A Comparison Between Oncoplastic Breast Conserving Surgery andStandard Wide Local Excision: A UK Experience

Abstract

Breast Cancer: Current ResearchBr ea s t C a n ce r: Curre nt R e se ar ch Khawaja et al., Breast Can Curr Res 2015, 1:1 Keywords: Breast conserving surgery; Oncoplastic breast surgery;Wide local excision; Breast cancer; Cosmesis IntroductionIn women with early stage unifocal breast cancer, breast conserving surgery followed by radiotherapy is the recommended choice. However, in some women, lesions are difficult to excise without the risk of cosmetic deformity or inadequate margin clearance. These women often present with large tumors in relatively small breasts requiring an excision of approximately 15% to 20% of the breast volume or more than 30% in large breasts. Another factor affecting poor cosmesis after breast conserving surgery is tumors located in aesthetically sensitive areas such as the central, medial, and inferior quadrants [1,2].In recent years, oncoplastic breast conserving surgery (OPS) has increased in popularity. OPS combines the principles of oncologic and plastic surgery techniques to gain oncologically and aesthetically pleasing results [3]. As these techniques become more accepted there is a demand for surgeons to become familiar with the indications and skills required to make oncoplastic surgery safe and effective [4].The choice between different oncoplastic techniques are determined mainly by the site of the tumor in the breast, tumor characteristics, extent of resection, breast characteristics (size, shape and glandular density), previous surgery, and the expectations and wishes of the patient [5].OPS can be classified into two main approaches according to the reconstruction technique used. Volume displacement techniques are applied to correct quadrantectomy defects in medium to large breasts [6]. They are of particular benefit to those patients who present with ptotic dense glandular breasts. The breast glandular tissue is advanced, rotated or transpositioned to fill the defect [7]. Since this may result in a smaller sized breast, contralateral surgery may be required. Conversely, AbstractBackground: The goal of breast conserving surgery is to achieve complete excision of the tumor with adequate surgical margins, while preserving the natural shape and appearance of the breast. This is a retrospective study which compared operative outcomes in oncoplastic (OPS; n=54) versus standard wide local excision (WLE; n=265) populations. A total of 319 consecutive patients were included in the study. The primary outcomes were the size of the tumor, weight of the specimen and margin clearance. The secondary outcomes were patient satisfaction, local recurrence rates and operative time.

Achieving margin clearance following oncoplastic breast surgery in comparison with simple wide local excision: a three‐dimensional specimen assessment

“…Arguably, the pertinent influence is the pre‐operative tumour size, notably in the M‐L and S‐I dimensions. The increased pre‐operative tumour size and surgical specimen weight in the OBS group compared with the WLE group is of no surprise and has been demonstrated by several studies 9,10 …”

“…The increased preoperative tumour size and surgical specimen weight in the OBS group compared with the WLE group is of no surprise and has been demonstrated by several studies. 9,10 An overarching advantage with the OBS is the ability to preserve or improve breast aesthetics despite higher tumour-to-breast ratios. Specifically, WLE has been reported to yield inadequate aesthetic outcomes in 20-25% of patients, after both subjective and objective assessment.…”

Evaluation of the Surgical Outcomes of Breast Oncoplastic Techniques Carried Out by a General Surgical Oncologist

“…The average tumour size was 31mm in our cohort, with most of our patients with medium-sized breasts. Studies comparing BCS using oncoplastic techniques and standard wide local excision demonstrated that significantly larger tumours were excised using BCS oncoplastic techniques rather than those treated with a standard wide local excision [ 10 , 11 ].…”

“…In most patients, minor breast difference is not an issue [ 10 ]. In contrast, breast asymmetry in shape and size can be a problem in other cases, especially in patients with the preoperative size difference and those requiring large resections.…”