Oncoplastic Breast Surgery - Our Experiences in the Breast Clinic, IPGME&R, Kolkata

Abstract

Oncoplastic breast surgery is the fusion of oncological and surgical principles to gain successful breast tumour excision with good cosmesis. It is an widely accepted and popular method in the western world. However, the picture is different in India. The major issues here, like late detection and advanced tumours, poor socio-economic status overriding quality of life issue and shortage of dedicated oncoplastic surgeons result in a poor acceptance and practice of oncoplastic breast surgery. This article explores the use of various oncoplastic techniques in clinical practice and discusses future directions in this emerging field in an Indian perspective. In our institute (breast care unit, I.P.G.M.E&R,Kolkata), we performed a retrospective study over a period of five years (2005-2009). It included a sample size of 30 patients with diagnosed breast cancer or Phylloides Tumor (PT). The study focused on the indications, type of oncoplastic procedure used, cosmetic outcome (shape / volume replacement, ptosis correction & chest wall coverage), complications faced and response to subsequent therapy. The indications, for which oncoplastic techniques were applied, were DCIS (2), LCIS (1), IDC (19) and phylloides tumor (8). Of the 30 patients, RAT was used in 8, LDMF (of various types and volume) was used in 16, pedicled TRAM flap was used in 3 and reduction mastopexy in 3.The procedural indications of reconstruction were total glandular replacement by TRAM flap, mini-LDMF to fill volume loss after BCS or wide local excision, rotation advancement technique for reshaping / symmetry maintenance after BCS or wide local excision, LDMF for chest wall coverage after MRM and reduction mastopexy after wide local excision. From patient's point of view the outcome of surgery was highly satisfactory (score 3 or more) in 19 out of 30 patients (63.33%). LDMF was the most commonly used (16 out of 30) oncoplastic procedure with least complication rates (0 out of 16). 4 out of 30 patients had complications related to the procedure. Chest wall coverage after MRM still forms the main indication of oncoplastic surgery in this country.

Breast cancer: An overview of published Indian data

“…As the survival for breast cancer patients continues to improve, the future of surgery for breast cancer lies in integrating the principles of OPS into our practice as the focus of care shifts to improving QOL. Several Indian authors[ 20 21 22 ] have reported case series on the safety and esthetic outcome of oncoplastic procedures. The risk factors reported for poor cosmetic outcome were age, volume of breast tissue excised, and estimated percentage of breast volume excised ( P < 0.05).…”

Surgery of congenital breast asymmetry—which objective parameter influences the subjective satisfaction with long-term results

“…Any deformation of the breast is associated with a reduction in or loss of these values and is often viewed as a socio-esthetic handicap. Especially psychological symptoms such as depression and psychosexual problems burden the patients [4][5][6][7]. However, it is important to note that breast 1 3 asymmetry to some degree is natural, and small differences in volume between the right and left breasts may be detected in nearly all women [8][9][10].…”

“Surgery of Congenital Breast Asymmetry – Which Objective Parameter Influences the Subjective Satisfaction With Long-term Results?”

“…Consequently, a deformation of this organ is associated with the loss of these values and often leads to a socio-aesthetic handicap. Especially psychological symptoms such as depression and psychosexual problems burden the patients [4][5][6][7]. It is important to note that breast asymmetry to some degree is natural and small volume differences between right and left breasts are found in almost every woman [8][9][10].…”