Updated Evidence on the Oncoplastic Approach to Breast Conservation Therapy

Abstract

The oncoplastic approach to breast conservation therapy has become a useful and popular option for women with breast cancer who wish to preserve their breast. The initial driving forces were aimed at minimizing the potential for a breast conservation therapy deformity; however, various other benefits have been identified that include broadening the indications for breast conservation therapy in some patients and improved margin control. The various techniques can be categorized into glandular rearrangement techniques such as breast reductions usually in patients with larger breasts or flap reconstruction such as the latissimus dorsi muscle usually in patients with smaller breasts. As the acceptance continues to increase, we are starting to see more outcomes evidence in terms of patient satisfaction, quality of life, complications, and recurrence, to further support the safety and efficacy of the oncoplastic approach.

Oncoplastic mammaplasty with geometric compensation: Evolution of the technique, outcomes and follow‐up in a multicentre retrospective cohort

“…Moreover, it is associated with lower complication rates, better symmetry, better quality of life and better satisfaction, particularly in cases in which radiotherapy was necessary. 20,21 The complication rates with GCM were low, comparable to the rates found with other conventional techniques of oncoplastic mammaplasty. 7,20 Despite major differences in the follow-up of cases, the oncologic outcome appears to be comparable to results reported from other series of oncoplastic surgeries.…”

“…Oncoplastic surgery is cost‐effective. Moreover, it is associated with lower complication rates, better symmetry, better quality of life and better satisfaction, particularly in cases in which radiotherapy was necessary 20,21 . The complication rates with GCM were low, comparable to the rates found with other conventional techniques of oncoplastic mammaplasty 7,20 .…”

“…A meta-analysis showed that oncoplastic breast surgery was significantly associated with lower rates of positive margins (12%) and fewer re-excisions (3-6%) compared to conventional lumpectomies or quadrantectomies (21% and 15%, respectively). 4,7,20 Since it was possible for large parts of the breast, including the overlying skin, to be resected, GCM resulted in affected margins in less than 3% of cases. Although intraoperative frozen section assessment of the margins is popular in Brazil, it was used in less than 40% of the cases, at the surgeon's discretion.…”

Current practice and short-term outcomes of therapeutic mammaplasty in the international TeaM multicentre prospective cohort study

“…It is not clear whether these rates were per breast or per patient, but the present complication rate of 20⋅1 per cent per breast and 23⋅3 per cent per patient are broadly comparable. Incomplete excisions were reported in between 5⋅8 and 18⋅9 per cent of patients in these studies, leading to completion mastectomy rates of 2⋅9-12⋅5 per cent 49 . Here, incomplete excision occurred in less than 15 per cent of cases and the completion mastectomy rate was less than 6 per cent.…”

“…The 'real world' outcome data generated from the multicentre TeaM (Therapeutic Mammaplasty) study are consistent with complication and re-excision rates reported in other series of oncoplastic surgery in which TM formed a part of the oncoplastic approach 27,29,34 . The most recent review 49 of ten large studies found complication rates ranging between 8⋅9 and 24⋅6 per cent. It is not clear whether these rates were per breast or per patient, but the present complication rate of 20⋅1 per cent per breast and 23⋅3 per cent per patient are broadly comparable.…”