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Breast reconstruction

Oncoplastic breast surgery

Authors: Mia Demant, MD, Mia Steffensen, MD

Definition

Oncoplastic breast surgery is tumor resection, which ensures oncological safety, merged with plastic surgery, which ensures the most aesthetic outcome.

Generally, the techniques of oncoplastic breast-conserving surgery have followed three main paths (18):

  1. The use of (modified) breast reduction techniques to allow resection of any part of the breast
  2. The use of volume replacement techniques (e.g. LD- and local perforator flaps)
  3. The use of techniques to allow en bloc closure of breast defects

Nonetheless, it is also important to apply the oncoplastic principles to mastectomy and reconstruction, e.g. the use of contralateral breast reduction with unilateral mastectomy in women with sincerely ptotic or large breasts. Moreover, the creation of low-lying scars, uniform surfaces for implant cover, and avoiding dog-ears will improve the outcome. 

Methods and indications

Oncoplastic breast-conserving surgical techniques fall into four main categories (1): 

  1. Simple wide local excision (with thoughtful incision planning)
  2. Therapeutic breast reduction (bilateral breast reduction can be offered to women with large breasts, especially with morbidity associated with breast size)
  3. Therapeutic mastopexy (for women with ptosis who do not necessarily ask for a breast reduction – the only breast volume reduction is the wide local excision itself, and a variable reduction in the skin envelope, makes the procedure more akin to a mastopexy than a reduction)
  4. Volume replacement (for women with small and/or non-ptotic breasts, the breast shape is usually best maintained by combining wide local excision with volume replacement – e.g. perforator flaps, advancement flaps, fat grafting, and free flaps)

Therapeutic breast reduction and therapeutic mastopexy are collectively termed therapeutic mammaplasty. In general, when different options are available, the simplest is preferred. 

References

  1. Macmillan RD, McCulley SJ. Oncoplastic Breast Surgery: What, When, and for Whom? Curr Breast Cancer Rep. 2016;8:112–7. 
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