Oncoplastic breast surgery

Abstract

Breast Surgery is now a recognized subspecialty of General Surgery abroad with structured training for designated 'Oncoplastic Breast Surgeons'. Oncoplastic Breast surgery is probably one of the most interesting and challenging new developments over the past 20 years. The aims of Oncoplastic surgery are wide local excision of the cancer coupled with partial reconstruction of the defect to achieve a cosmetically acceptable result. Avoidance of mastectomy and consequent reduction of psychological morbidity are the principal goals in the development of various oncoplastic techniques. The use of plastic surgical techniques not only ensures good cosmetic outcome, but also allows the cancer surgeon to remove the tumour with greater volume of surrounding tissue, thus extending the boundaries of breast conserving surgery. Proper patient selection and careful planning after proper radiological and clinical assessment are the two essential prerequisites before undertaking oncoplastic breast surgery. Oncoplastic surgery involves both volume displacement and volume replacement techniques. Some commonly used volume displacement procedures are described in the article. The need for adjustment of contralateral breast should also be anticipated at the time of planning breast conserving surgery, which can be done either at the same time as breast cancer surgery or as a delayed setting.

Fig. 1

Round block technique for cancers in the upper inner quadrant of the breast. Reprinted from Oncoplastic and Reconstructive Surgery of the Breast published by Informa Healthcare (2004). Copyright Informa Healthcare

Fig. 2

Round block technique – skin marking. Reprinted from Oncoplastic and Reconstructive Surgery of the Breast published by Informa Healthcare (2004). Copyright Informa Healthcare

Fig. 3

Round block technique – view after completion of operation. Reprinted from Oncoplastic and Reconstructive Surgery of the Breast published by Informa Healthcare (2004). Copyright Informa Healthcare

Fig. 4

Round block technique – postoperative view. Reprinted from Oncoplastic and Reconstructive Surgery of the Breast published by Informa Healthcare (2004). Copyright Informa Healthcare

Fig. 5

Comma-shaped breast mammoplasty breast reduction or mastoplexy. Reprinted from Oncoplastic and Reconstructive Surgery of the Breast published by Informa Healthcare (2004). Copyright Informa Healthcare

Fig. 6

Superior pedicle breast reduction for cancers in the lower part of the breast. Reprinted from Oncoplastic and Reconstructive Surgery of the Breast published by Informa Healthcare (2004). Copyright Informa Healthcare

Fig. 7

Superior pedicle breast reduction – skin marking and extent of excision. Reprinted from Oncoplastic and Reconstructive Surgery of the Breast published by Informa Healthcare (2004). Copyright Informa Healthcare

Fig. 8

Superior pedicle breast reduction. Reprinted from Oncoplastic and Reconstructive Surgery of the Breast published by Informa Healthcare (2004). Copyright Informa Healthcare

Fig. 9

Superior pedicle breast reduction – postoperative view. Reprinted from Oncoplastic and Reconstructive Surgery of the Breast published by Informa Healthcare (2004). Copyright Informa Healthcare

Fig. 10

Inferior pedicle breast reduction for cancers above the nipple or in the lower medial or lateral quadrants. Reprinted from Oncoplastic and Reconstructive Surgery of the Breast published by Informa Healthcare (2004). Copyright Informa Healthcare

Fig. 11

Inferior pedicle breast reduction. Dotted lines represent the inferior pedicle and ‘X’ the extent of excision (reduction). Reprinted from Oncoplastic and Reconstructive Surgery of the Breast published by Informa Healthcare (2004). Copyright Informa Healthcare

Fig. 12

Inferior pedicle breast reduction – skin marking and extent of excision. Reprinted from Oncoplastic and Reconstructive Surgery of the Breast published by Informa Healthcare (2004). Copyright Informa Healthcare

Fig. 13

Inferior pedicle breast reduction – postoperative view. Reprinted from Oncoplastic and Reconstructive Surgery of the Breast published by Informa Healthcare (2004). Copyright Informa Healthcare

Fig. 14

Inferior pedicle breast reduction – postoperative view with contralateral reduction. Reprinted from Oncoplastic and Reconstructive Surgery of the Breast published by Informa Healthcare (2004). Copyright Informa Healthcare

Fig. 15

Grisotti advancement (rotation flap) for central quadrant tumours. Reprinted from Oncoplastic and Reconstructive Surgery of the Breast published by Informa Healthcare (2004). Copyright Informa Healthcare

Fig. 16

Grisotti advancement (rotation flap) for Central quadrant tumours – Line diagram. Reprinted from Oncoplastic and Reconstructive Surgery of the Breast published by Informa Healthcare (2004). Copyright Informa Healthcare

Fig. 17

Grisotti advancement – skin marking. Reprinted from Oncoplastic and Reconstructive Surgery of the Breast published by Informa Healthcare (2004). Copyright Informa Healthcare

Fig. 18

Grisotti advancement – wound completely closed. Reprinted from Oncoplastic and Reconstructive Surgery of the Breast published by Informa Healthcare (2004). Copyright Informa Healthcare

Fig. 19

Grisotti advancement – postoperative view. Reprinted from Oncoplastic and Reconstructive Surgery of the Breast published by Informa Healthcare (2004). Copyright Informa Healthcare

Fig. 20

Thoraco-epigastric flap after breast-conserving surgery. Reprinted from Oncoplastic and Reconstructive Surgery of the Breast published by Informa Healthcare (2004). Copyright Informa Healthcare

Fig. 21

Glandular rotation after breast-conserving surgery. Reprinted from Oncoplastic and Reconstructive Surgery of the Breast published by Informa Healthcare (2004). Copyright Informa Healthcare

Fig. 22

Lateral mammoplasty. Reprinted from Oncoplastic and Reconstructive Surgery of the Breast published by Informa Healthcare (2004). Copyright Informa Healthcare

Fig. 23

Horizontal mammoplasty. Reprinted from Oncoplastic and Reconstructive Surgery of the Breast published by Informa Healthcare (2004). Copyright Informa Healthcare

Fig. 24

Horizontal mammoplasty. Reprinted from Oncoplastic and Reconstructive Surgery of the Breast published by Informa Healthcare (2004). Copyright Informa Healthcare

Fig. 25

Poor outcomes following breast-conserving surgery. Reprinted from Oncoplastic and Reconstructive Surgery of the Breast published by Informa Healthcare (2004). Copyright Informa Healthcare