Skip to main content

Advertisement

SpringerLink
Log in

Management algorithm for repairing partial mastectomy defects and oncologic safety: evaluation of oncoplastic reduction

  • Review
  • Published:
European Journal of Plastic Surgery Aims and scope Submit manuscript

Abstract

Oncoplastic breast reduction is a novel technique that involves surgical treatment of breast lesions in combination with plastic surgery reconstructive techniques. According to recent data, it provides better cosmetic outcomes; however, concerns still exist about oncologic safety. The goal of this study is to evaluate the latest evidence concerning oncologic safety of oncoplastic techniques and to provide a management algorithm for repairing partial mastectomy defects. Medline and PubMed searches were performed from 1998 until 2012 of publications using the search terms “oncoplastic,” “mastopexy,” “breast conservation surgery,” “therapeutic mammoplasty,” and “breast reduction.” All abstracts were studied and the papers that primarily discussed oncoplastic surgery were included. From this investigation, we concluded that oncoplastic surgery can be a safe alternative to breast conserving therapy in females with large breasts. Evidence suggests that contralateral breast reduction reduces metachronous breast cancer recurrence by up to one third simply by reducing the load of breast epithelium. It also adds to the oncologic safety of breast conserving treatment because wider margins can be achieved. The majority of the patients undergoing therapeutic mammoplasty have good to excellent cosmetic outcomes. Oncoplastic techniques require a multidisciplinary approach between oncologists, breast surgeons, and plastic surgeons. We provide a management algorithm that can be useful in the decision making process to determine the best approach for patients requiring partial mastectomy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Iwuchukwu OC, Harvey JR, Dordea M, Critchley AC, Drew PJ (2011) The role of oncoplastic therapeutic mammoplasty in breast cancer surgery—a review. Surg Oncol. doi:10.1016/j.suronc.2011.01.002

  2. Sarkar DK, Maji A, Saha S, Biswas JK (2011) Oncoplastic breast surgery—our experiences in the breast clinic. Indian J Surg Oncol 2(2):112–117. doi:10.1007/s13193-011-0065-7

    Article  PubMed  Google Scholar 

  3. Urban C (2011) Oncoplastic principles in breast conserving surgery. Breast S3:S92–S95

    Article  Google Scholar 

  4. Holmes DR, Schooler W, Smith R (2011) Oncoplastic approaches to breast conservation. Int J of Breast Cancer. doi:10.4061/2011/303879

  5. Losken A, Styblo TM, Carlson GW, Jones GE, Amerson BJ (2007) Management algorithm and outcome evaluation of partial mastectomy defects treated using reduction or mastopexy techniques. Ann Plast Surg 59:235–242

    Google Scholar 

  6. Clough KB, Lewis JS, Coururaud B, Fitoussi A, Nos C, Falcout M-C (2003) Oncoplastic techniques allow extensive resections for breast-conserving therapy of breast carcinomas. Ann Surg 237(1):26–34

    Article  PubMed  Google Scholar 

  7. de Lorenzi F (2010) Oncoplastic surgery: the evolution of breast cancer treatment. Breast J. doi:10.1111/j.1524-4741.2010.00997.x

    Google Scholar 

  8. Giacalone P-L, Roger P, Dubon O, El Gareh N, Rihaoui S, Taourel P, Daurés JP (2007) Comparative study of the accuracy of breast resection in oncoplastic surgery and quadrantectomy in breast cancer. Ann Surg Oncol 14(2):605–614. doi:10.1245/s10434-006-9098-5

    Google Scholar 

  9. Kronowitz SJ, Feledy JA, Hunt KK, Kuerer HM, Youssef A, Koutz CA et al (2006) Determining the optimal approach to breast reconstruction after partial mastectomy. Plast Reconstr Surg 117:1

    Article  PubMed  CAS  Google Scholar 

  10. Dogan L, Gulcelik MA, Bulut M, Karaman N, Kiziltan G, Ozaslan C (2011) The evaluation of contralateral breast lesions in breast cancer patients using reduction mammoplasty. J Breast Cancer 14(3):219–222. doi:10.4048/jbc.2011.14.3.219

    Article  PubMed  Google Scholar 

  11. Song HM, Styblo TM, Carlson GW, Losken A (2010) The use of oncoplastic reduction techniques to reconstruct partial mastectomy defects in women with ductal carcinoma in situ. Breast J. doi:10.1111/j.1524-4741.2009.00891.x

  12. Kronowitz SJ, Hunt KK, Kuerer HM, Strom EA, Buchholz TA, Ensor JE, Koutz CA, Robb GL (2007) Practical guidelines for repair of partial mastectomy defects using the breast reduction technique in patients undergoing breast conservation therapy. Plast Reconstr Surg 120(7):1755–1768. doi:10.1097/01.prs.0000287130.77835.f6

    Google Scholar 

  13. Losken A, Schaefer TG, Newell M, Styblo TM (2009) The impact of partial breast reconstruction using reduction techniques on postoperative cancer surveillance. Plast Reconstr Surg 124(1):9–17

    Article  PubMed  CAS  Google Scholar 

  14. Munshi A, Kakkar S, Bhutani R, Jalali R, Budrukkar A, Dinshaw KA (2009) Factors influencing cosmetic outcome in breast conservation. Clin Oncol 21:285–293. doi:10.1016/j.clon.2009.02.001

    Article  CAS  Google Scholar 

  15. Kronowitz SJ, Kuerer HM, Buchholz TA, Valero V, Hunt KK (2008) A management algorithm and practical oncoplastic surgical techniques for repairing partial mastectomy defects. Plast Reconstr Surg 122:1631–1647

    Google Scholar 

  16. Fisher CS, Martin-Dunlap T, Ruppel MB, Gao F, Atkins J, Margenthaler JA (2012) Fear of recurrence and perceived survival benefit are primary motivators for choosing mastectomy over breast-conservation therapy regardless of age. Ann Surg Oncol. doi:10.1245/s10434-012-2525-x

  17. Franchelli S (2011) Preliminary experience using oncoplastic techniques of reduction mammaplasty and intraoperative radiotherapy: report of 2 cases. Aesth Plast Surg. doi:10.1007/s00266-011-9735-7

    Google Scholar 

  18. Andree C, Farhadi J, Goossens D, Masia J, Sarfati I, Germann G, Macmillan RD, Scheflan M, Van Not HP, Catanuto G, Nava MB (2012) A positional statement on optimizing the role of oncoplastic breast surgery. Eplasty 12: e40. www.eplasty.com

  19. Audisio RA, Chagla LS (2007) Oncoplastic fellowship: can we do better? Breast 16:11–12

    Article  PubMed  Google Scholar 

  20. Asgeirsson KS, Rasheed T, McCulley SJ, Macmillan RD (2005) Oncological and cosmetic outcomes of oncoplastic breast conserving surgery. Eur J Surg Oncol 31:817–823

    Google Scholar 

  21. Kaur N, Petit JY, Rietjens M, Maffini F, Luini A, Gatti G, Rey PC, Urban C, De Lorenzi F (2005) Comparative study of surgical margins in oncoplastic surgery and quadrantectomy in breast cancer. Ann Surg Oncol 12(7):1–7. doi:10.1245/ASO.2005.12.046

    Google Scholar 

  22. Acea-Nebril B, López S, Cereijo C, Bazarra A, Pais P, Uriarte I, Gómez C (2005) Impacto asistencial de las tecnicas oncopalsticas conservadoras en un programa quirurgico para enfermas con cancer de mama. Cir Esp 78(3):175–182

    Google Scholar 

  23. Stolier A, Allen R, Linares L (2003) Breast conservation therapy with concomitant breast reduction in large-breasted women. Breast J 9:269–271

    Google Scholar 

  24. Chang E, Johnson N, Webber B, Booth J, Rahhal D, Gannett D, Johnson W, Franzini D, Zegzula H (2004) Bilateral reduction mammoplasty in combination with lumpectomy for treatment of breast cancer in patients with macromastia. Am J Surg 187:647–651. doi:10.1016/j.amsurg.2004.01.002

    Google Scholar 

  25. Thornton BP, Stewart DH, McGrath PC, Pu LL (2006) Breast reduction as an alternative treatment option for early breast cancer in women with macromastia. Ann Plast Surg 56(1):26–30. doi:10.1097/01.sap.0000183791.51843.40

    Article  PubMed  CAS  Google Scholar 

  26. Munhoz AM, Montag E, Arruda EG, Aldrighi C, Gemperli R, Aldrighi JM, Ferreira MC (2006) Critical analysis of reduction mammaplasty techniques in combination with conservative breast surgery for early breast cancer treatment. Plast Reconstr Surg 117(4):1091–1103. doi:10.1097/01.prs.0000202121.84583.0d

    Google Scholar 

  27. Losken A, Elwood ET, Styblo TM, Bostwick J III (2002) The role of reduction mammaplasty in reconstructing partial mastectomy defects. Plast Reconstr Surg 109(3):968–975

    Article  PubMed  Google Scholar 

  28. Spear SL, Pelletiere CV, Wolfe AJ, Tsangaris TN, Pennanen MF (2003) Experience with reduction mammaplasty combined with breast conservation therapy in the treatment of breast cancer. Plast Reconstr Surg 111(3):1102–1109. doi:10.1097/01.PRS.0000046491.87997.40

    Google Scholar 

  29. Rietjens M, Urban CA, Rey PC, Mazzarol G, Maisonneuve P, Garusi C, Intra M, Yamaguchi S, Kaur N, De Lorenzi F, Matthes AGZ, Zurrida S, Petit JY (2007) Long-term oncological results of breast conservation treatment with oncoplastic surgery. Breast 16:387–395. doi:10.1016/j.breast.2007.01.008

    Google Scholar 

Download references

Conflict of interest

None

Author information

Authors and Affiliations

  1. Department of Surgery, Easton Hospital, Drexel University College of Medicine, Philadelphia, PA, 19102, USA

    Katie Belleisle & Alexey Markelov

Authors
  1. Katie Belleisle
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Alexey Markelov
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Katie Belleisle.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Belleisle, K., Markelov, A. Management algorithm for repairing partial mastectomy defects and oncologic safety: evaluation of oncoplastic reduction. Eur J Plast Surg 36, 469–475 (2013). https://doi.org/10.1007/s00238-013-0846-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00238-013-0846-z

Keywords

Search

Navigation