Oncological safety and cosmetic outcomes in oncoplastic breast conservation surgery, a review of the best level of evidence literature

Abstract

Oncoplastic breast conservation surgery (OBCS) is increasingly becoming part of routine breast cancer surgical management. OBCS may be viewed as an extension of standard breast conservation surgery for resecting tumors of larger sizes without compromising on cosmetic outcome, or as an alternative to mastectomy. High quality evidence to support the oncological safety and benefits of OBCS is lacking. This review will focus on the best available level of evidence and address key issues regarding oncological safety in OBCS, such as tumor resection margins and re-excision rates, local recurrence and patient outcome, postoperative complications and adjuvant therapy delivery, and briefly discuss cosmetic outcome in OBCS. Comparative observational studies and systematic review report no poorer outcomes compared with standard breast conservation surgery. More evidence needs to be generated to support the oncological safety and improved aesthetic outcome. Prospective data collection will significantly contribute to the generation of stronger evidence.

Therapeutic mammaplasty is a safe and effective alternative to mastectomy with or without immediate breast reconstruction

“…This study has shown that oncoplastic breast conservation is likely to offer better outcomes than mastectomy with or without breast reconstruction for many women and, together with emerging evidence to support the long‐term oncological safety of oncoplastic breast conservation, adds further support to the use of TM as an alternative to mastectomy. Further work is now needed determine whether TM improves patient‐reported outcomes and is cost‐effective compared with mastectomy with and without immediate breast reconstruction before definitive recommendations for best practice can be made.…”

“…Therapeutic mammaplasty (TM) combines wide local excision to remove the cancer with breast reduction and mastopexy techniques to reshape the remaining tissue. These techniques can extend the boundaries of BCS by allowing adequate resection of large or multifocal cancers in patients with medium/large or ptotic breasts, without compromising oncological outcomes. This may offer women a safe and effective alternative to mastectomy, with or without reconstruction.…”

Patient-reported outcome after oncoplastic breast surgery compared with conventional breast-conserving surgery in breast cancer

“…Breast-conserving surgery (BCS) followed by adjuvant radiotherapy, is documented to be equal to mastectomy with regard to oncological outcomes [1][2][3], and has to a large extent replaced total mastectomy in the last few decades. Oncoplastic breast surgery (OBS) was developed with the aim of further improving the esthetic and functional outcomes of BCS [4][5][6][7], as these affect health-related quality of life (HRQoL). However, only a few studies have addressed patient-reported outcomes (PROs), e.g., physical and psychosocial well-being, following OBS or among patients treated with conventional BCS [8,9].…”

Current practice and short-term outcomes of therapeutic mammaplasty in the international TeaM multicentre prospective cohort study

“…Many are poorly designed and reported, with inconsistent end‐points that limit cross‐study comparison and meaningful data synthesis. Several recent systematic reviews have highlighted the paucity of high‐quality clinical, oncological and cosmetic outcome data, and emphasized the urgent need for well designed prospective studies to establish the indications and outcomes of TM to inform best practice.…”