Oncoplastic and Reconstructive Breast Surgery: A Comprehensive Review.

Bulent Citgez,Banu Yigit,Soysal Bas

doi:10.7759/cureus.21763

Abstract

Most of the approaches that were valid until recently in breast cancer surgery have undergone significant changes with rising awareness, increasing number of patients, and knowledge. It is important to repair the damage caused by surgical treatment performed in accordance with oncological principles and to obtain good cosmetic results. The quality-of-life indexes increase and body image is positively affected by the development of oncoplastic surgery and reconstruction techniques.The oncoplastic techniques are commonly used for the closure of glandular defects. Surgeons must pay attention to the breast volume, tumor location, the amount of breast tissue that would be removed, and the oncoplastic technique that may be required. Oncoplastic breast surgery allows wide local excision of the mass with good cosmetic results. In addition, a contralateral breast lift, breast augmentation or breast reduction may be required to accommodate the conceptually reconstructed breast. The use of oncoplastic breast surgery techniques results in lower mastectomy rates with equivalent local and long-term survival rates as compared with mastectomy and offers women the option of plastic and reconstructive interventions performed at the time of initial surgery. Mastectomy may be needed for large tumors, as breast-conserving surgery may not be possible or may not produce satisfactory cosmetic results. Breast reconstruction methods after mastectomy include autologous or implant-based breast reconstructions, which can be performed at the same time as the breast cancer surgery (immediate reconstruction) or at a later time (delayed reconstruction).Oncoplastic and reconstructive breast surgery minimizes the impact of breast cancer surgery and yields equivalent survival outcomes without psychological morbidity. With advanced techniques, better breast image than before can also be achieved. In this review, the technical details of oncoplastic breast surgery, surgical margin positivity management, reconstruction methods, radiation therapy given after reconstruction surgery, radiologic imaging modalities, and management of complications are discussed.

Highlights

Halsted's radical mastectomy has been transferred to less extensive procedures defined as breast-conserving surgery (BCS), which is based on the principles of complete resection of the primary tumor with negative margins
Oncoplastic surgery and reconstruction techniques with implant-based or autologous tissues are used if the standard BCS operation with safe surgical margins is either impossible or creates a large deformity in the breast
Oncoplastic and reconstructive breast surgery improves women’s quality of life and reduces the psychological distress associated with mastectomy

Summary

Introduction

Halsted's radical mastectomy has been transferred to less extensive procedures defined as breast-conserving surgery (BCS), which is based on the principles of complete resection of the primary tumor with negative margins. In patients undergoing RT, autologous tissue reconstruction is associated with fewer complications, better cosmetic results, reduced skin-sensation loss, and higher quality of life scores than reconstruction with a tissue expander or implant This procedure requires a highly experienced team in the field of reconstructive surgery and donor site morbidity should be minimized [32]. The risk of infection, skin necrosis and implant loss is increased in patients who have undergone breast reconstruction, for whom we need to apply additional radiation doses, such as surgical margin positivity [42]. Fat necrosis is commonly seen in category A or B breast density when we apply level-1 oncoplastic techniques that require mammary tissue to be separated from skin flaps and resected along with the pectoralis major fascia. It is usually corrected by a pocket change to the subcutaneous position or selective nerve ablation with botox injections [66]

Conclusions

Findings

Disclosures