Extended Supramedial Flap, An excellent option for oncoplastic repair of large breast defects in outer quadrants

Introduction: Oncoplastic procedures are used by trained breast surgeons to repair partial mastectomy defects. Type 1 oncoplastic procedures are used when weight of the excised tissue is less than 20% of the whole breast weight. Type 2 oncoplasticprocedures are recommended when excised sample is between 20-50% of whole breast weight. When tumour is located in outer quadrants racquet type procedures are used often with satisfactory results. In extensive resection however the cosmetic results of racquet type oncoplasty is not good because there is not enough breast tissue to approximate. In this situation an extended supramedial flap mammoplasty can give excellent cosmetic results. Method: I have performed this procedure on several patients with excellent results. This technique is suitable for D cup are larger breasts who require large excision in outer part of the breast. The operation design is similar to supramedial pedicle mammoplasty but in this procedure the lower part of the breast which is usually discarded must be left attached to the pedicle. The lower part of the breast then rotated to fill the outer quadrant defect.Results: The cosmetic results of this procedure is excellent. I haven’t had any skin necrosis or wound dehiscence in my patients. Fat necrosis is minimal specially when breast tissue is glandular. The patients also benefits from contralateral symmetrisation at the same time.Conclusion: This technique has excellent cosmetic results with minimal morbidity. It is an advanced oncoplastic procedure and the surgeon should be completely familiar with mammoplasty techniques to perform it safely.