The Chambaran Technique: A Surgical Compromise Between Radical Mastectomy and Lumpectomy for Upper Quadrant Breast Tumors

Résumé

Background: Conservative surgical management of breast cancer typically requires postoperative radiotherapy to control occult microscopic residual disease. However Numerous oncoplastic techniques have been described with the aim to achieve complete tumor resection with negative margins while preserving aesthetic outcomes. In this mind, the present technical and pathological report describes the Chambaran technique—an upper hemimastectomy with extended glandular mobilization and retro areolar triangular resection—as well as its variants and reports the pathological findings of a retrospective series of upper quadrant breast malignancies.

Methods: Between 2012 and 2015, 53 patients aged 40 to 70 years with invasive carcinomas of the upper quadrants, unifocal on preoperative imaging, were included retrospectively. Inclusion criteria were clinical tumor size ≤3 cm, clinical node-negative status (cN0), and absence of extensive microcalcifications. The surgical procedure consisted of an upper hemimastectomy with extended glandular mobilization and retroareolar triangular resection, including complete excision of the galactophoric tree according to Payan. For high-lying tumors located farther from the nipple-areola complex, a modified non-grafted technique was applied. Intraoperative high-frequency ultrasound was systematically utilized. Pathological margins and specimen volumes were analyzed.

Results: Histopathological review revealed 44 invasive ductal (83.0%), 4 invasive lobular (7.5%), 2 mucinous, 1 medullary, 1 apocrine, and 1 mixed carcinoma. Margins were negative (R0) in all 53 cases, with surgical margins exceeding 1 cm. Associated ductal carcinoma in situ (DCIS) was present in 19 cases (35.8%). Additional invasive foci were identified on final pathology in 5 cases (4 invasive ductal, 1 invasive lobular). The average specimen volume was 400 cm³ (range up to 720 cm³).

Conclusion: In this series of selected upper quadrant tumors, the Chambaran technique allowed wide local excision with negative margins in all patients and represents an oncoplastic option between lumpectomy and mastectomy. This report presents technical and pathological findings only; it does not include follow-up, oncological outcome or aesthetic evaluation, and no conclusion regarding adjuvant radiotherapy can be drawn.