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Article Open Access

‘Umbrella’ technique: An alternative approach to overcoming challenges in breast‑conserving surgery

  • Authors:
    • Abdulwahid M. Salih
    • Shaban L. Tofiq
    • Hiwa O. Baba
    • Rebaz O. Mohammed
    • Halkawt O. Ali
    • Zuhair D. Hammood
    • Ayman M. Mustafa
    • Lana R.A. Pshtiwan
    • Abdullah A. Qadir
    • Shko H. Hassan
    • Vanya Ibrahim Jwamer
    • Bushra O. Hussein
    • Harzal Hiwa Fatih
    • Shilan Raouf Qadir
    • Fahmi H. Kakamad
  • View Affiliations / Copyright

    Affiliations: Department of Breast Surgery, Smart Health Tower, Sulaymaniyah 46001, Iraq, Department of Surgery, Tikrit Teaching Hospital, Saladin 34001, Iraq, Department of Scientific Affairs, Smart Health Tower, Sulaymaniyah 46001, Iraq, Department of Radiology, Smart Health Tower, Sulaymaniyah 46001, Iraq, Department of Head and Neck Surgery, Smart Health Tower, Sulaymaniyah 46001, Iraq
    Copyright: © Salih et al. This is an open access article distributed under the terms of Creative Commons Attribution License [CC BY 4.0].
  • Article Number: 67
    |
    Published online on: May 21, 2026
       https://doi.org/10.3892/wasj.2026.482
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Abstract

Breast‑oncoplastic surgery can cause deformities, particularly following large excisions or radiotherapy. While oncoplastic techniques enhance patient outcomes, they have limitations in complex cases. The present study aimed to introduce the ‘umbrella’ technique to overcome these limitations and optimize both oncologic and aesthetic results. The present single‑center retrospective study, conducted from January, 2022 to December, 2023, evaluated the ‘umbrella’ technique for breast cancer treatment. It included patients with early‑stage breast cancer, primarily those who had undergone neoadjuvant chemotherapy. Exclusion criteria included prior breast surgery for unrelated reasons, central tumors and aggressive cancers. Data on demographics, treatments, imaging, tumor characteristics and post‑operative outcomes were collected. Patient satisfaction and follow‑up lasted from 1 month to 2 years, with no documented recurrences. A total of 107 patients participated, with a mean age of 48.49±9.22 years. Of these patients, 95 (88.8%) were <60 years of age, 97 (90.65%) were married and 77 (72%) were non‑smokers. The majority of patients (90, 84.11%) had received chemotherapy. Tumor laterality was almost even, with 54 (50.47%) tumors on the right. Invasive ductal carcinoma was the most common diagnosis (n=61, 57%). The majority of tumors were grade II (n=73, 68.22%). Post‑operative complications included shoulder stiffness (n=27, 25.23%) and infection (n=26, 24.30%). Reoperation was required in 10 (9.35%) patients. All assessed variables had high mean satisfaction scores, >8.0. On the whole, the present study demonstrates that the ‘umbrella’ technique improves breast‑conserving surgery by addressing limitations in sensitive tumor areas, providing clear margins, superior cosmetic outcomes and high patient satisfaction, particularly in early‑stage cases. However, the short follow‑up limits oncological conclusions, and long‑term outcomes require further study.
View Figures

Figure 1

(A and B) Images of a 51-year-old
female patient with grade II invasive ductal carcinoma presenting
with a mass (36x20 mm) in the upper outer quadrant of the breast.
(A) Pre-operative markings based on breast size, orientation and
surgical planning. (B) Initiation of the incision with exposure of
the subcutaneous tissue while maintaining hemostasis. (C) A
different 48-year-old female patient with grade II breast carcinoma
presenting with a mass (23x20 mm) in the upper inner quadrans of
the breast, showing the fully developed incision with tissue
mobilization and surgical access for resection or
reconstruction.

Figure 2

Image of a 51-year-old female patient
with grade II invasive ductal carcinoma presenting with a mass
(36x20 mm) in the upper outer quadrant of the breast. The mass,
along with the surrounding margins and breast tissue, was excised
using cauterization, followed by the application of a rotational
flap.

Figure 3

(A) Image of a 44-year-old female
patient with grade III breast carcinoma presenting with a breast
mass (25x16 mm), demonstrating the post-operative appearance of the
scar at 1-month follow-up after surgery. (B) Image of a 51-year-old
female patient with grade II invasive ductal carcinoma presenting
with a mass (36x20 mm) in the upper outer quadrant of the breast,
showing intraoperative skin closure immediately following
surgery.
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Copy and paste a formatted citation
Spandidos Publications style
Salih AM, Tofiq SL, Baba HO, Mohammed RO, Ali HO, Hammood ZD, Mustafa AM, Pshtiwan LR, Qadir AA, Hassan SH, Hassan SH, et al: &lsquo;Umbrella&rsquo; technique: An alternative approach to overcoming challenges in breast‑conserving surgery. World Acad Sci J 8: 67, 2026.
APA
Salih, A.M., Tofiq, S.L., Baba, H.O., Mohammed, R.O., Ali, H.O., Hammood, Z.D. ... Kakamad, F.H. (2026). &lsquo;Umbrella&rsquo; technique: An alternative approach to overcoming challenges in breast‑conserving surgery. World Academy of Sciences Journal, 8, 67. https://doi.org/10.3892/wasj.2026.482
MLA
Salih, A. M., Tofiq, S. L., Baba, H. O., Mohammed, R. O., Ali, H. O., Hammood, Z. D., Mustafa, A. M., Pshtiwan, L. R., Qadir, A. A., Hassan, S. H., Jwamer, V. I., Hussein, B. O., Fatih, H. H., Qadir, S. R., Kakamad, F. H."&lsquo;Umbrella&rsquo; technique: An alternative approach to overcoming challenges in breast‑conserving surgery". World Academy of Sciences Journal 8.4 (2026): 67.
Chicago
Salih, A. M., Tofiq, S. L., Baba, H. O., Mohammed, R. O., Ali, H. O., Hammood, Z. D., Mustafa, A. M., Pshtiwan, L. R., Qadir, A. A., Hassan, S. H., Jwamer, V. I., Hussein, B. O., Fatih, H. H., Qadir, S. R., Kakamad, F. H."&lsquo;Umbrella&rsquo; technique: An alternative approach to overcoming challenges in breast‑conserving surgery". World Academy of Sciences Journal 8, no. 4 (2026): 67. https://doi.org/10.3892/wasj.2026.482
Copy and paste a formatted citation
x
Spandidos Publications style
Salih AM, Tofiq SL, Baba HO, Mohammed RO, Ali HO, Hammood ZD, Mustafa AM, Pshtiwan LR, Qadir AA, Hassan SH, Hassan SH, et al: &lsquo;Umbrella&rsquo; technique: An alternative approach to overcoming challenges in breast‑conserving surgery. World Acad Sci J 8: 67, 2026.
APA
Salih, A.M., Tofiq, S.L., Baba, H.O., Mohammed, R.O., Ali, H.O., Hammood, Z.D. ... Kakamad, F.H. (2026). &lsquo;Umbrella&rsquo; technique: An alternative approach to overcoming challenges in breast‑conserving surgery. World Academy of Sciences Journal, 8, 67. https://doi.org/10.3892/wasj.2026.482
MLA
Salih, A. M., Tofiq, S. L., Baba, H. O., Mohammed, R. O., Ali, H. O., Hammood, Z. D., Mustafa, A. M., Pshtiwan, L. R., Qadir, A. A., Hassan, S. H., Jwamer, V. I., Hussein, B. O., Fatih, H. H., Qadir, S. R., Kakamad, F. H."&lsquo;Umbrella&rsquo; technique: An alternative approach to overcoming challenges in breast‑conserving surgery". World Academy of Sciences Journal 8.4 (2026): 67.
Chicago
Salih, A. M., Tofiq, S. L., Baba, H. O., Mohammed, R. O., Ali, H. O., Hammood, Z. D., Mustafa, A. M., Pshtiwan, L. R., Qadir, A. A., Hassan, S. H., Jwamer, V. I., Hussein, B. O., Fatih, H. H., Qadir, S. R., Kakamad, F. H."&lsquo;Umbrella&rsquo; technique: An alternative approach to overcoming challenges in breast‑conserving surgery". World Academy of Sciences Journal 8, no. 4 (2026): 67. https://doi.org/10.3892/wasj.2026.482
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