Oncoplastic Surgery in Management of Breast Cancer

Abstract

Nowadays about up to 80 % of patients are treated with breast conservation which is known to be the best method for treating breast cancer when concerning the psychological sequelae to the patient for tumours < 3 cm, and recently up to 4 cm and 5cm for intraductal cancer. A clear margin of 10 mm is recommended to keep the local recurrence rate acceptable, and a good cosmetic results are to be achieved, so Oncoplastic surgery had emerged to solve the equation of wide excision that decrease the recurrence rates, and better cosmetic efficacy. Technique choice is according to tumors location, form and size of the breast, existing scars, the requirement for cutaneous excision with some tumours. And the desire to symmetrize the contralateral breast, also patient desire, the local condition of the thoracic tissues, and of course surgeon experience and skills. Usually it is an immediate procedure but sometimes are to be immediate/delayed (expander/implant reconstruction) or delayed. Oncoplastic surgery include:  Volume displacement techniques mainly for large ptotic breasts  Adjacent tissue rearrangement  Reduction mammaplasty according to the location of the tumor (superior, inferior, medial, lateral pedicle reduction mammaplasty).  Volume replacement techniques mainly for small breasts  Autologus flaps (latissimus dorsi myocuotanus flap (LDMF), Transverse Rectus Abdominis Myocutaneous (TRAM) flap or even microvascular Deep Inferior Epigastric Artery Perforator( DIEP) flap, superficial inferior epigastric artery (SIEA) flap, Superior Gluteal Artery Perforator (SGAP) flap, Inferior Gluteal Artery Perforator flap (IGAP), Transverse Upper Gracilis (TUG) Flap, and Thoracodorsal Artery Perforator (TDAP) flap.  Implants  Expanders Neoadjuvant chemotherapy does not interfere with Oncoplastic surgery while oncoplastic procedures after primary radiotherapy made for difficult subsequent surgery and generally poorer aesthetic results, Radiotherapy is reserved for postoperative treatment. However there is an impact on the final outcome with postoperative radiotherapy especially with implant reconstruction, acellular dermal matrix as an implant cover can reduce infection and capsular contracture rates even in the setting of radiotherapy. Autologus tissue can withstand the effect of radiotherapy better than implants. Knowledge of potential radiological changes following BCS and RT is necessary to distinguish common postoperative changes such as scars, fatty tissue necrosis or calcifications from breast cancer recurrence, and identification of wires placed intraoperatively at tumor site and rotation flaps is very important.