What is oncoplastic breast surgery?

Oncoplastic Breast Surgery

Oncoplastic breast surgery is a specialized surgical approach that combines breast cancer removal with plastic surgery techniques to achieve optimal cosmetic outcomes while maintaining oncological safety.

Definition and Core Principles

• Oncoplastic breast surgery integrates breast cancer surgical treatment with immediate reconstruction techniques to preserve or improve breast appearance 1, 2.
• It represents an evolution in breast cancer treatment that allows for wider tumor excisions while preventing breast deformities through immediate reconstruction of resection defects 2, 3.
• The approach enables the removal of 20-40% of breast tissue - cases that might have previously required mastectomy 2.

Key Components

• Appropriate surgical excision of the cancer with adequate margins 2, 3.
• Partial reconstruction to correct wide excision defects 2.
• Immediate reconstruction using various available techniques 1, 2.
• Correction of volume and shape asymmetries compared to the contralateral breast 2.

Main Techniques

Volume Displacement Techniques

• Combines removal of breast tissue with mastopexy (breast lift) techniques 4.
• Remaining breast tissues are shifted together within the breast envelope to fill the surgical defect 4.
• Generally performed during the same operation as the lumpectomy by the same surgeon 4.
• Advantages include:
  • Permits removal of larger regions of breast tissue 4.
  • Achieves wider surgical margins around the cancer 4.
  • Better preserves the natural shape and appearance of the breast compared to standard resections 4.

Volume Replacement Techniques

• Combines resection with immediate reconstruction using local flaps 2.
• Options include glandular flaps, fasciocutaneous flaps, and latissimus dorsi mini-flaps 2.
• May also incorporate implants in some cases 2.

Clinical Applications

• Preoperative evaluation of the likely cosmetic outcome of lumpectomy should be performed 4.
• Oncoplastic techniques can extend breast-conserving surgical options when standard resection would likely yield an unacceptable cosmetic outcome 4.
• These procedures may reduce the need for mastectomy and minimize breast deformity 4.
• Can be combined with surgery on the contralateral unaffected breast to minimize long-term asymmetry 4.

Benefits

• Increases oncological safety by allowing larger breast volume excision and wider surgical margins 2.
• Improves quality of life and body image for patients 1.
• Provides equivalent local and long-term survival rates compared to mastectomy 1.
• Offers immediate aesthetic solutions during initial cancer surgery 1, 3.

Limitations and Considerations

• Lack of standardization among centers 4.
• Limited availability at some medical centers, particularly in the United States 4.
• Potential need for mastectomy if pathologic margins are positive and further breast-conserving attempts are impractical 4.
• Patients should be informed about the possibility of positive margins and potential need for secondary surgery 4.
• Secondary procedures might include re-excision, segmental resection, or mastectomy with or without nipple loss 4.

Important Caveats

• Breast reconstruction should never interfere with appropriate surgical management of the cancer 4.
• The primary focus must remain on proper treatment of the tumor 4.
• The process of reconstruction should not govern the timing or scope of appropriate surgical treatment 4.
• Requires an experienced breast surgery team working in a coordinated, multidisciplinary fashion 4, 5.