reconstruction following Breast Conservative Treatment. PLASTIC AND RECONSTRUCTIVE SURGERY. PHILADELPHIA: LIPPINCOTT WILLIAMS & WILKINS; 2009;124(1):28–38.
IEEE
[1]
P. Blondeel, J. Hijjawi, H. Depypere, N. Roche, and K. Van Landuyt, “Shaping the Breast in Aesthetic and Reconstructive Breast Surgery: An Easy Three-Step Principle. Part III-Reconstruction following Breast Conservative Treatment,” PLASTIC AND RECONSTRUCTIVE SURGERY, vol. 124, no. 1, pp. 28–38, 2009.
@article{839618,
  abstract     = {Of the relatively few studies that exist regarding the cosmetic satisfaction of patients following breast conservation therapy, several indicate significant dissatisfaction in many patients. Breast conservation often results in some of the most challenging and complex reconstructive problems. Indeed, even defining the problem or analyzing the defect can be difficult for the junior surgeon. For the more seasoned reconstructive surgeon, analyzing the problem and applying solutions may be less difficult, but clearly communicating the defects typically seen after an aggressive lumpectomy and radiotherapy can be difficult, especially with trainees or junior surgeons. The goal of this article, the third in a four-part series, is to provide a template for the analysis and surgical reconstruction of defects resulting from breast conservation therapy utilizing a systematic three-step method. Part I of this series described the three main anatomical features of the breast-the footprint, the conus of the breast, and the skin envelope-and how they interact. By systematically analyzing the breast with this three-step method, a "problem list" based in specific anatomic traits of the breast can be generated, allowing the surgeon to then generate an appropriate surgical plan for reconstruction. Surgical approaches based on the percentage of breast parenchyma resected are suggested, with a focus on glandular rearrangement, breast reduction techniques, and locoregional flaps. The three-step method of breast analysis, evaluating the anatomical deformation of the breast footprint, conus, and skin envelope, remains the fundamental "fall-back" principle of this approach.},
  author       = {Blondeel, Phillip and Hijjawi, John and Depypere, Herman and Roche, Nathalie and Van Landuyt, Koenraad},
  issn         = {0032-1052},
  journal      = {PLASTIC AND RECONSTRUCTIVE SURGERY},
  keywords     = {THERAPY,IRRADIATION,PARTIAL MASTECTOMY DEFECTS,CANCER,LATERAL THORACODORSAL FLAP},
  language     = {eng},
  number       = {1},
  pages        = {28--38},
  publisher    = {LIPPINCOTT WILLIAMS & WILKINS},
  title        = {Shaping the Breast in Aesthetic and Reconstructive Breast Surgery: An Easy Three-Step Principle. Part III-Reconstruction following Breast Conservative Treatment},
  url          = {http://dx.doi.org/10.1097/PRS.0b013e3181ac7608},
  volume       = {124},
  year         = {2009},
}

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