From Radical Mastectomy to Breast-Conserving Therapy and Oncoplastic Breast Surgery: A Narrative Review Comparing Oncological Result, Cosmetic Outcome, Quality of Life, and Health Economy

Abstract

Surgical management of breast cancer has evolved considerably over the last two decades. There has been a major shift toward less-invasive local treatments, from radical mastectomy to breast-conserving therapy (BCT) and oncoplastic breast surgery (OBS). In order to investigate the efficacy of each of the three abovementioned methods, a literature review was conducted for measurable outcomes including local recurrence, survival, cosmetic outcome, quality of life (QOL), and health economy. From the point of view of oncological result, there is no difference between mastectomy and BCT in local recurrence rate and survival. Long-term results for OBS are not available. The items assessed in the QOL sound a better score for OBS in comparison with mastectomy or BCT. OBS is also associated with a better cosmetic outcome. Although having low income seems to be associated with lower BCT and OBS utilization, prognosis of breast cancer is worse in these women as well. Thus, health economy is the matter that should be studied seriously. OBS is an innovative, progressive, and complicated subspeciality that lacks published randomized clinical trials comparing surgical techniques and objective measures of outcome, especially from oncologic and health economy points of view.

Avaliação dos resultados estéticos e de qualidade de vida após tratamento cirúrgico do câncer de mama

“…O ideal para uma cirurgia bem sucedida é alcançar um resultado estético aceitável, tanto para o paciente como para o médico 11 . O resultado estético insatisfatório está relacionado a uma série de fatores, alguns relacionados ao próprio tratamento realizado, como por exemplo, reintervenções para obtenção de margens livres, seroma pós-operatório e radioterapia 12 , e outros relacionados às características das pacientes, como idade mais jovem, índice de massa corporal (IMC) elevado, tumores grandes, tumores localizados nos quadrantes súpero-medial e ínfero-lateral 11 e mamas pequenas 13 .…”

Local re-operation and recurrence in oncoplastic breast surgery

“…An oncoplastic surgery (OP) is considered a well-conducted tumor resection followed by immediate breast reconstructive surgery, which evaluates the symmetry with the contralateral breast in the same surgery 1,2 . In addition to a surgical option, this is a new philosophy in the mammary oncologic therapy, since it combines concepts of oncologic surgery and plastic surgery.…”

“…The OP is an innovative methodology. However, it needs further studies comparing different surgical techniques and evaluating oncologic and repairing results in a more objective way 2,[8][9][10] .…”

Oncoplastic surgery in breast conservation: a prospective evaluation of the patients, techniques, and oncologic outcomes

“…small masses the excisions do not cause visible deformities, but while large proportionate breast volumes are excised, subsequent defects and deformities are inevitable, which again may not go along with patients' esthetic desires. 10 Oncoplastic breast surgery (OBS) is a new method of breast conservation. It offers concomitant techniques of oncologic and plastic surgeries that grant better esthetic outcomes.…”

“…OBS also cares about the symmetry of the breasts, as procedures on contralateral breast (either immediate or delayed) try to reconstruct or downsize the healthy breast so that the breasts look identically alike. 10 From the application of primary OBS techniques in the early 1980s, we now have multiple OBS techniques for any tumor location within the breast (Fig. 1).…”