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Oncoplastic Techniques
Dalliah M. Black, MD; Mark W. Clemens, MD
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KEY FACTS

  • Terminology

    • Preprocedure

      • Procedure

        • Outcomes

          TERMINOLOGY

          • Synonyms

            • Breast-conserving surgery (BCS) = lumpectomy = segmental mastectomy = partial mastectomy
          • Definitions

            • Breast conservation therapy (BCT): Breast cancer patients treated with BCS followed by radiation therapy (XRT)
            • Oncoplastic surgery: Surgical repair of partial mastectomy or mastectomy defects
              • Immediate: At time of breast cancer surgery
                • With BCS, adjacent tissue transfer &/or reductive techniques prior to XRT
                • With mastectomy, implant-based or autologous flap performed for breast reconstruction
              • After XRT (~ 6-12 months): Autologous flap reconstruction has safer long-term outcomes

          PREPROCEDURE

          • Indications

            • Contraindications

              • Preprocedure Imaging

                • Getting Started

                  • Clinical Issues

                    PROCEDURE

                    • Procedure Steps

                      POST PROCEDURE

                      • Expected Outcome

                        • Things to Do

                          • Things to Avoid

                            OUTCOMES

                            • Problems

                              • Complications

                                Selected References

                                1. Nakada H et al: Fat necrosis after breast-conserving oncoplastic surgery. Breast Cancer. 26(1):125-30, 2019
                                2. Chatterjee A et al: Results from the American Society of Breast Surgeons Oncoplastic Surgery Committee 2017 survey: current practice and future directions. Ann Surg Oncol. ePub, 2018
                                3. Habibi M et al: Oncoplastic breast reconstruction: should all patients be considered? Surg Oncol Clin N Am. 27(1):167-80, 2018
                                4. Hillberg NS et al: Delay of adjuvant radiotherapy due to postoperative complications after oncoplastic breast conserving surgery. Breast. 39:110-16, 2018
                                5. Kimball CC et al: Trends in lumpectomy and oncoplastic breast-conserving surgery in the US, 2011-2016. Ann Surg Oncol. ePub, 2018
                                6. Smith ML et al: Defining the role of free flaps in partial breast reconstruction. J Reconstr Microsurg. 34(3):185-92, 2018
                                7. Wiens N et al: Effect of BioZorbĀ® surgical marker placement on post-operative radiation boost target volume. J Radiat Oncol. 7(2):175-179, 2018
                                8. Losken A et al: Updated evidence on the oncoplastic approach to breast conservation therapy. Plast Reconstr Surg. 140(5S Advances in Breast Reconstruction):14S-22S, 2017
                                9. Srinivasa DR et al: Direct-to-implant versus two-stage tissue expander/implant reconstruction: 2-Year risks and patient-reported outcomes from a prospective, multicenter study. Plast Reconstr Surg. 140(5):869-77, 2017
                                10. Carter SA et al: Operative and oncologic outcomes in 9861 patients with operable breast cancer: single-institution analysis of breast conservation with oncoplastic reconstruction. Ann Surg Oncol. 23(10):3190-8, 2016
                                11. De Lorenzi F et al: Oncological results of oncoplastic breast-conserving surgery: Long term follow-up of a large series at a single institution: A matched-cohort analysis. Eur J Surg Oncol. 42(1):71-7, 2016
                                12. Piper M et al: Comparison of mammographic findings following oncoplastic mammoplasty and lumpectomy without reconstruction. Ann Surg Oncol. 23(1):65-71, 2016
                                13. Losken A et al: A meta-analysis comparing breast conservation therapy alone to the oncoplastic technique. Ann Plast Surg. Epub ahead of print, 2013
                                14. Fischer JP et al: Breast reconstruction modality outcome study: a comparison of expander/implants and free flaps in select patients. Plast Reconstr Surg. 131(5):928-34, 2013
                                15. Schaverien MV et al: Implant-based augmentation mammaplasty following breast conservation surgery. Ann Plast Surg. 69(3):240-3, 2012
                                16. Kronowitz SJ et al: A management algorithm and practical oncoplastic surgical techniques for repairing partial mastectomy defects. Plast Reconstr Surg. 122(6):1631-47, 2008
                                17. Kronowitz SJ et al: Practical guidelines for repair of partial mastectomy defects using the breast reduction technique in patients undergoing breast conservation therapy. Plast Reconstr Surg. 120(7):1755-68, 2007
                                18. Kronowitz SJ et al: Determining the optimal approach to breast reconstruction after partial mastectomy. Plast Reconstr Surg. 117(1):1-11; discussion 12-4, 2006
                                19. Bajaj AK et al: Aesthetic outcomes in patients undergoing breast conservation therapy for the treatment of localized breast cancer. Plast Reconstr Surg. 114(6):1442-9, 2004
                                20. Chen AM et al. Breast conservation after neoadjuvant chemotherapy: The M. D. Anderson Cancer Center experience. J. Clin. Oncol. 22: 2303, 2004
                                21. Pawlik TM et al: Potential applicability of balloon catheter-based accelerated partial breast irradiation after conservative surgery for breast carcinoma. Cancer. 100(3):490-8, 2004
                                22. Clough KB et al: An approach to the repair of partial mastectomy defects. Plast Reconstr Surg. 104(2):409-20, 1999
                                23. Clough KB et al: Cosmetic sequelae after conservative treatment for breast cancer: classification and results of surgical correction. Ann Plast Surg. 41(5):471-81, 1998
                                24. Clough KB et al: Conservative treatment of breast cancers by mammaplasty and irradiation: a new approach to lower quadrant tumors. Plast Reconstr Surg. 96(2):363-70, 1995
                                25. Slavin SA et al: Reconstruction of the radiated partial mastectomy defect with autogenous tissues. Plast Reconstr Surg. 90(5):854-65; discussion 866-9, 1992
                                26. Matory WE Jr et al: Aesthetic results following partial mastectomy and radiation therapy. Plast Reconstr Surg. 85(5):739-46, 1990
                                Related Anatomy
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                                References
                                Tables

                                Tables

                                KEY FACTS

                                • Terminology

                                  • Preprocedure

                                    • Procedure

                                      • Outcomes

                                        TERMINOLOGY

                                        • Synonyms

                                          • Breast-conserving surgery (BCS) = lumpectomy = segmental mastectomy = partial mastectomy
                                        • Definitions

                                          • Breast conservation therapy (BCT): Breast cancer patients treated with BCS followed by radiation therapy (XRT)
                                          • Oncoplastic surgery: Surgical repair of partial mastectomy or mastectomy defects
                                            • Immediate: At time of breast cancer surgery
                                              • With BCS, adjacent tissue transfer &/or reductive techniques prior to XRT
                                              • With mastectomy, implant-based or autologous flap performed for breast reconstruction
                                            • After XRT (~ 6-12 months): Autologous flap reconstruction has safer long-term outcomes

                                        PREPROCEDURE

                                        • Indications

                                          • Contraindications

                                            • Preprocedure Imaging

                                              • Getting Started

                                                • Clinical Issues

                                                  PROCEDURE

                                                  • Procedure Steps

                                                    POST PROCEDURE

                                                    • Expected Outcome

                                                      • Things to Do

                                                        • Things to Avoid

                                                          OUTCOMES

                                                          • Problems

                                                            • Complications

                                                              Selected References

                                                              1. Nakada H et al: Fat necrosis after breast-conserving oncoplastic surgery. Breast Cancer. 26(1):125-30, 2019
                                                              2. Chatterjee A et al: Results from the American Society of Breast Surgeons Oncoplastic Surgery Committee 2017 survey: current practice and future directions. Ann Surg Oncol. ePub, 2018
                                                              3. Habibi M et al: Oncoplastic breast reconstruction: should all patients be considered? Surg Oncol Clin N Am. 27(1):167-80, 2018
                                                              4. Hillberg NS et al: Delay of adjuvant radiotherapy due to postoperative complications after oncoplastic breast conserving surgery. Breast. 39:110-16, 2018
                                                              5. Kimball CC et al: Trends in lumpectomy and oncoplastic breast-conserving surgery in the US, 2011-2016. Ann Surg Oncol. ePub, 2018
                                                              6. Smith ML et al: Defining the role of free flaps in partial breast reconstruction. J Reconstr Microsurg. 34(3):185-92, 2018
                                                              7. Wiens N et al: Effect of BioZorbĀ® surgical marker placement on post-operative radiation boost target volume. J Radiat Oncol. 7(2):175-179, 2018
                                                              8. Losken A et al: Updated evidence on the oncoplastic approach to breast conservation therapy. Plast Reconstr Surg. 140(5S Advances in Breast Reconstruction):14S-22S, 2017
                                                              9. Srinivasa DR et al: Direct-to-implant versus two-stage tissue expander/implant reconstruction: 2-Year risks and patient-reported outcomes from a prospective, multicenter study. Plast Reconstr Surg. 140(5):869-77, 2017
                                                              10. Carter SA et al: Operative and oncologic outcomes in 9861 patients with operable breast cancer: single-institution analysis of breast conservation with oncoplastic reconstruction. Ann Surg Oncol. 23(10):3190-8, 2016
                                                              11. De Lorenzi F et al: Oncological results of oncoplastic breast-conserving surgery: Long term follow-up of a large series at a single institution: A matched-cohort analysis. Eur J Surg Oncol. 42(1):71-7, 2016
                                                              12. Piper M et al: Comparison of mammographic findings following oncoplastic mammoplasty and lumpectomy without reconstruction. Ann Surg Oncol. 23(1):65-71, 2016
                                                              13. Losken A et al: A meta-analysis comparing breast conservation therapy alone to the oncoplastic technique. Ann Plast Surg. Epub ahead of print, 2013
                                                              14. Fischer JP et al: Breast reconstruction modality outcome study: a comparison of expander/implants and free flaps in select patients. Plast Reconstr Surg. 131(5):928-34, 2013
                                                              15. Schaverien MV et al: Implant-based augmentation mammaplasty following breast conservation surgery. Ann Plast Surg. 69(3):240-3, 2012
                                                              16. Kronowitz SJ et al: A management algorithm and practical oncoplastic surgical techniques for repairing partial mastectomy defects. Plast Reconstr Surg. 122(6):1631-47, 2008
                                                              17. Kronowitz SJ et al: Practical guidelines for repair of partial mastectomy defects using the breast reduction technique in patients undergoing breast conservation therapy. Plast Reconstr Surg. 120(7):1755-68, 2007
                                                              18. Kronowitz SJ et al: Determining the optimal approach to breast reconstruction after partial mastectomy. Plast Reconstr Surg. 117(1):1-11; discussion 12-4, 2006
                                                              19. Bajaj AK et al: Aesthetic outcomes in patients undergoing breast conservation therapy for the treatment of localized breast cancer. Plast Reconstr Surg. 114(6):1442-9, 2004
                                                              20. Chen AM et al. Breast conservation after neoadjuvant chemotherapy: The M. D. Anderson Cancer Center experience. J. Clin. Oncol. 22: 2303, 2004
                                                              21. Pawlik TM et al: Potential applicability of balloon catheter-based accelerated partial breast irradiation after conservative surgery for breast carcinoma. Cancer. 100(3):490-8, 2004
                                                              22. Clough KB et al: An approach to the repair of partial mastectomy defects. Plast Reconstr Surg. 104(2):409-20, 1999
                                                              23. Clough KB et al: Cosmetic sequelae after conservative treatment for breast cancer: classification and results of surgical correction. Ann Plast Surg. 41(5):471-81, 1998
                                                              24. Clough KB et al: Conservative treatment of breast cancers by mammaplasty and irradiation: a new approach to lower quadrant tumors. Plast Reconstr Surg. 96(2):363-70, 1995
                                                              25. Slavin SA et al: Reconstruction of the radiated partial mastectomy defect with autogenous tissues. Plast Reconstr Surg. 90(5):854-65; discussion 866-9, 1992
                                                              26. Matory WE Jr et al: Aesthetic results following partial mastectomy and radiation therapy. Plast Reconstr Surg. 85(5):739-46, 1990