Advanced breast conservation and partial breast reconstruction – a review of current available options for oncoplastic breast surgery

Abstract

Breast cancer is the most common cancer affecting one in three women with new cancer diagnosis in England. Breast-conserving surgery is the primary surgical option in a vast majority of these patients. Use of oncoplastic techniques in breast conservation surgery has significantly improved the aesthetic outcomes without compromising the oncological safety of cancer resections. Oncoplastic breast-conserving surgery (OPBCS) has transformed the specialty with a paradigm shift in ideology and the recognition that aesthetic and oncological resections are synonymous when planning surgical intervention for patients with breast cancer. The two main options for OPBCS are therapeutic mammoplasty and partial beast reconstruction using pedicle-based flaps. This review aims to highlight key concepts in OPBCS demonstrating an overview of these surgical techniques, their safety, outcomes and the emergence of extreme oncoplastic breast surgery.

Extreme oncoplasty: past, present and future

“…Retrospective cohort studies maintained the indications for EO ( 13 , 14 , 17 ), showing that it is a safe procedure for large tumours (> 5 cm), multicentric tumours, and multifocal tumours with acceptable complication rates (7.7% to 28%) ( 8 , 9 , 13 , 14 , 17 ) and low recurrence rates at a follow-up of > 5 years (6% to 9%) ( 12 , 17 ). Some studies mentioned breast sized/tumour size ratio or resection size to breast size ratio ( 35 , 36 ), which can be used for small- and medium-sized breasts, using regional tissue transfer with local/regional flaps ( 18 , 35 – 37 ). We also observed new options, such as regional flaps ( 38 – 47 ), partial breast amputation ( 48 – 51 ), and flap guides for central tumours ( 52 ).…”

“…With the wide knowledge and dissemination of EO, it is necessary to review potential techniques and group them to facilitate decision-making regarding the indications, surgical possibilities, technical training, and associated complications ( 8 , 18 ). GC ( 9 ) is a technical modification of the initially described procedure ( 22 ).…”

Superficial Thoracic Artery Perforator Flap for Volume Replacement Oncoplastic Breast-conserving Surgery

“…The LICAP, LTAP, and TDAP flaps often reconstruct lateral and inferior partial breast defects. 2 If suitable perforators cannot be found, the reconstructive tissue can be converted to a latissimus dorsi musculocutaneous flap. 3 In addition to the above advantage, the STAP flap leads to less visible postoperative scarring.…”

“…1 For partial breast reconstruction with VR technique in the lateral and central breast, the lateral intercostal artery perforator (LICAP) flap, lateral thoracic artery perforator (LTAP) flap, or thoracodorsal artery perforator (TDAP) flap are often the first choices. 1,2 However, there are cases in which these perforators are missing or too thin, making it difficult to raise a flap for partial breast reconstruction. 3 In such cases, VR-OPBCS could be performed by raising a superficial thoracic artery perforator (STAP) flap.…”