Oncoplastic Surgery: Pushing the Limits of Breast-Conserving Surgery

Abstract

In recent decades, the surgical management of breast cancer has steadily and considerably improved. Mutilating procedures have given way to more individualized surgical approaches aiming to preserve the breast as much as possible. For large tumors, preoperative chemotherapy is a major tool, but emerging oncoplastic surgery techniques are also a new approach in the armamentarium of breast cancer surgery, as a third option between conventional breast-conserving surgery and mastectomy. As this new treatment modality allows wider margin excision, it reduces the need for re-excision procedures and possibly increases breast conservation rates by extending the indications of breast-conserving surgery. This review will provide an overview of current practices and clinical data available to date on oncoplastic surgery.

Oncoplastic Breast Surgery after Neoadjuvant Chemotherapy Replacing Mastectomy in Locally Advanced Breast Cancer (LABC): Single Institute Experience

“…Ipsilateral local and locoregional recurrence were 11.2% and 15.3% respectively in the study published by Carrrara in 2017 [13]. Clough et al [21] had 4 years follow up with 9.5% LR rate.…”

“…Standard conservative breast surgery still have limitations especially in difficult quadrants (UIQ, LIQ and central), when >10% of breast volume had to be resected and when skin resection is required [13].…”

Coordination of Care for Breast Reconstruction Patients: A Provider Survey

“…More patients than ever are undergoing neoadjuvant chemotherapy and immediate reconstruction prior to radiation. 19,28–30 Patients who have all of these treatments must have full range of motion of the arms and complete expansion of a tissue expander or complete healing of a flap prior to radiation, which commonly starts 6 weeks after surgery. Based on current standard of care, such a patient would generally not receive more chemotherapy unless on a clinical trial and would have little time for healing before radiation would need to start.…”

El vendaje cohesivo en el tratamiento de la trombosis linfática superficial en mujeres intervenidas de cáncer de mama. Serie de casos

“…El nivel uno corresponde a aquellas cirugías en las cuales se va a extirpar como máximo un 20% del volumen glandular, e incluye técnicas de reaproximación glandular, reposicionamiento o escisión del complejo areola pezón. El nivel dos corresponde a aquellas en las cuales se va a extirpar más de un 20% del volumen total glandular mediante mamoplastias uni o bilaterales, y reorganización de la mama asociadas (15) En pacientes susceptibles de cirugía conservadora de la mama, se realiza preferiblemente antes la RT, ya que por lo general no es posible realizar una transferencia de tejido local ni una cirugía reductora en mamas previamente irradiadas. Por ello, se suele realizar de manera inmediata, para evitar que la RT acentúe las deformidades.…”