The Expanded Use of Auto-augmentation Techniques in Oncoplastic Breast Surgery.

Background: Auto-augmentation techniques have been applied to oncoplastic reductions to assist with filling larger, more remote defects and women with smaller breasts. The purpose of this report is to describe the use of auto-augmentation techniques in OR and compare the results with traditional OR. Methods: We queried a prospectively maintained database of all women who underwent partial mastectomy and OR between 1994 and October 2015. The auto-augmentation techniques were defined as 1) extended primary nipple auto-augmentation pedicle, and 2) primary nipple pedicle and secondary auto-augmentation pedicle. Comparisons were made to a control oncoplastic group. Results: There were a total of 333 patients, 222 patients (67.7%) without auto-augmentation and 111 patients (33%) with auto-augmentation. Fifty-one patients had extended auto-augmentation pedicle, and 60 patients with a secondary auto-augmentation pedicle. Biopsy weight was smallest in the extended pedicle group (136 grams) and largest in the regular oncoplastic group (235 grams, p=0.017). Superomedial was the most common extended pedicle and lateral being the most common location. Inferorolateral was the most common secondary pedicle for lateral and upper outer defects. There were no significant differences in the overall complication rate: 15.5% in the regular oncoplastic group, 19.6% in the extended pedicle group, and 20% in the secondary pedicle group. Conclusions: Auto-augmentation techniques have evolved to manage complex defects not amenable to standard oncoplastic reduction methods. They are often required for lateral defects especially in smaller breasts. Auto-augmentation can be done safely without increase risk of complications, broadening the indications for breast conservation therapy. (C)2017American Society of Plastic Surgeons

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