Extremely Large Liposarcoma of Breast Excised with Breast Reduction Method -- A Case Report

以縮乳方式切除超巨大乳房脂肪肉瘤──罕見病例報告

Yi-Shang Yu(余奕尚)；Lin-Yin Wang(王淩音)；Yu-Tse Weng(翁御哲)；Chih-Hsin Wang(王志信)

breast liposarcoma ； breast reduction ； inverted T technique ； vertical bipedicle flap technique ； McKissock technique

臺灣整形外科醫學會雜誌

33卷2期（2024 / 06 / 01）

189 - 198

英文;繁體中文

Background: Breast liposarcoma is a rare malignant soft tissue tumor which clinically manifests as a palpable breast mass that mimics other primary breast cancers. Surgical removal of the tumor can improve overall survival. However, it remains challenging to remove large breast tumors during oncologic resection without compromising aesthetic appearance. Aims and Objectives: We report the case of a 51-year-old female patient who presented with an extremely large liposarcoma of the left breast. The patient underwent breast removal surgery using the breast reduction technique. A good aesthetic appearance was successfully achieved after surgery without redundant skin or an asymmetrical appearance. This breast reduction technique can be employed in other patients with large breast tumors. Materials and Methods: A 51-year-old female with a relatively thin body presented with a unilateral protruding mass in the left breast that was unaesthetic and prominent. A mammogram and breast sonography indicated a large fatty content in the left breast. The breast ultrasound showed a huge fatty mass lipoma or well-differentiated liposarcoma in the left breast. The inverted-T technique was used for incision and tumor removal. Extremely large tumors weighing 1550 g and 90 g were removed. We then used a vertical bipedicle flap to excise the excess skin while safely maintaining the circulation of the nipple-areolar complex. Results: A good cosmetic and symmetrical appearance without nipple necrosis or hematoma was achieved at the week follow-up. This showed that despite potential challenges, this plastic surgery technique can be applied in oncological surgery to achieve a better aesthetic appearance and psychological condition. The final pathological examination of the tumor revealed well-differentiated liposarcomas with R0 resection, and the patient received further adjuvant radiotherapy under stable treatment conditions. Conclusion: Extremely large breast tumors, such as the one reported in our case, can be treated by simple excision through the inframammary fold or circumareolar route without correcting the asymmetry. The combination of inverted-T technique with the vertical bipedicle technique can simplify tumor excision and ptotic correction while restoring symmetry with the normal breast in a safe manner without damaging the circulation of the nipple-areolar complex.

背景：乳房脂肪肉瘤是一種罕見的惡性軟組織腫瘤，臨床表現類似於其他原發性乳癌有可觸及的乳房腫塊。手術切除腫瘤可以提高總體生存率。然而，要在不影響美觀的情況下，以腫瘤切除手術徹底切除這麼大的乳房腫瘤十分具有挑戰性。目的及目標：報告一例51歲的女性患者，她的左乳房出現了一個非常大的脂肪肉瘤。她接受了以縮乳方式切除乳房脂肪肉瘤。手術後成功獲得美觀的外觀，沒有多餘的皮膚或明顯不對稱的雙乳。這種以縮乳方式的乳房腫瘤切除技巧可以用於其他也有如此巨大乳房腫瘤的患者。材料及方法：一名51歲女性，體型偏瘦，左側乳房單側隆起，非常地不美觀且突出。再進行了乳房攝影和乳房超音波檢查後，發現左乳有脂肪含量高的腫塊。在乳房超音波檢查中，顯示左乳房有一個巨大的含有脂肪團的脂肪瘤或分化良好的脂肪肉瘤。我們使用倒T縮乳手術技巧進行皮膚的切開和腫瘤切除。重達1550克90克的特大腫瘤被完全切除。然後我們使用倒T縮乳手術及乳房垂直雙蒂皮瓣手術技巧切除多餘的皮膚，同時安全地保持乳頭乳暈複合體的血液循環。結果：在手術一周後的追蹤中，在沒有乳頭壞死或血腫的情況下保有相當不錯的外觀和對稱性，且完成腫瘤R0切除。儘管具有挑戰性，我們仍然可以將整形技術應用於腫瘤外科手術，以造就腫瘤病人更好的外觀和心理狀態。結論：儘管像本例這樣的超大乳房腫瘤可以簡單地以通過乳下皺襞切口或乳暈環切口切除治療，但無法立即糾正不對稱問題。倒T縮乳手術技巧結合乳房垂直雙蒂手術可便利地作腫瘤切除和下垂矯正，同時以安全的方式恢復與正常乳房的對稱性，而不損害乳頭乳暈複合體的血液循環。