Breast Conserving Surgery with Oncoplastic Techniques: Six Years Experience

Abstract

INTRODUCTION: Breast conserving surgery (BCS) with adjuvant radiotherapy is a well-established treatment in patients with breast cancer, not compromising survival or local recurrence. Oncoplastic surgery combines breast and plastic surgery techniques in BCS, increasing the indication of BCS, reducing both mastectomy and re-excision rates, avoiding breast deformities, improving cosmetic result without compromising oncologic outcome. OBJECTIVES: The aim of this study is to analyze the experience in a breast cancer unit during the last six years, in order to evaluate oncologic and aesthetics results in patients with breast pathology treated with BCS using oncoplastic techniques (OpT). MATERIAL AND METHODS: Retrospective, descriptive study, analyzing hospital data base and patients records with breast pathology that were treated at the Breast Surgical Unit, Hospital San Borja Arriaran, Santiago, Chile, since July 2006 till April 2012. Surgeries were done by breast surgeons trained in OpT. All patients were discussed in oncologic committee before treatment. RESULTS: Sixty-nine patients underwent BCS combined with OpT. Average age and body mass index of patients were 46 years (16-73) and 26 (19-37) respectively. Thirty-seven cases (54%) were associated to breast cancer, mainly in stage II; and 32 (46%) in patients with benign pathology, mainly fibroadenomas and phyllodes tumors. In 64 patients (93%), the tumor was unilateral; in 5 (7%) they were synchronic bilateral tumors. Most surgeries were based on principles of reductive mammaplasty and breast-flap advancement. Contra-lateral simetrization was done in 40 patients (59%). There were 3 cases of incidental contra-lateral cancer. In 5 cases surgeries were done after neoadjuvant chemotherapy. The average breast weight resected was 322 grs. (30-990 grs.). Breast complications occurred in 14 patients (marginal skin necrosis, areola ischemia, suture dehiscence, late fat necrosis). Actually there is 1 reported case of local recurrence and 1 case of multiple distance metastases. No mortality been reported. CONCLUSIONS: Oncoplastic surgery are reliable techniques that could be considered in any case of breast-conserving reconstruction, either for malignant or benign disease. The use of OpT has allowed us to resolve cases were BCS was impossible to apply because of tumor location or breast/tumor relationship. In breast surgeons with experience in classical BCS, oncoplastic techniques must be part of their skills to treat breast cancer patients, in order to increase the indication of BCS, maintaining oncologic outcomes and improving aesthetic results and patient satisfaction.