42 - Oncoplastic Breast Reconstruction: Extreme Oncoplasty and Split Reduction Techniques

Abstract

Oncoplastic breast surgery combines oncologic principles with plastic surgical techniques to completely excise the cancer, with a wide surgical margin, while maintaining or improving cosmesis. Poor esthetic outcomes have been reported in up to 30% of breast conservation procedures. For large, poorly defined, or unfavorably situated tumors, standard lumpectomies may lead to unacceptable cosmetic results in addition to close or involved resection margins. Integration of the two surgical disciplines avoids or minimizes poor cosmetic results after wide excision. It increases the number of women who can be treated with breast-conserving surgery by allowing larger breast excisions with more acceptable cosmetic results. Oncoplastic surgery requires a multidisciplinary approach and thorough preoperative planning. Using these techniques, tumors can be successfully resected from any quadrant of the breast while maintaining breast cosmesis, diminishing postradiation deformities, and providing breast symmetry. Extreme oncoplasty describes a breast-conserving operation, using oncologic principles and plastic surgery techniques, in a patient who, in most physicians’ opinions, requires a mastectomy. The majority of the literature for breast conservation reports on lesions that are ≤5cm. Women with lesions >5cm, or those with multicentric or multifocal disease, are usually recommended to go straight to mastectomy. For a subset of patients who seek breast conservation, even after they were recommended for mastectomy, extreme oncoplasty may allow for successful breast conservation. The split reduction is a variation on the standard Wise pattern reduction mammoplasty and is used when a tumor to be resected falls outside of the Wise pattern and is close to or involves a skin margin. The split is used when the surgeon desires removal of the skin over the tumor at the time of resection, eliminating the chances of the anterior margin being involved at pathology review.