Operative Time for Partial Mastectomy with Mastopexy
Partial mastectomy combined with mastopexy (oncoplastic volume displacement technique) is typically performed during the same operative setting as the breast-conserving lumpectomy, though specific operative time data is not standardized in the literature. 1
Procedural Context and Timing
Volume displacement techniques using mastopexy are generally performed during the same operative setting as the breast-conserving lumpectomy by the same surgeon who is performing the cancer resection. 1 This approach combines the removal of generous regions of breast tissue with mastopexy techniques in which remaining breast tissues are shifted together within the breast envelope to fill the surgical defect. 1
Available Operative Time Data
While comprehensive guidelines describe the technique, they do not provide specific operative time benchmarks. However, research data offers some insight:
In a series of 63 patients undergoing partial mastectomy with reduction/mastopexy, the average biopsy weight was 236 g, with total specimen weight of 762 g on the tumor side. 2 The study demonstrated that oncoplastic surgery was the definitive procedure 93% of the time, though specific operative times were not reported. 2
In 85 consecutive simultaneous partial mastectomy/reduction mammoplasty procedures, the technique proved feasible even for tumors averaging 2.4-5.7 cm depending on histology, with 29.4% of tumors larger than 4 cm. 3 Again, specific operative times were not documented. 3
For comparison, breast augmentation with mastopexy under local anesthesia showed mean recovery room time of 52.9 minutes, suggesting the mastopexy component adds time compared to augmentation alone (49.9 minutes recovery). 4 This provides indirect evidence that mastopexy techniques require additional operative time beyond the primary procedure. 4
Technical Factors Affecting Operative Time
The Wise pattern is used 84% of the time for these procedures, with various pedicles employed including superomedial, inferior, and central approaches depending on tumor location. 2 The most common tumor location is the upper outer quadrant. 2
Meticulous hemostasis is of critical importance, as hematoma formation produces changes difficult to interpret by physical examination and makes mammography interpretation difficult. 1 This attention to hemostasis necessarily extends operative time but is essential for optimal outcomes. 1
Staged vs. Simultaneous Approach
Eight patients (13%) in one series had reduction/mastopexy only after final pathology confirmed negative margins rather than simultaneously. 2 This staged approach may be preferable in younger patients with extensive ductal carcinoma in situ (DCIS), as all 4 patients who failed the combined approach in this series were younger women with extensive DCIS. 2
Internal mastopexy techniques require little additional operative time and no additional scars when performed in conjunction with the primary procedure. 5
Common Pitfall
The primary focus should be on treatment of the tumor, and this treatment should not be compromised when decisions regarding breast reconstruction are made. 1 Attempting to minimize operative time at the expense of adequate tumor margins or proper hemostasis will lead to worse outcomes. 1