Update on oncoplastic breast surgery.

Department of Surgery, Breast Unit, School of Medicine, Catholic University of the Sacred Heart, Rome, Italy. .
European review for medical and pharmacological sciences (Impact Factor: 0.99). 11/2012; 16(11):1530-40.
Source: PubMed

ABSTRACT Oncoplastic surgery of the breast (OPS) has generated great excitement over the past years and has become an integrated component of the surgical treatment of breast cancer. Oncoplastic surgical procedures associate the best surgical oncologic principles to achieve wide tumor-free margins with the best principles of plastic surgery to optimize cosmetic outcomes. Thanks to oncoplastic techniques, the role of breast conserving surgery (BCS) has been extended to include a group of patients who would otherwise require mastectomy to achieve adeguate tumor clearance. As OPS continues to gain acceptance and diffusion, an optimal and systematic approach to these techniques is becoming increasingly necessary. This article has the aim to review the essential principles and techniques associated with oncoplastic surgery, based on the data acquired through an extensive search of the PUBMED and MEDLINE database for articles published using the key words "breast cancer oncoplastic surgery". This review analyzes possible the advantages", classifications, indications, and the criteria for a proper selection of oncoplastic techniques to facilitate one's ability to master these procedures and make OPS a safe and an effective procedure.

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    ABSTRACT: Oncoplastic breast surgery is a standard treatment of early breast cancer, offering a balance between good cosmetic outcome and limited risk of locoregional recurrence, by enabling proper resection margins.Aim of studyTo present multiple techniques of partial breast reconstruction following the resection of centrally located breast cancer (CLBC) resection.Patients and methodsFrom January 2011 to August 2014, 21 patients underwent central quadrantectomy for carcinoma of the central region of the breast. Excisions included the nipple/areola complex, in most of the cases, down to the pectoralis fascia with a wide safety margin, and proper axillary management. Oncoplastic approaches included latissimus dorsi flap, inferior pedicle flap, Melon slice, Grisotti and round block techniques.ResultsMean age of patients was 49.5 ± 10.61 years. Tumor size ranged from 1.5 to 4.5 cm. Postoperative pathology revealed a tumor mean safety margin of 2.5 ± 0.83 cm, with positive axillary lymph nodes in 15 (75.0%) patients. Nineteen (95.0%) patients received postoperative breast radiotherapy, while 9/20 (45.0%) and 3/20 (15.0%) received adjuvant chemotherapy or hormonal therapy, respectively, and only 8/20 (40.0%) patients received both therapies. During a median follow-up period of 14.89 months, neither local nor distant metastasis, were detected. The postoperative cosmetic result evaluated by the patients was excellent in 6/20 patients (30.0%), good in 11/20 patients (55.0%), fair in 3/20 (15.0%) with neither poor nor bad results, with an overall mean of 4.0 ± 0.5 equivalent to 80% satisfaction.Conclusion Multiple oncoplastic breast surgery techniques can be used for the resection of CLBC with satisfying cosmetic outcomes.
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    ABSTRACT: Oncologic, reconstructive, and cosmetic breast surgery has evolved in the last 20 years. Familiarity with cutting-edge surgical techniques and their imaging characteristics is essential for radiologic interpretation and may help avert false-positive imaging findings. Novel surgical techniques include skin- and nipple-sparing mastectomies, autologous free flaps, autologous fat grafting, and nipple-areola-complex breast reconstruction. These techniques are illustrated and compared with conventional surgical techniques, including modified radical mastectomy and autologous pedicled flaps. The role of magnetic resonance (MR) imaging in surgical planning, evaluation for complications, and postsurgical cancer detection is described. Breast reconstruction and augmentation using silicone gel-filled implants is discussed in light of the Food and Drug Administration's recommendation for MR imaging screening for "silent" implant rupture 3 years after implantation and every 2 years thereafter. Recent developments in skin incision techniques for reduction mammoplasty are presented. The effects of postsurgical changes on the detection of breast cancer are discussed by type of surgery. ©RSNA, 2014.
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