gms | German Medical Science

Breast cancer surgery evolved significantly over last two decades. One of the most exciting developments was introduction of oncoplastic surgery, which combines cancer excision with various plastic surgery techniques to enhance cosmetic outcome.

The Milan trials and NSABP-06 study results validated use of breast conserving surgery in many women as an alternative for mastectomy. They also confirmed that radical cancer excision with good margins is fundamental to ensure adequate locoregional control and prevent local recurrence.

There is however natural conflict between performing resection wide enough to obtain optimal cancer excision and preserving sufficient volume of breast tissue to avoid deformity. This is particularly important in cases when tumour-breast ratio is unfavourable. It is estimated that traditional breast conserving surgery results in unsatisfactory cosmesis in about 20% of cases.

Oncoplastic surgery has been gradually integrated into comprehensive management of breast cancer. Currently there are various techniques of oncoplastic surgery available, which can be offered when significant parenchymal defect after cancer excision is anticipated. These techniques include: superior and inferior pedicle reduction mammoplasty, lateral mammoplasty, round block technique, rotational flaps, Grisotti flap, “bat wing“ mammoplasty and others.

Choice of specific type of operation depends on several factors ie. tumour location, proximity to nipple-areola complex, breast size and volume of parenchymal excision, degree of ptosis and need for contralateral surgery for symmetry. Oncological considerations have major impact on patients' selection and should always take precedence over cosmetic aspects.

Different oncoplastic techniques will be reviewed during the presentation and decision-making process in specific scenarios will be also discussed.