Avaliação da técnica do Retalho Bilobulado de Tostes como opção de reconstrução mamária no tratamento cirúrgico conservador do câncer de mama

Abstract

Introduction: Invasive breast tumors located in the medial or subareolar area, or tumors requiring broad resections of adjacent connective tissue are not indicated as a conservative surgical treatment due to precarious aesthetic results. Objective: To evaluate the Tostes´s surgical technique bilobulated flap (RBLT) as an alternative to the conservative treatment of breast cancer localizated in mammary regions under unfavorable conservation. Patients and methods: 46 patients with breast carcinoma were submitted to RBLT and monitored regularly by Breast Disease Division HC/UFMG in the period from March 2000 to January 2011. Results: 41 (89%) patients had tumors located medially, 3 (7%) located in the upper outer quadrant and 2 (4%) in the region retroaureolar. Tumor size ranged from 0.4 to 4.5 cm. 38 (83%) underwent axillary lymphadenectomy and 8 (17%) the sentinel lymphnode biopsy. Clinical staging ranged from IA to IIIC and invasive ductal carcinoma was the most frequent occurring in 28 (61%) patients, all received adjuvant radiotherapy, 40 (87%) used tamoxifen for 5 years and 33 (72%) received adjuvant chemotherapy. After 7.7 years median follow-up (60-127 months), the SLD and the SD were 87% and 91% respectively. In two (4%) patients were detected clinically detected local recurrence and, in one extensive intraductal component associated. The stage III was related to poor disease-free survival (p=0,022).The cosmetic results were satisfactory and no patient required a second surgery to correct aesthetic breast surgery Conclusion: Despite the limited number of cases, the RBLT has resulted in high rates of disease-free and overall survival, and low rate of local recurrence. The opportunity of extended resection and axillary facilitated access favor conservative surgical treatment and mammary reconstruction in patients of stage III with good aesthetic results.