Oncoplastic BCS consists of volume displacement and volume replacement techniques. A lot of procedures have been reported as volume replacement techniques [4,5,6,7,8,9]. Each technique has advantages and disadvantages, and has suitable quadrants to utilize. Thus, the surgeon must make a correct decision to choose an individualized and appropriate technique.

Both of an indication and a contraindication of the OF for breast reconstruction are described elsewhere [3, 5]. In our 200-case series of the OF, the successful rate of laparoscopically harvesting of the OF was 99.5%. The rate of complications including minor fat necrosis was 12.0%. Laparoscopy-associated complications occurred only in 4 cases (2.0%). One major vascular injury to the main trunk of the gastroepiploic artery fell into total loss of the OF. Late complications include two ventral hernias in the infra-xiphoid area [5]. In brief, the OF flap has big advantages with its minimal donor-site scar and applicability to any quadrants because of its long pedicle. A disadvantage is inability to estimate preoperative volume of the flap [3, 5]. In the present case, the OF was divided and utilized for bilateral volume replacement. To our knowledge, it is the first case in which a single flap could replace bilateral partial mastectomy defects. A vascular anatomy of the OF is unique, in which the main gastroepiploic vessels supply several descending epiploic vessels. Thus, a blood supply of the flap is rich enough even the flap is divided at the middle part as long as the main gastroepiploic vessels are preserved. However, there are limitations of the OF for bilateral application. One is tumor locations. When the bilateral tumors are located in both the upper outer quadrants, it is difficult for the proximal half of the flap to reach the defect. At least, one of tumors should be located in the lower medial quadrant. The other is the volume of the defects which should not exceed 100 g each.

There would be concern about indication of bilateral BCS for three tumors. Negative for BRCA mutation cannot always exclude hereditary breast cancer. Synchronous bilateral breast carcinomas are relatively rare, and the choice of BCS is not well studied. The study from Sloan Kettering Cancer Center reported that patients with synchronous bilateral breast carcinomas were more likely to undergo bilateral mastectomy, in which the breast-conserving rate was only 33% [10]. Furthermore, multicentric disease in the ipsilateral breast is basically contraindication to BCS. Careful and close follow-up are mandatory for this patient.

The case of bilateral breast carcinomas treated with bilateral volume replacement technique with the OF is presented. This unique technique can be considered in a highly selected patient.

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