We defined the glandular flap including fat in the subclavicular area as an extended glandular flap, which has been used for breast-conserving reconstruction in the upper portion of the breast. Indication. The excision volume was 20% to 40% of the breast volume, and the breast density was dense. Surgical Technique. The upper edge of the breast at the subclavicular area was drawn in the standing position before surgery. After partial mastectomy, an extended glandular flap was made by freeing the breast from both the skin and the pectoralis fascia up to the preoperative marking in the subclavicular area. It is important to keep the perforators of the internal mammary artery and/or the branches of the lateral thoracic artery intact while making the flap. Results. Seventeen patients underwent remodeling using an extended glandular flap. The cosmetic results at 1 year after the operation: excellent in 11, good in 1, fair in 3, and poor in 2. All cases of unacceptable outcome except one were cases with complications, and more than 30% resection of moderate or large size breasts did not obtain an excellent result for long-term followup. Conclusion. This technique is useful for performing the breast-conserving reconstruction of small dense breasts. 1. Introduction Conservative breast surgery has rapidly become the standard procedure for breast cancer. Cancer control is the primary goal of all breast-cancer treatments, but conservative breast surgery has the additional goal of achieving cosmetic results that are acceptable to the patients. However, conservative breast surgery has not always produced good cosmetic results in all patients. The important factors considered to influence the cosmetic results are the excision volume, tumor location, and glandular density [1]. The excision volume is the most predictive factor of the cosmetic outcome, and it should be estimated in comparison to the total volume. Previous studies have suggested that excision of 20% of the breast volume has a clear risk of deformity [2]. The upper outer quadrant of the breast is a favorable location for large-volume excisions. In this location, defects can be corrected by the mobilization of adjacent tissue. In contrast, the lower pole of the breast is a less favorable tumor location [1, 3]. Glandular density can be evaluated using mammography. A dense glandular breast can be mobilized with undermining and advancement of breast tissue without complications. However, low-density breast tissue with major fatty components has a much high risk of fat necrosis if extensive undermining is
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