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Alternatives for Optimizing Outcomes in Oncoplastic Breast Surgery

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Breast conservation treatment (BCT) is an accepted option for the treatment of breast malignancies. However, as suboptimal surgical techniques result in poor cosmetic outcomes, a plethora of operative approaches to prevent potential deformity has emerged in contemporary literature. Many of these procedures, referred to as oncoplastic breast surgery (OBS), depend on complex mammoplasty-type procedures, often with contralateral symmetrisation, and the frequent use of volume replacement techniques with implants or autologous tissue flaps. However, there have been reports of moderately high rates of complications for these types of procedures.

Objective

To propose surgical approaches that reduce tissue manipulation and lower complication rates without sacrificing local control and survival.

Methods

A description of methods is presented, involving closely coordinated collaboration with members of the interdisciplinary team to enable accurate resection with minimal tissue loss for appropriate margins, allowing adequate retained tissue for acceptable cosmesis.

Results

Using these techniques, more women with breast malignancies may undergo BCT without elaborate mammoplasty procedures or volume replacement operations with implants or autologous flaps.

Conclusions

The approaches described are alternatives to the conventional volume displacement techniques for optimising outcomes with OBS. They allow a greater proportion of women to undergo BCT with less tissue manipulation and lower complication rates.

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References

  1. Veronesi U, Cascinelli N, Nariani L, et al. Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med. 2002;347:1227–32.

    Article  PubMed  Google Scholar 

  2. Fisher B, Anderson S, Bryant J, et al. Twenty-year follow-up of a randomized trial comparing mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med. 2002;347:1233–41.

    Article  PubMed  Google Scholar 

  3. Poggi MM, Danforth DN, Sciuto LC, et al. Eighteen-year results in the treatment of early breast carcinoma with mastectomy versus breast conservation therapy. Cancer. 2003;98:697–702.

    Article  PubMed  Google Scholar 

  4. Clough KB, Kaufman GJ, Nos C, Buccimazza I, Sarfati IM. Improving breast cancer surgery: a classification and quadrant per quadrant atlas for oncoplastic surgery. Ann Surg Oncol. 2010;17:1375–91.

    Article  PubMed  Google Scholar 

  5. Patel KM, Hannan CM, Gatti ME, Nahabedian MY. A head-to-head comparison of quality of life and aesthetic outcomes following immediate, staged-immediate, and delayed oncoplastic reduction mammoplasty. Plast Reconstr Surg. 2011;127:2167–75.

    Article  PubMed  CAS  Google Scholar 

  6. Losken A, Styblo TM, Carlson GW, Jones GE, Amerson BJ. Management algorithm and outcome evaluation of partial mastectomy defects treated using reduction or mastopexy techniques. Ann Plast Surg. 2007;59:235–42.

    Article  PubMed  CAS  Google Scholar 

  7. Munhoz AM, Montag E, Arruda E, et al. Reliability of inferior dermoglandular pedicle reduction mammoplasty in reconstruction of partial mastectomy defects: surgical planning and outcome. Breast. 2007;16:577–89.

    Article  PubMed  Google Scholar 

  8. Rainsbury RM, Paramanathan N. UK survey of partial mastectomy and reconstruction. Breast. 2007;16:637–45.

    Article  PubMed  CAS  Google Scholar 

  9. Indelicato D, Grobmyer SR, Newlin H, et al. Association between operative closure type and acute infection, local recurrence, and disease surveillance in patients undergoing breast conserving therapy for early-stage breast cancer. Surgery. 2007;141:645–53.

    Article  PubMed  Google Scholar 

  10. Kronowitz SJ, Feledy JA, Hunt KK, et al. Determining the optimal approach to breast reconstruction after partial mastectomy. Plast Reconstr Surg. 2006;117:1–11.

    Article  PubMed  CAS  Google Scholar 

  11. Kronowitz SJ, Kuerer HM, Buchholz TA, Valero V, Hunt KK. A management algorithm and practical oncoplastic surgical techniques for repairing partial mastectomy defects. Plast Reconstr Surg. 2008;122:1631–47.

    Article  PubMed  CAS  Google Scholar 

  12. Asgeirsson KS, Rasheed T, McCulley SJ, Macmillan RD. Oncological and cosmetic outcomes of oncoplastic breast conserving surgery. Eur J Surg Oncol. 2005;31:817–23.

    Article  PubMed  CAS  Google Scholar 

  13. Silverstein MJ. How I do it: oncoplastic breast-conservation surgery. Ann Surg Oncol. 2010;17:S242–4.

    Article  Google Scholar 

  14. Kaufmann M, Morrow M, von Minckwitz G, Harris JR; Biedenkopf expert panel members. Locoregional treatment of primary breast cancer. Cancer. 2010;116:1184–91.

    Article  PubMed  Google Scholar 

  15. Kirstein LJ, Rafferty E, Specht MC, et al. Outcomes of multiple wire localisation for larger breast cancers: When can mastectomy be avoided? J Am Coll Surg. 2008;207:342–6.

    Article  PubMed  Google Scholar 

  16. Javid SH, Kirstein LJ, Rafferty E, et al. Outcome of multiple-sire localisation for large breast cancers: Do multiple wires translate into additional imaging, biopsies and recurrences? Am J Surg. 2009;198:368–72.

    Article  PubMed  Google Scholar 

  17. Schwartz GF, Veronesi U, Clough KB, et al. Consensus conference on breast conservation. J Am Coll Surg. 2006;203:198–207.

    Article  PubMed  Google Scholar 

  18. Mathew J, Asgeirsson KS, Cheung KL, Chan S, Dahda A, Robertson JFR. Neoadjuvant chemotherapy for locally advanced breast cancer: a review of the literature and future directions. Eur J Surg Oncol. 2009;35:113–22.

    Article  PubMed  CAS  Google Scholar 

  19. Buchholz TA, Lehman CD, Harris JH, et al. Statement of the science concerning locoregional treatments after preoperative chemontherapy for breast cancer: a National Cancer Institute conference. J Clin Oncol. 2008;26:791–7.

    Article  PubMed  Google Scholar 

  20. Mieog JS, Van de Velde CJ. Neoadjuvant chemotherapy for early breast cancer. Expert Opin Pharmacother. 2009;10:1423–34.

    Article  PubMed  CAS  Google Scholar 

  21. Chen AM, Meric-Bernstam F, Hunt KK, et al. Breast conservation after neoadjuvant chemotherapy. Cancer. 2005;103:689–95.

    Article  PubMed  Google Scholar 

  22. Huang E, Strom EA, Perkins GH, et al. Comparison of risk of local-regional recurrence after mastectomy or breast conservation therapy for patients treated with neoadjuvant chemotherapy and radiation stratified according to a prognostic index score. Int J Radiation Oncol Biol Phys. 2006;66:352–7.

    Article  Google Scholar 

  23. Oh JL, Nguyen G, Whitman GJ, et al. Placement of radiopaque clips for tumour localisation in patients undergoing neoadjuvant chemotherapy and breast conservation therapy. Cancer. 2007;110:2420–7.

    Article  PubMed  Google Scholar 

  24. Malmgren JA, Atwood MK, Kaplan HG. Increase in mammography detected breast cancer over time at a community based regional cancer centre: a longitudinal cohort study, 1990–2005. BMC Cancer. 2008;8:131–7.

    Article  PubMed  Google Scholar 

  25. Veronesi U, Bonadonna G, Zurrida S, et al. Conservation surgery after primary chemotherapy in large carcinomas of the breast. Ann Surg. 1995;222:612–8.

    Article  PubMed  CAS  Google Scholar 

  26. Tan MP. The boomerang incision for periareolar breast malignancies. Am J Surg. 2007;194:690–3.

    Article  PubMed  Google Scholar 

  27. Tan M, Ung O. Alternative approaches for oncoplastic breast surgery. Ann Surg Oncol. 2011;18:297–9.

    Article  PubMed  Google Scholar 

  28. Anderson BO, Masetti R, Silverstein MJ. Oncoplastic approaches to partial mastectomy: an overview of volume-displacement techniques. Lancet Oncol. 2005;6:145–57.

    Article  PubMed  Google Scholar 

  29. Mannino M, Yarnold J. Effect of breast-duct anatomy and wound-healing responses on local tumour recurrence after primary surgery for early breast cancer. Lancet Oncol. 2009;10:425–9.

    Article  PubMed  Google Scholar 

  30. Tan M. The “golf-tee” incision for lower mid-pole peri-areolar cancers. Ann R Coll Surg Engl. 2010;92:438–9.

    Article  PubMed  Google Scholar 

  31. Losken A, Hamdi M. Partial breast reconstruction: current perspectives. Plast Reconstr Surg. 2009;124:722–36.

    Article  PubMed  CAS  Google Scholar 

  32. Margenthaler J. Optimizing conservative breast surgery. J Surg Oncol. 2011;103:306–12.

    Article  PubMed  Google Scholar 

  33. Pezner RD. Oncoplastic breast surgery challenge to the local radiation boost. Int J Radiat Oncol Biol Phys. 2011;79:963–4.

    Article  PubMed  Google Scholar 

  34. Albino FP, Koltz PF, Ling MN, Largstein HN. Irradiated autologous breast reconstruction: effects of patient factors and treatment variables. Plast Reconstr Surg. 2010;126:12–6.

    PubMed  CAS  Google Scholar 

  35. Scarth H, Cantin J, Levine M, et al. Clinical practice guidelines for the care and treatment of breast cancer: Mastectomy or lumpectomy? The choice of operation for clinical stages I and II breast cancer. CMAJ. 2002;167:154–5.

    PubMed  Google Scholar 

  36. Odofin O, Harris K, Paramanathan N, Laws S, Rainsbury R. The impact of providing an oncoplastic service on the workload of a specialist breast unit. Breast J. 2011;17:371–6.

    Article  PubMed  Google Scholar 

  37. Eberlein TJ. Assessing the state of surgical oncology: the future is now. Ann Surg Oncol. 2006;13:1345–53.

    Article  PubMed  Google Scholar 

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Correspondence to Mona P. Tan MBBS, FRCS.

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Tan, M.P. Alternatives for Optimizing Outcomes in Oncoplastic Breast Surgery. Ann Surg Oncol 19, 2327–2333 (2012). https://doi.org/10.1245/s10434-012-2261-2

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  • DOI: https://doi.org/10.1245/s10434-012-2261-2

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