Abstract
Until recently, the surgical management of breast cancer has centered around two main options—either tumor resection by carrying out breast-conserving surgery or mastectomy with or without reconstruction. Lately, techniques that combine the skills of resection with those of reconstruction in one procedure are leading to the emergence of a third approach—oncoplastic breast-conserving reconstruction. This approach involves reconstruction of resection defects either by volume replacement or by volume displacement. Both techniques are adaptations of conventional methods of breast reconstruction or breast reduction. Emerging data on the oncological and cosmetic outcomes of oncoplastic breast-conserving reconstruction are confirming the clinical utility of this new approach to the surgical management of patients with breast cancer.
Key Points
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Breast-conserving reconstruction is extending the role of breast-conserving surgery, and is preventing the need for mastectomy in an increasing number of patients
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Breast-conserving reconstruction enables very wide resection of the tumor without the unsightly deformity that often follows the removal of 20–50% of the breast
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Reconstruction of the resection defect is achieved by the transposition of tissue from elsewhere, or by recruiting tissue from within the breast
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These techniques hybridize the skills of the oncological and reconstructive surgeon in one procedure
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Early results suggest that this approach has a promising future in the surgical management of patients with breast cancer
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References
Fisher B et al. (1994) Twenty-year follow-up of a randomised trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of breast cancer. N Engl J Med 347: 1233–1241
Clough KB et al. (1999) An approach to the repair of partial mastectomy defects. Plast Reconstr Surg 104: 409–420
Early Breast Cancer Trialists' Collaborative Group (2005) Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials. Lancet 366: 2087–2106
Shrotria S (2001) Techniques for improving cosmetic outcome of breast-conserving surgery. Eur J Surg Oncol 27: 109–112
Al-Ghazal SK et al. (1999) Does cosmetic outcome for the treatment of primary breast cancer influence psychological morbidity? Eur J Surg Oncol 25: 571–573
Olivotto IA et al. (1989) Late cosmetic outcome after conservative surgery and radiotherapy: analysis of causes of cosmetic failure. Int J Radiat Oncol Biol Phys 17: 747–753
Berrino P (1987) Post-quadrantectomy breast deformities: classifications and techniques of surgical correction. Plast Reconstr Surg 79: 567–572
Cochrane R et al. (2003) Cosmesis and satisfaction after breast-conserving surgery correlates to the percentage of breast volume excised. Br J Surg 90: 1505–1509
Audretsch WP (1998) Reconstruction of the partial mastectomy defect: classification and method. In Surgery of the Breast: Principles and Art, 155–195 (Ed. Spear SL) Philadelphia: Lippincott-Raven
Rainsbury R (2003) Training and skills for breast surgeons in the New Millennium. ANZ J Surg 73: 511–516
Skillman JM and Humzah MD (2003) The future of breast surgery: a new subspecialty of oncoplastic breast surgeons? Breast 12: 161–162
Rainsbury R and Paramanathan N : UK survey of partial mastectomy and breast reconstruction. Breast, in press
Bulstrode N et al. (2001) Breast volume assessment: comparing five different techniques. Breast 10: 117–123
Clough K et al. (2003) Oncoplastic techniques allow extensive resection for breast-conserving therapy of breast carcinomas. Ann Surg 237: 26–34
Tran N et al. (2001) Comparison of immediate and delayed free TRAM-flap breast reconstruction in patients receiving post mastectomy radiation therapy. Plast Reconstr Surg 108: 78–82
Laws S et al. (2001) Temporal changes in breast volume after surgery for breast cancer and the implications for volume replacement with the latissimus dorsi miniflap. Eur J Surg Oncol 27: 790
Slavin S et al. (1992) Reconstruction of the radiated partial mastectomy defect with autogenous tissues. Plast Reconstr Surg 90: 854–865
Clough K et al. (2004) Reconstruction after conservative treatment for breast cancer: cosmetic sequelae classification revisited. Plast Reconstr Surg 114: 1473–1453
Gendy et al. (2003) Impact of skin-sparing mastectomy with immediate reconstruction and breast-sparing reconstruction with miniflaps on the outcomes of oncoplastic breast surgery. Br J Surg 19: 433–439
Veronesi U (1990) Quadrantectomy versus lumpectomy for small sized breast cancer. Eur J Cancer 26: 671–673
Noguchi M et al. (1990) Immediate transposition of a latissimus dorsi muscle for correcting a quadrantectomy breast deformity in Japanese patients. Int Surg 75: 166–170
Rainsbury R (1994) Breast conservation with latissimus dorsi miniflap: a new technique. Eur J Surg Oncol 20: 102–103
Raja M et al. (1997) Extending the role of breast-conserving surgery by immediate volume replacement. Br J Surg 84: 101–105
Clough K et al. (1995) Conservative treatment of breast cancers by mammoplasty and irradiation: a new approach to lower quadrant tumours. Plast Reconstr Surg 96: 363–370
Spear S et al. (2003) Experience with reduction mammoplasty combined with breast conservation therapy in the treatment of breast cancer. Plast Reconstr Surg 111: 1102–1109
Lanfrey E et al. (1997) Mammoplasty for asymmetry of the contralateral breast and its oncologic value. Ann Chir Plast Esthet 42: 160–167
Thomas P et al. (1993) Use of silicone implants after wide local excision of the breast. Br J Surg 80: 868–870
Elton C and Jones PA (1999) Initial experience of intramammary prosthesis in breast-conserving surgery. Eur J Surg Oncol 25: 138–141
Pearl RM and Wisnicki J (1985) Breast reconstruction following lumpectomy and irradiation. Plast Reconstr Surg 76: 83–86
Audretsch W et al. (1998) Tumour-specific immediate reconstruction (TSIR) in breast cancer patients. Perspect Plast Surg 11: 76–106
Santi P et al. (1986) Anterior transposition of the latissimus dorsi muscle through minimum incisions. Scand J Reconstr Surg 20: 89–92
Papp C et al. (1988) Volume replacement using the de-epithelialised latissimus dorsi myocutaneous flap. Eur J Plast Surg 11: 120–125
Monticillio D et al. (1996) Autogenous breast reconstruction with endoscopic latissimus dorsi with musculo-subcutaneous flaps in patients choosing breast-conserving therapy: mammographic appearance. Am J Radiol 167: 385–389
Ohuchi M et al. (1997) Breast-conserving surgery for primary breast cancer: immediate volume replacement using lateral tissue flap. Breast Cancer 4: 135–141
Grisotti A (1994) Immediate reconstruction after partial mastectomy. Op Tech Plast Reconstr Surg 1: 1–12
Hudson D (2007) A modified excision for combined reduction mammoplasty and breast conservation therapy in the treatment of breast cancer. Aesth Plast Surg 31: 71–75
McCulley S and Macmillan R (2005) Planning and use of therapeutic mammoplasty—the Nottingham approach. Br J Plast Surg 58: 889–901
Benelli L (1990) A new periareolar mammoplasty: round block technique. Aesth Plast Surg 14: 99–109
Noguchi M et al. (1991) Breast deformity, its correction and assessment of breast-conserving surgery. Breast Cancer Res Treat 18: 111–118
Rainsbury R and Paramanathan N (1998) Recent progress with breast-conserving volume replacement using latissimus dorsi miniflaps in UK patients. Breast Cancer 5: 139–147
Dixon J et al. (2002) Latissimus dorsi miniflap: a new technique for extending breast conservation. Breast 11: 58–65
Kat C et al. (1999) The use of the latissimus dorsi musculocutaneous flap for immediate correction of the deformity resulting from breast conservation surgery. Br J Plast Surg 52: 99–103
Nano T et al. (2004) Breast volume replacement using the latissimus dorsi miniflap. ANZ J Surg 74: 98–104
Losken A et al. (2004) Immediate endoscopic latissimus dorsi flap: risk or benefit in reconstructing partial mastectomy defects. Am Plast Surg 1: 1–5
Nos C et al. (1998) Conservative treatment of lower pole breast cancers by bilateral mammoplasty and radiotherapy. Eur J Surg Oncol 24: 508–514
Masetti R et al. (2000) Oncoplastic techniques in the conservative surgical treatment of breast cancer. Breast Cancer 7: 276–280
Chang E et al. (2004) Bilateral reduction mammoplasty in combination with lumpectomy for treatment of breast cancer in patients with macromastia. Am J Surg 187: 647–651
Petit J-Y et al. (2001) Breast reconstructive techniques in cancer patients: which one, when to apply, which immediate and long term risks? Crit Rev Oncol Haematol 38: 231–239
Galimberti V et al. (1993) Central small size breast cancer: how to overcome the problem of nipple and areola involvement. Eur J Cancer 29A: 1093–1096
Newman L et al. (2001) Reduction mammoplasty improves breast conservation therapy in patients with macromastia. Am J Surg 181: 215–220
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Rainsbury, R. Surgery Insight: oncoplastic breast-conserving reconstruction—indications, benefits, choices and outcomes. Nat Rev Clin Oncol 4, 657–664 (2007). https://doi.org/10.1038/ncponc0957
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DOI: https://doi.org/10.1038/ncponc0957
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