Management algorithm for repairing partial mastectomy defects and oncologic safety: evaluation of oncoplastic reduction

Oncoplastic breast reduction is a novel technique that involves surgical treatment of breast lesions in combination with plastic surgery reconstructive techniques. According to recent data, it provides better cosmetic outcomes; however, concerns still exist about oncologic safety. The goal of this study is to evaluate the latest evidence concerning oncologic safety of oncoplastic techniques and to provide a management algorithm for repairing partial mastectomy defects. Medline and PubMed searches were performed from 1998 until 2012 of publications using the search terms “oncoplastic,” “mastopexy,” “breast conservation surgery,” “therapeutic mammoplasty,” and “breast reduction.” All abstracts were studied and the papers that primarily discussed oncoplastic surgery were included. From this investigation, we concluded that oncoplastic surgery can be a safe alternative to breast conserving therapy in females with large breasts. Evidence suggests that contralateral breast reduction reduces metachronous breast cancer recurrence by up to one third simply by reducing the load of breast epithelium. It also adds to the oncologic safety of breast conserving treatment because wider margins can be achieved. The majority of the patients undergoing therapeutic mammoplasty have good to excellent cosmetic outcomes. Oncoplastic techniques require a multidisciplinary approach between oncologists, breast surgeons, and plastic surgeons. We provide a management algorithm that can be useful in the decision making process to determine the best approach for patients requiring partial mastectomy.