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      Oncoplastic Breast Surgery: What, When and for Whom?

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          Abstract

          Oncoplastic surgery is integral to all breast cancer surgeries. The use of an aesthetic approach to breast conservation or mastectomy greatly enhances the range of options that can be offered to women with breast cancer and facilitates better outomes from it. It should be the standard of care. However, a structured approach to selecting appropriate techniques is essential, and although many operative procedures are reported, this article sets out to describe a set of principles and an algorithm by which the what, when and for whom for oncoplastic surgery can be defined.

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          Improving breast cancer surgery: a classification and quadrant per quadrant atlas for oncoplastic surgery.

          Krishna Clough, Ines Buccimazza, Claude Nos … (2010)
          Oncoplastic surgery (OPS) has emerged as a new approach for extending breast conserving surgery (BCS) possibilities, reducing both mastectomy and re-excision rates, while avoiding breast deformities. OPS is based upon the integration of plastic surgery techniques for immediate reshaping after wide excision for breast cancer. A simple guide for choosing the appropriate OPS procedure is not available. To develop an Atlas and guideline for oncoplastic surgery (OPS) to help in patient selection and choice of optimal surgical procedure for breast cancer patients undergoing BCS. We stratify OPS into two levels based on excision volume and the complexity of the reshaping technique. For resections less than 20% of the breast volume (level I OPS), a step-by-step approach allows easy reshaping of the breast. For larger resections (level II OPS), a mammoplasty technique is required. We identified three elements that can be used for patient selection and for determination of the appropriate OPS technique: excision volume, tumor location, and glandular density. For level II techniques, we defined a quadrant per quadrant Atlas that offers a different mammoplasty for each quadrant of the breast. OPS is the "third pathway" between standard BCS and mastectomy. The OPS classification and Atlas improves patient selection and allows a uniform approach for surgeons. It proposes a specific solution for different scenarios and helps improve breast conservation outcomes.
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            Cosmesis and satisfaction after breast-conserving surgery correlates with the percentage of breast volume excised.

            Sameeh Ghazal, Dawn Cochrane, Daniel Macmillan … (2003)
            The cosmetic outcome after breast-conserving surgery correlates with psychosocial adjustment. Previous studies have shown that, among other factors, cosmesis is dependent on breast size and weight of the wide local excision specimen. This study assessed cosmetic outcome relative to a combination of these factors-the estimated percentage of breast volume excised (EPBVE). The study group consisted of 151 women who had undergone breast-conserving surgery. All had previously completed a patient satisfaction questionnaire and an independent panel had assessed cosmetic outcome. Their mammograms were reviewed and breast volume was estimated. A validation series showed cone volume on the oblique mammogram to predict true breast weight most accurately (r = 0.93). Both subjective cosmetic assessment and patient satisfaction correlated strongly with EPBVE. Overall, when the EPBVE was below 10 per cent, 83.5 per cent of patients were very satisfied with their appearance and only 3.1 per cent were not satisfied, compared with 37.0 and 16.7 per cent respectively if the EPBVE was more than 10 per cent. However, tumour location in the breast was also an important factor; cosmetic outcome was worse for medial tumours. The percentage of breast volume excised was an important determinant of cosmesis and patient satisfaction after breast-conserving surgery. Calculating the EPBVE before surgery may help select women in whom breast reshaping or volume replacement should be considered. Copyright 2003 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
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              Oncoplastic Techniques Allow Extensive Resections for Breast-Conserving Therapy of Breast Carcinomas

              Krishna Clough, Jacqueline S Lewis, Benoît Couturaud … (2003)
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                Author and article information

                Contributors
                R. Douglas Macmillan: douglas.macmillan@nottingham.ac.uk
                Journal
                Journal ID (nlm-ta): Curr Breast Cancer Rep
                Journal ID (iso-abbrev): Curr Breast Cancer Rep
                Title: Current Breast Cancer Reports
                Publisher: Springer US (New York )
                ISSN (Print): 1943-4588
                ISSN (Electronic): 1943-4596
                Publication date (Electronic): 3 May 2016
                Publication date PMC-release: 3 May 2016
                Publication date (Print): 2016
                Volume: 8
                Pages: 112-117
                Affiliations
                Nottingham Breast Institute, Nottingham, NG5 1PB UK
                Article
                Publisher ID: 212
                DOI: 10.1007/s12609-016-0212-9
                PMC ID: 4886147
                PubMed ID: 27330677
                SO-VID: 55caca5f-c017-4ef9-b17a-8a51c3881a6b
                Copyright © © The Author(s) 2016
                License:

                Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

                History
                Categories
                Subject: Local-Regional Evaluation and Therapy (EP Mamounas, Section Editor)
                Custom metadata
                issue-copyright-statement © Springer Science+Business Media New York 2016

                ScienceOpen disciplines: Oncology & Radiotherapy
                Keywords: oncoplastic breast surgery,breast-conserving surgery,licap,therapeutic mammaplasty
                Data availability:
                ScienceOpen disciplines: Oncology & Radiotherapy
                Keywords: oncoplastic breast surgery, breast-conserving surgery, licap, therapeutic mammaplasty

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