Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Oncoplastic techniques in breast conserving surgery

Benjamin O Anderson, MD
Kristine Calhoun, MD
Section Editor
Anees B Chagpar, MD, MSc, MA, MPH, MBA, FACS, FRCS(C)
Deputy Editor
Wenliang Chen, MD, PhD


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 [1]. These techniques are best suited for the following patients:

When the cancer resection is large in relation to the size of the breast.

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: Oct 31, 2016.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Silverstein MJ. An argument against routine use of radiotherapy for ductal carcinoma in situ. Oncology (Williston Park) 2003; 17:1511.
  2. Clough KB, Kaufman GJ, Nos C, et al. Improving breast cancer surgery: a classification and quadrant per quadrant atlas for oncoplastic surgery. Ann Surg Oncol 2010; 17:1375.
  3. National Comprehensive Cancer Network (NCCN). NCCN Clinical practice guidelines in oncology. http://www.nccn.org/professionals/physician_gls/f_guidelines.asp (Accessed on February 27, 2016).
  4. Roughton MC, Shenaq D, Jaskowiak N, et al. Optimizing delivery of breast conservation therapy: a multidisciplinary approach to oncoplastic surgery. Ann Plast Surg 2012; 69:250.
  5. Anderson BO, Masetti R, Silverstein MJ. Oncoplastic approaches to partial mastectomy: an overview of volume-displacement techniques. Lancet Oncol 2005; 6:145.
  6. Weiser TG, Haynes AB, Dziekan G, et al. Effect of a 19-item surgical safety checklist during urgent operations in a global patient population. Ann Surg 2010; 251:976.
  7. Leaper DJ, Melling AG. Antibiotic prophylaxis in clean surgery: clean non-implant wounds. J Chemother 2001; 13 Spec No 1:96.
  8. Gagliardi AR, Fenech D, Eskicioglu C, et al. Factors influencing antibiotic prophylaxis for surgical site infection prevention in general surgery: a review of the literature. Can J Surg 2009; 52:481.
  9. Throckmorton AD, Boughey JC, Boostrom SY, et al. Postoperative prophylactic antibiotics and surgical site infection rates in breast surgery patients. Ann Surg Oncol 2009; 16:2464.
  10. Fry DE. Surgical site infections and the surgical care improvement project (SCIP): evolution of national quality measures. Surg Infect (Larchmt) 2008; 9:579.
  11. Bratzler DW, Houck PM, Surgical Infection Prevention Guidelines Writers Workgroup, et al. Antimicrobial prophylaxis for surgery: an advisory statement from the National Surgical Infection Prevention Project. Clin Infect Dis 2004; 38:1706.
  12. Braxton CC, Gerstenberger PA, Cox GG. Improving antibiotic stewardship: order set implementation to improve prophylactic antimicrobial prescribing in the outpatient surgical setting. J Ambul Care Manage 2010; 33:131.
  13. Tejirian T, DiFronzo LA, Haigh PI. Antibiotic prophylaxis for preventing wound infection after breast surgery: a systematic review and metaanalysis. J Am Coll Surg 2006; 203:729.
  14. Kronowitz SJ, Feledy JA, Hunt KK, et al. Determining the optimal approach to breast reconstruction after partial mastectomy. Plast Reconstr Surg 2006; 117:1.
  15. Nahabedian, MY. Determining the Optimal Approach to Breast Reconstruction after Partial Mastectomy: Discussion. Plast Reconstr Surg 2006; 117:12.
  16. Gainer SM, Lucci A. Oncoplastics: techniques for reconstruction of partial breast defects based on tumor location. J Surg Oncol 2011; 103:341.
  17. Grisotti, A. Conservation treatment of breast cancer: Reconstructive problems. In: Surgery of the breast: Principle and art, 2nd edition, Spear, SL (Eds), Lippincott Williams and Wilkins, Philadelphia 2006. p.137.
  18. Clough KB, Ihrai T, Oden S, et al. Oncoplastic surgery for breast cancer based on tumour location and a quadrant-per-quadrant atlas. Br J Surg 2012; 99:1389.
  19. Haffty BG, Wilson LD, Smith R, et al. Subareolar breast cancer: long-term results with conservative surgery and radiation therapy. Int J Radiat Oncol Biol Phys 1995; 33:53.
  20. Fowble B, Solin LJ, Schultz DJ, Weiss MC. Breast recurrence and survival related to primary tumor location in patients undergoing conservative surgery and radiation for early-stage breast cancer. Int J Radiat Oncol Biol Phys 1992; 23:933.
  21. Dale PS, Giuliano AE. Nipple-areolar preservation during breast-conserving therapy for subareolar breast carcinomas. Arch Surg 1996; 131:430.
  22. Masetti R, Di Leone A, Franceschini G, et al. Oncoplastic techniques in the conservative surgical treatment of breast cancer: an overview. Breast J 2006; 12:S174.
  23. Clough KB, Gouveia PF, Benyahi D, et al. Positive Margins After Oncoplastic Surgery for Breast Cancer. Ann Surg Oncol 2015; 22:4247.
  24. Iwuagwu OC. Additional considerations in the application of oncoplastic approaches. Lancet Oncol 2005; 6:356.
  25. Losken A, Dugal CS, Styblo TM, Carlson GW. A meta-analysis comparing breast conservation therapy alone to the oncoplastic technique. Ann Plast Surg 2014; 72:145.
  26. Fitoussi AD, Berry MG, Famà F, et al. Oncoplastic breast surgery for cancer: analysis of 540 consecutive cases [outcomes article]. Plast Reconstr Surg 2010; 125:454.
  27. Rietjens M, Urban CA, Rey PC, et al. Long-term oncological results of breast conservative treatment with oncoplastic surgery. Breast 2007; 16:387.