Oncoplastic Techniques Allow Extensive Resections for Breast-Conserving Therapy of Breast Carcinomas

Abstract

ObjectiveTo assess the oncologic and cosmetic outcomes in women with breast carcinoma who were treated with breast-conserving therapy using oncoplastic techniques with concomitant symmetrization of the contralateral breast. Summary Background DataAlthough breast-conserving therapy is the standard form of treatment for invasive breast tumors up to 4 cm, in patients with large, ill-defined, or poorly situated tumors, cosmetic results can be poor and clear resection margins difficult to obtain. The integration of oncoplastic techniques with a concomitant contralateral symmetrization procedure is a novel surgical approach that allows wide excisions and prevents breast deformities. MethodsThis is a prospective study of 101 patients who were operated on for breast carcinoma between July 1985 and June 1999 at the Institut Curie. The procedure was proposed for patients in whom conservative treatment was possible on oncologic grounds but where a standard lumpectomy would have led to poor cosmesis. Standard institutional treatment protocols were followed. All patients received either pre-or postoperative radiotherapy. Seventeen patients received preoperative chemotherapy to downsize their tumors. Mean follow-up was 3.8 years. Results were analyzed statistically using Kaplan-Meier estimates. ResultsMean weight of excised material on the tumor side was 222 g. The actuarial 5-year local recurrence rate was 9.4%, the overall survival rate was 95.7%, and the metastasis-free survival rate was 82.8%. Cosmesis was favorable in 82% of cases. Preoperative radiotherapy resulted in worse cosmesis than when given postoperatively. ConclusionsThe use of oncoplastic techniques and concomitant symmetrization of the contralateral breast allows extensive resections for conservative treatment of breast carcinoma and results in favorable oncologic and esthetic outcomes. This approach might be useful in extending the indications for conservative therapy.

Evaluation of Surgical Outcomes of Oncoplasty Breast Surgery in Locally Advanced Breast Cancer and Comparison with Conventional Breast Conservation Surgery

“…In this study, it is seen that OBS resulted in larger specimen volume size as well as wider mean margins being obtained. This is similar to the experience of other authors too [6][7][8]. In our patients, total excision was made possible by tattooing the tumor skin projection preoperatively as suggested by Mathieu et al [14].…”

“…Although some authors [6,19] have reported more number of complications in OBS leading to a delay in the start of adjuvant therapy, in this study, the complication rates were similar in both groups, and there was no delay noted in the start of adjuvant therapy. In this study, no locoregional recurrence has been seen in OBS while 11 % cases in conventional BCS have demonstrated local relapse.…”

“…Studies have demonstrated that in early breast cancers and large operable breast cancers, as compared to conventional breast conservation surgery (wide local excision or lumpectomy with a gross margin of 1 cm plus axillary lymph node dissection), OBS achieves wider excision of tumor, superior mean volume of specimen, and potentially reduces margin involvement. It is more effective from aesthetic-functional point of view and does not compromise local control and survival [6][7][8]. Locally advanced breast cancer (LABC) accounts for a large proportion of breast cancers in India; 40-60 % in some series.…”

High rates of breast conservation for large ductal and lobular invasive carcinomas combining multimodality strategies

“…Additionally, to really benefit from higher rates of breast conservation, one needs to closely evaluate the cosmetic effects of this therapeutic approach but which could not be assessed in our study. One particular concern is indeed that it is associated with worse cosmetic results, because they deteriorate with the radiotherapy total dose (whole breast þ boost; Vrieling et al, 1999), with chemotherapy (Vass and Bairati, 2005), and when radiotherapy is given pre-rather than post-operatively, both in the case of standard (Durand et al, 1987) or oncoplastic (Clough et al, 2003) surgeries.…”

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

“…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].…”