Oncoplasty as the Standard of Care in Breast Cancer Surgery

Abstract

Oncoplastic surgery is redefining breast cancer surgery today. Despite the lack of randomised clinical trials, current evidence suggests at least equivalent oncological outcomes, reduced re-excision rates and superior aesthetic results. This review outlines the arguments for the superiority of this new approach over the current standard of care and discusses some of the difficulties with regards to training and mentoring the next generation of surgeons.

The current pattern of reconstructive surgery for breast cancer

“…Оценивая эстетические результаты органосохран-ных операций, следует отметить высокую долю дефор-маций молочной железы, которая, по данным некото-рых авторов, составляет до 2 / 3 среди всех операций [14]. Таким образом, с одной стороны, необходимо соблюдать принципы онкологического радикализма, с другой -удаление большого объема молочной желе-зы ведет к деформации органа и, как следствие, эсте-тически неприемлемому результату.…”

“…Лечение специализации, подготовка врачей проходит в течение 3-5 лет, при этом в ординатуру принимаются онколо-ги-хирурги со стажем не менее 5 лет (Британия, Гер-мания) [14].…”

Oncoplastic Breast Surgery in India: Thinking Globally, Acting Locally

“…(a) Level I/II oncoplasty: BCT with surgical procedure based on either volume displacement/rearrangement (i.e., local tissue rearrangement, mastopexy, reduction mammoplasty, extreme mammoplasty) or volume replacement (i.e., autologous fat grafting, transposition/ rotational flaps) [15] (b) Level III/IV oncoplasty: Mastectomy followed by oneor two-stage breast reconstruction (i.e., expander or implant) or autologous breast reconstruction (i.e., abdominal tissue (DIEP, TRAM), latissimus dorsi flap, gluteal tissue, or other tissue sources) [16] It is now well-established that OBS techniques provide optimal oncological safety, survival advantages, superior esthetic outcomes, and improvement in QoL of patients [17]. The OBS field is constantly evolving as a result of parallel developments in related fields of surgical tools and technology, lipo-filling, acellular dermal matrices (ADMs), breast implants, and regenerative scaffolds.…”

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.…”

“…However, contrarily to this initial concern, a combination of mammoplasty techniques to mammary oncologic surgery showed to be positive. It could even add safety regarding margins, and at the same time reduce the risk of a poor esthetic-functional result 1 . OP techniques are more complex and require more time than the traditional conservative surgery (BCS).…”