Abstract
Breast conservation surgery is available to the vast majority of women with breast cancer. The combination of neoadjuvant therapies and oncoplastic surgical techniques allows even large tumours to be managed with a breast-conserving approach. The relationship between breast size and the volume of tissue to be excised determines the need for volume displacement or replacement. Such an approach can also be used in the management of carefully selected cases of multifocal or multicentric breast cancer. The role of novel techniques, such as endoscopic breast surgery and radiofrequency ablation, is yet to be precisely defined.
Highlights
The replacement of obligatory mastectomy, be it radical or modified radical, by simple mastectomy or wide local excision and adjuvant radiotherapy, reflected a paradigm shift in the understanding of breast cancer pathology and biology [1]
The concept of downstaging tumours by means of neo-adjuvant chemotherapy or endocrine therapy is increasingly being applied to improve the chance of successful conservation surgery in the same way as it can render operable the inoperable [3, 4]
Tumours may be successfully downstaged with neoadjuvant chemotherapy and/or endocrine therapy, allowing the majority of patients to undergo breast conservation surgery [4, 17]
Summary
The replacement of obligatory mastectomy, be it radical or modified radical, by simple mastectomy or wide local excision and adjuvant radiotherapy, reflected a paradigm shift in the understanding of breast cancer pathology and biology [1]. The combination of multimodal treatments, both locoregional, in the form of conservation surgery and radiotherapy, and systemic endocrine treatment and chemotherapy, has resulted in reduced postsurgical morbidity without compromising oncological outcomes [2]. Multifocal and multicentric tumours remain relative contraindications to attempts at breast conserving surgery. Such patients need careful counselling regarding the possible need for further surgery if excision is incomplete, and the increased risk of locoregional recurrence. The importance of the oncoplastic approach, defined as the application of plastic surgery techniques of partial breast reconstruction at the time of breast cancer surgery, to optimising the oncological and cosmetic outcomes of breast conservation, has never been more keenly felt [14,15,16]
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