Surgical Management of Lower Inner Quadrant Breast Cancer: A Narrative Review of Oncoplastic and Reconstructive Options
Authors: Dr Fahtiha Nasreen, Dr MD Shahriar Hossain
Institution: Evercare Hospital Dhaka, Apollo JMI Hospitals Ltd
Introduction
Lower inner quadrant breast cancers pose a particular reconstructive challenge because wide local excision can cause medial contour loss, nipple displacement and inframammary fold distortion. Oncoplastic surgery offers opportunities to preserve breast shape while maintaining the principles of oncological resection.To review oncoplastic and reconstructive options for lower inner quadrant breast cancer and identify factors guiding individualised surgical selection.
Methods
A focused narrative review of selected PubMed-indexed clinical studies was undertaken. Volume displacement, volume replacement and post-mastectomy reconstruction were examined, with attention to tumour-to-breast volume ratio, breast morphology, margin management, complications, aesthetic outcomes and adjuvant treatment.
Results
For limited defects, glandular advancement and local tissue rearrangement may be sufficient. Larger defects can be addressed using LIQ-V mammoplasty, tailored reduction mammoplasty or dermoglandular rotation flaps in appropriately selected breasts. Anterior and medial intercostal artery perforator flaps provide muscle-sparing volume replacement, particularly when residual breast tissue is insufficient for reshaping. When breast conservation is unsuitable, implant-based or autologous reconstruction following mastectomy should be considered according to patient preference, comorbidity and anticipated radiotherapy. Clear margins, accurate tumour-bed marking and multidisciplinary planning remain essential. Published series report encouraging cosmetic outcomes and acceptable morbidity; however, evidence specific to this quadrant is largely derived from small observational studies, limiting conclusions regarding comparative effectiveness and long-term oncological outcomes.
Conclusion
Lower inner quadrant location alone should not preclude breast conservation. A tailored approach integrating resection requirements, breast anatomy, patient priorities and local expertise can broaden surgical options. Prospective studies with standardised oncological, aesthetic and patient-reported outcomes are needed to refine technique selection.