Oncoplastic techniques in breast conserving surgery
- Benjamin O Anderson, MD
Benjamin O Anderson, MD
- Department of Surgery
- University of Washington
- Kristine Calhoun, MD
Kristine Calhoun, MD
- Associate Professor
- Department of Surgery
- University of Washington
- Section Editor
- Anees B Chagpar, MD, MSc, MA, MPH, MBA, FACS, FRCS(C)
Anees B Chagpar, MD, MSc, MA, MPH, MBA, FACS, FRCS(C)
- Section Editor — Breast Surgery
- Associate Professor, Department of Surgery
- Yale University School of Medicine
Oncoplastic surgery merges the principles of oncology and plastic surgery, utilizing full-thickness breast-flap advancement to address tissue defects and improve cosmesis from breast conserving surgery (BCS). BCS followed by radiation treatment comprises breast conserving therapy (BCT). The goals of BCT are to provide the survival equivalent of mastectomy, a cosmetically acceptable breast, and a low rate of recurrence in the treated breast.
BCT is appropriate for most women with early stage breast cancer although there are clear contraindications to it, such as extensive or multicentric disease and persistently positive surgical resection margins. For breast conservation to be maximally effective, the cancer must be resected with adequate surgical margins while simultaneously maintaining the breast's shape and appearance.
This review will present oncoplastic techniques for breast conservation. The management of early stage breast cancer and the major issues related to breast conservation techniques for surgical treatment of invasive breast cancer are reviewed elsewhere. (See "Overview of the treatment of newly diagnosed, non-metastatic breast cancer" and "Breast conserving therapy".)
Oncoplastic techniques for breast conserving surgery (BCS) can provide adequate or even wide surgical margins around large and/or segmentally distributed breast cancers using closure techniques that help preserve the shape and appearance of the breast . These techniques are best suited for the following patients:
●When the cancer resection is large in relation to the size of the breast.
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- PATIENT SELECTION AND PREOPERATIVE CONSIDERATIONS
- SURGEON’S SAFETY CHECKLIST FOR ONCOPLASTIC SURGERY
- ONCOPLASTIC TECHNIQUES
- Surgical approach
- - Superior pole or lateral cancers
- - Lower pole breast cancers
- - Centrally located cancers
- - Upper outer quadrant cancers
- - Upper inner quadrant cancers
- Alternative approach
- - Level one
- - Level two
- Surgical techniques
- - Parallelogram skin incision
- Resection, clip placement, tissue advancement, and closure
- - Lateral segmentectomy
- - Batwing mastopexy
- - Central breast resection
- - Reduction mastopexy
- - Donut mastopexy
- SUMMARY AND RECOMMENDATIONS