Breast reshaping can be difficult to do when breast cancer is treated with conservative surgery. When less than 20-30% of the breast is removed with minimal ptosis, Level 1 oncoplastic surgery (OPS) techniques, such as advancement or rotation of glandular flaps, are recommended.
The extensive undermining of the epidermis and nipple-areolar complex results in a large, symmetrical, centro-lateral glandular flap that is turned into a hollow. This rotation glandular flap is a new technique that can be used after a wide excision in glandular breasts, not fatty breasts, and when the standard way of closing the hole would not look good.
When less than 20% of the breast volume will be removed, Level I OBS is carried out. In this surgery, the defect is repaired using tissue displacement procedures, and the nipple-areola complex (NAC) may need to be realigned if necessary. Level II methods are needed for the 20%–50% of breast volume that needs to be removed.
Therefore, smaller flaws are filled by local tissue displacement and glandular reshaping (such as round-block, omega, vertical, radial, V-, J-, and L-type incisions). 4, 13 The proper oncoplastic method will also be determined by the size and location of the tumour, as well as the ptosis and breast size. For instance, an oncoplastic tumorectomy is advised for medium to large tumours in a peripheral region of a small or medium breast.
But the current range of OBS techniques leaves surgeons with two big problems. The first one has to do with tumours in certain parts of the breast, like the upper inner quadrant (UIQ). When the resection zone is farther from the NAC, this problem will get worse.
This means that removing tumours close to where the sternum meets the clavicle, where there is less breast tissue and where the surgeon should try to avoid making incisions, is one of the hardest parts of Breast-Conserving Surgery. The size of the breasts is the other problem. Smaller breasts are harder to work with. When these things happen, you can’t use techniques where the NAC is moved or the skin is cut away.
The technique described here was first made for tumours in the upper inner quadrant, but it can be used for tumours in any quadrant. It is done when it is not possible to close the hole by bringing the edges of the resection together or when doing so would leave a deformity.
This technique involves a lot of undermining of the gland, so it should only be used on people with glandular breasts to reduce the risk of necrosis of the fat after surgery. Both clinically and with x-rays, this should be checked before surgery. Mammography done before surgery can tell how dense the breast is. A BIRADS 3 or 4 (heterogeneously dense or very dense) is necessary. This method is not good for people who are likely to get glandular necrosis, like those with fatty breasts, diabetes, who smoke, or who have had radiation therapy.
A breast tissue resection was performed using an elliptical breast tissue incision. The ellipse of tissue resection must cross the skin incision at a straight angle, hence the term “Cross.” Then, a typical lumpectomy was performed from the subcutaneous region to the prepectoral fascia. To maintain clean margins, the excision of the tumour should be conducted precisely. The resection site (elliptical tissue defect) was repaired radially, followed by the implantation of clips for more precise tumour site localization prior to radiation therapy.
After repairing the breast tissue defect, it is preferable, but not required, to install a closed suction draining system. The treatment concluded with the subcutaneous tissue and skin being sutured together. Depending on the preoperative strategy, intraoperative findings, and the multidisciplinary team’s choice, axillary surgery (axillary lymph node dissection or sentinel lymph node biopsy) may be conducted via a different incision.
This rotating glandular flap makes it possible to safely transfer the central gland into the defect that was created by a large local excision in the upper inner quadrant. It broadens the application of Level I OPS and makes it possible to safely repair larger faults while maintaining their cosmetic integrity.
All breast surgeons should be able to conduct this procedure, as it is based on regular surgical techniques, and does not require any additional training in plastic surgery.
Dr. Mansi Chowhan is an outstanding surgical oncologist with over a decade of experience in the medical field. She was awarded a gold medal in appreciation of her outstanding performance while studying for post-graduate education. She is extensively trained from world-renowned institutions like MSKCC, New York and Paris Breast Centre. Dr. Mansi specialises in breast oncoplastic surgery, head and neck surgery, and reconstructive procedures.
Dr. Mansi Chowhan
Oncoplastic Breast Surgeon-Surgical Oncologist
MS (Gold Medalist), FIAGES, MCh Breast Oncoplasty (UK), Fellow Breast Surgery (Paris), Fellow Head & Neck Surgery, IFHNOS – MSKCC (New York)
Dr. Mansi Chowhan is an expert Oncoplastic Breast Surgeon with experience of more than 14 years and has been awarded with a gold medal during her surgical post-graduation. Dr. Mansi is well-trained from world renowned surgeons and cancer institutions like the Paris Breast Centre, Memorial Sloan Kettering Cancer Centre (New York), University of East Anglia (U.K.) and Tata Memorial Hospital, Mumbai. She is a skilled surgeon with over 14 years of experience in some of the best hospitals in the Delhi- NCR region including Fortis Hospital, Artemis Hospital, Paras Hospital and Asian Institute of Medical Sciences, CK Birla Hospital. She works with utmost dedication and compassion to deliver international standard and personalized cancer care to the patients.
First of all, I would like to thank Dr. Mansi Cowhan for the effort she made to remove a tumor and lymph nodes from the breast of the patient Rawaa Abd Abbas from Iraq, and to follow up on the patient’s condition and gave her the right medical instructions after the operation. Now patient is in a very good health. My advice for all patients who are suffering from breast cancer is to visit Dr Mansi Chowhan she has a very good knowledge and experience in her field .Thank you to Dr Mansi.
Dr. Mansi Chowhan, my wife’s breast cancer surgeon, empathized with my wife’s condition. She gave us the technical details in understandable language. She made it clear that the approach was primarily redemptive. She was happy with us when the tests came out favorable. She was sad with us for unfavourable pointers. She was caring throughout the process. We wish that she will bring such care and comfort to many more cancer patients.
I was diagnosed with DCIS. My gynaecologist Dr.Anjali Kumar whom I have known for 12 years and trust her completely, recommended Dr Mansi Chowhan to me. I am very happy that I took the decision of getting my breast surgery done from Dr.Mansi. She is very warm, polite and understands the emotional state of a patient. She explained to me in detail what exactly will be her plan of action. I went for other opinions too but Dr. Mansi was the only doctor who didn’t ask for unnecessary tests and procedures like MRI and Biopsy. Luckily, the lump in my breast was benign. I am grateful to her for handling my case so efficiently and would highly recommend her for breast surgery.
Dr Mansi Chowhan Dr. Mansi is one of the finest, sweetest and humble doctor I have ever met! I think she follows the rule to not overcomit and under deliver. During the period of my mother’s breast cancer consultation, treatment and surgery, she was sometimes upfront for few things, which we as Patient’s family took time to digest. But I really admire and appreciate all the support that Dr. Mansi and team extended during the entire period of pre & post surgery. And the kind of tumor removal + breast conservation surgery that she has done with her magical hands is commendable. I had so many negative thoughts before the surgery, but looking at the result and my mother recovering day by day…I can’t thank her enough for doing such wonders in saving her breast and her life! ❤
Dr Mansi Chowhan is an excellent Breast Cancer specialist we have in NCR, she is just amazing.
She is my wife’s doctor. She is very caring, understanding & listens to the patients.
In as much as she is a Gold Medalist, she is very knowledgeable and gives the best advice for the treatment.
She is very genuine in her dealings. She is a very kind and soft spoken to her patients. And takes special interest in caring for her patients, My wife feels very comfortable meeting her.
We highly recommend her to everyone with the above said problem.
My mother Mrs Santosh admitted under Dr Mansi Chowhan for procedure .
She is the outstanding doctor with golden heart , attend us guide us at each & every level of investigations.
A very big thanks for her & Mr Ibrahim & whole team for supportive hands given to us to fight against disease .
God bless you all & achieve success in future.
Our gratitude towards Dr Mansi Chowhan, my wife’s treating doctor cannot be expressed in words. She diagnosed my wife’s breast cancer and took great care throughout her journey from biopsy to breast surgery to chemotherapy now. To our great relief, a breast conservation surgery was done. She is exceptionally efficient and compassionate towards her patients. Highly recommended for any breast lump or cancer.
Dr Mansi Chowhan is one of the finest, sweetest and humble doctor I have ever met! I think she follows the rule to not overcomit and under deliver. During the period of my mother’s breast cancer consultation, treatment and surgery, she was sometimes upfront for few things, which we as Patient’s family took time to digest. But I really admire and appreciate all the support that Dr. Mansi and team extended during the entire period of pre & post surgery. And the kind of tumor removal + breast conservation surgery that she has done with her magical hands is commendable. I had so many negative thoughts before the surgery, but looking at the result and my mother recovering day by day…I can’t thank her enough for doing such wonders in saving her breast and her life! ❤.
I was diagnosed with DCIS. My gynaecologist Dr.Anjali Kumar whom I have known for 12 years and trust her completely, recommended Dr Mansi Chowhan to me. I am very happy that I took the decision of getting my breast surgery done from Dr Mansi. She is very warm, polite and understands the emotional state of a patient. She explained to me in detail what exactly will be her plan of action. I went for other opinions too but She was the only doctor who didn’t ask for unnecessary tests and procedures like MRI and Biopsy. Luckily, the lump in my breast was benign. I am grateful to her for handling my case so efficiently and would highly recommend her for breast surgery..
Dr Mansi Chowhan was really a blessing for us. She was so empathetic. I went to her for Sister In Law. She operated her for carotid body tumor. We were really scared but once we met Dr Mansi. we were at ease. She excellently handled the case. She was patient enough to hear all our worries and problems. I am thankful to her for all that she has done.
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