How to manage ptosis in a patient with breast (carcinoma) cancer?

Management of Breast Ptosis in Breast Cancer Patients

For patients with breast cancer and ptosis, management should be carried out in specialized breast units by a multidisciplinary team including breast surgeons, plastic/reconstructive surgeons, radiation oncologists, medical oncologists, and other specialists to ensure optimal oncologic and aesthetic outcomes. 1

Initial Assessment

• Treatment decisions should be based on tumor burden/location, cancer biology, patient age, general health status, and patient preferences 1
• Comprehensive evaluation of the degree of ptosis is necessary to determine appropriate surgical approach 2
• Ptosis can be classified as pseudoptosis, partial ptosis, or true ptosis (with three degrees based on nipple position relative to the inframammary fold) 2

Surgical Management Options

For Unilateral Breast Cancer with Ptosis

• Two-stage reconstruction approach:

  • First stage: Tissue expander placement with simultaneous contralateral mastopexy 3
  • Second stage (4-6 months later): Definitive reconstruction using autologous tissue (such as DIEP flap) or implant after the contralateral breast shape has stabilized 3
  • 3D imaging and printing technologies can be used to create breast molds based on the mirror image of the contralateral breast to achieve better symmetry 3

• Single-stage approach options:

  • Oncoplastic breast-conserving surgery with immediate correction of ptosis when appropriate for tumor characteristics 1
  • Mastectomy with immediate reconstruction and contralateral mastopexy for symmetry 1

For Bilateral Breast Cancer with Ptosis

• Bilateral mastectomy with reconstruction that addresses the ptosis during the reconstruction process 1
• Oncoplastic breast-conserving techniques that incorporate mastopexy principles when appropriate for tumor characteristics 1

Decision-Making Factors

• The choice between breast-conserving surgery and mastectomy should consider:

  • Tumor size and location
  • Breast size and degree of ptosis
  • Patient preference
  • Need for adjuvant radiation therapy 1

• Breast-conserving surgery is the preferred local treatment option for the majority of early breast cancer patients, with oncoplastic techniques used to address ptosis 1

• If mastectomy is required, reconstruction options include:

  • Implant-based reconstruction
  • Autologous tissue reconstruction (DIEP flap, latissimus dorsi flap, etc.) 3

Special Considerations

• Patients should be involved in all management decisions after being provided comprehensive information about their options 1

• For patients with ptosis who require radiation therapy, the timing of ptosis correction should be carefully considered, as radiation can affect tissue healing and aesthetic outcomes 1

• Objective assessment tools using clinical photographs can help evaluate ptosis and surgical outcomes 4

• In patients with advanced disease (metastatic breast cancer), the decision to correct ptosis should consider the overall treatment goals, quality of life, and patient preferences 1

Follow-Up Care

• Regular follow-up is essential to monitor both oncologic and aesthetic outcomes 1

• Patients should have access to specialized rehabilitation facilities to address physical and psychological aspects of breast cancer treatment 1

• Objective assessment methods can be used to evaluate aesthetic outcomes, including measurements of ptosis from clinical photographs 4

Potential Complications

• Surgical correction of ptosis may have unpredictable results in some cases, and patients should be informed about the possibility of revisional surgery 5

• Careful surgical planning is necessary to minimize complications such as nipple malposition, asymmetry, or poor scarring 5, 2

• For patients receiving systemic therapy, timing of surgery should consider potential wound healing complications 1