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Abstract. Wide local excision combined with postoperative removal of tissue from both breasts, also creates
radiotherapy is a useful technique for patients with breast breast symmetry. In addition, it enables some path-
cancer. For patients with macromastia whose tumor is sit- ologic assessment of the opposite breast [2].
uated in the lower pole of the breast, a breast reduction This article reports on three patients whose tumor
(keyhole\inverted T pattern ) can be used to achieve wide was situated close to the skin in the upper and lateral
local excision. However, for patients whose tumor is not in aspect of the breast. A bilateral breast reduction was
the inferior portion of the breast, and in whom this cancer performed, but the skin markings were modied to
also is situated close to the skin (requiring excision of skin enable an oncologically safe procedure including
with a 1-cm margin for oncologic safety), the traditional excision of the overlying skin.
keyhole pattern cannot be used. A modication of the
keyhole pattern\inverted T is described. The pedicle used
depends on the site of the tumor. Although the breast scars
Technique
are in dierent positions, a similar breast shape as well as
symmetry still can be achieved. This is a useful technique
The technique involves the keyhole\inverted T pat-
for a select subgroup of patients. The outcomes for three
tern consisting of three triangles (Fig. 1). There is a
patients are presented.
vertical triangle, a medial triangle, and a lateral
triangle. The inferior margins of the medial, lateral,
Key words: Breast cancerConservation surgery and vertical triangles usually are placed along the
inframammary fold. With this technique, the lateral
triangle is not positioned at the lateral base of the
Breast conservation therapy consisting of wide local breast, but is advanced up onto the breast to overlie
excision and postoperative radiotherapy is a well- the tumor (Fig. 2).
established form of treatment for breast cancer [2 4].
The technique has the advantage of preserving the
Markings
original breast skin and retaining the nipple areola
complex [2 4]. The disadvantages include the eects
The patient is marked routinely in a standing position
of radiotherapy on the breast and the fact that if
before breast reduction. The tumor is identied and
tissue is excised from only one breast, asymmetry
the skin overlying the tumor is marked such that a
may result.
1-cm tumor clearance of the tumor is achieved
For patients with large breasts whose tumor is
(including skin). In the reported cases, the tumor was
situated in the inferior pole of the breast, a bilateral
situated in the upper and lateral aspect of the breast,
breast reduction can be performed [2 4]. This en-
and would not be included inside the markings of a
ables a wide local excision of the tumor, and by
traditional keyhole pattern.
The new nipple position is marked at the level of
the inframammary fold, according to standard pro-
Correspondence to D. A. Hudson, F.R.C.S., M. Med.; email: cedure. The markings are completed as if only a
hudsond@ uctgsh1.uct.ac.za vertical and medial reduction is to be performed
72 Breast Conservation Therapy
Fig. 4. Oblique view showing the site of the tumor and the
markings of the lateral triangle.