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Improving Breast Cancer Surgery: A Classification and Quadrant per Quadrant Atlas for Oncoplastic Surgery

Annals of Surgical Oncology volume 17, pages 1375–1391 (2010)Cite this article

Abstract

Background

Oncoplastic surgery (OPS) has emerged as a new approach for extending breast conserving surgery (BCS) possibilities, reducing both mastectomy and re-excision rates, while avoiding breast deformities. OPS is based upon the integration of plastic surgery techniques for immediate reshaping after wide excision for breast cancer. A simple guide for choosing the appropriate OPS procedure is not available.

Objective

To develop an Atlas and guideline for oncoplastic surgery (OPS) to help in patient selection and choice of optimal surgical procedure for breast cancer patients undergoing BCS.

Methods

We stratify OPS into two levels based on excision volume and the complexity of the reshaping technique. For resections less than 20% of the breast volume (level I OPS), a step-by-step approach allows easy reshaping of the breast. For larger resections (level II OPS), a mammoplasty technique is required.

Results

We identified three elements that can be used for patient selection and for determination of the appropriate OPS technique: excision volume, tumor location, and glandular density. For level II techniques, we defined a quadrant per quadrant Atlas that offers a different mammoplasty for each quadrant of the breast.

Conclusions

OPS is the “third pathway” between standard BCS and mastectomy. The OPS classification and Atlas improves patient selection and allows a uniform approach for surgeons. It proposes a specific solution for different scenarios and helps improve breast conservation outcomes.

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References

  1. Clough KB, Soussaline M, Campana F, Salmon RJ. Mammoplasty combined with irradiation: conservative treatment of cancers located in the lower quadrants. Ann Chir Plast Esthet. 1990;35(2):117–22.

    CAS  PubMed  Google Scholar 

  2. Cothier-Savey I, Otmezguine Y, Calitchi E, et al. Value of reduction mammoplasty in the conservative treatment of breast neoplasm. A propos of 70 cases. Ann Chir Plast Esthet. 1996;41(4):346–53.

    CAS  PubMed  Google Scholar 

  3. Petit JY, Rietjens M, Garusi C, et al. Integration of plastic surgery in the course of breast-conserving surgery for cancer to improve results and radicality of tumor excision. Recent Results Cancer Res. 1998;152:202–11.

    CAS  PubMed  Google Scholar 

  4. Spear SL, Pelletiere CV, Wolfe AJ, et al. Experience with reduction mammoplasty combined with breast conservation therapy in the treatment of breast cancer. Plast Reconstr Surg. 2002;111(3):1102–09.

    Article  Google Scholar 

  5. Rainsbury R. Surgery insight: oncoplastic breast-conserving reconstruction-indications, benefits, choices and outcomes. Nat Clin Pract Oncol. 2007;4(11):657–64.

    Article  PubMed  Google Scholar 

  6. Bulstrode NW, Shortri S. Prediction of cosmetic outcome following conservative breast surgery using breast volume measurements. Breast. 2001;10:124–6.

    Article  CAS  PubMed  Google Scholar 

  7. Kaur N, Petit JY, Rietjens M, et al. Comparative study of surgical margins in oncoplastic surgery and quadrantectomy in breast cancer. Ann Surg Oncol. 2005;12(7):539–45.

    Article  PubMed  Google Scholar 

  8. American College of Radiology. Breast imaging reporting and data systems (BI-RADS), American College of Radiology, Reston, VA; 2003.

  9. McCulley SJ, Macmillan RD. Therapeutic mammaplasty: analysis of 50 consecutive cases. Br J Plast Surg. 2005;58(7):902–7.

    Article  CAS  PubMed  Google Scholar 

  10. Kraissl CJ. The selection of appropriate lines for elective surgical incisions. Plast Reconstr Surg. 1951;8(1):1–28.

    Article  CAS  Google Scholar 

  11. Schlenz I, Rigel S, Schemper M, Kuzbari R. Alteration of nipple and areola sensitivity by reduction mammaplasty: a prospective comparison of five techniques. Plast Reconstr Surg. 2005;115(3):743–51.

    Article  CAS  PubMed  Google Scholar 

  12. Petit JY, De Lorenzi F, Rietjens M, et al. Technical tricks to improve the cosmetic results of breast-conserving treatment. Breast. 2007;16(1):13–6.

    Article  PubMed  Google Scholar 

  13. O’Dey D, Prescher A, Pallua N. Vascular reliability of the nipple-areola complex-bearing pedicles: an anatomical microdissection study. Plast Reconstr Surg. 2007;119(4):1167–77.

    Article  PubMed  Google Scholar 

  14. Smith ML, Evans GR, Gurlek A, et al. Reduction mammaplasty: its role in breast conservation surgery for early-stage breast cancer. Ann Plast Surg. 1998;41(3):234–9.

    Article  CAS  PubMed  Google Scholar 

  15. Clough KB, Nos C, Salmon RJ, et al. Conservative treatment of breast cancers by mammaplasty and irradiation: a new approach to lower quadrant tumors. Plast Reconstr Surg. 1995;96(2):363–70.

    Article  CAS  PubMed  Google Scholar 

  16. Vlajcic Z, Zic R, Stanec S, Stanec Z. Omega and inverted omega incision: a concept of uniform incisions in breast surgery. Ann Plast Surg. 2004;53(1)31–8.

    Article  PubMed  Google Scholar 

  17. Nos C, Fitoussi A, Bourgeois D, et al. Conservative treatment of lower pole breast cancers by bilateral mammoplasty and radiotherapy. Eur J Surg Oncol. 1998;24(6):508–14.

    Article  CAS  PubMed  Google Scholar 

  18. Clough KB, Lewis J, Couturaud B, et al. Oncoplastic Techniques allow extensive resections for breast-conserving therapy of breast carcinomas. Ann Surg. 2003;237(1):26–34.

    Article  PubMed  Google Scholar 

  19. Lejour M. Reduction of mammaplasty scars: from a short inframammary scar to a vertical scar. Ann Chir Plast Esthet. 1990;35(5):369–79.

    CAS  PubMed  Google Scholar 

  20. Lassus C. A 30-year experience with vertical mammaplasty. Plast Reconstr Surg. 1996;97(2):373–80.

    Article  CAS  PubMed  Google Scholar 

  21. Renouvel F, Nos C, Clough KB, Lecuru F. Preliminary outcome of breast cancer located at the lower quadrant treated with a thoracomammary flap. Bull Cancer. 2008;95(7):773–8.

    PubMed  Google Scholar 

  22. Clough KB, Kroll S, Audretsch W. An approach to the repair of partial mastectomy defects. Plast Reconstr Surg. 1999;104(2):409–20.

    Article  CAS  PubMed  Google Scholar 

  23. Anderson BO, Masetti R, Silverstein MJ. Oncoplastic approaches to partial mastectomy: an overview of volume-displacement techniques. Lancet Oncol. 2005;6:145–57.

    Article  PubMed  Google Scholar 

  24. Spear SL, pelletiere CV, Wolfe AJ, et al. Experience with reduction mammoplasty combined with breast conservation therapy in the treatment of cancer. Plast Reconstr Surg. 2003;111(3):1102–9.

    Article  PubMed  Google Scholar 

  25. Benelli L. A new periareolar mammaplasty: the “round block” technique. Aesthetic Plast Surg. 1990;14(2):93–100.

    Article  CAS  PubMed  Google Scholar 

  26. Hammon DC. Short scar periareolar inferior pedicle reduction (SPAIR) mammoplasty. Plast Reconstr Surg. 1999;103(3):890–901.

    Article  Google Scholar 

  27. Veronesi U, Banfi A, Saccozzi R, et al. Conservative treatment of breast cancer. A trial in progress at the cancer institute of Milan. Cancer. 1977;39(6)2822–6.

    Article  CAS  PubMed  Google Scholar 

  28. Veronesi U, Banfi A, del Vechhio M, et al. Comparison of Halsted mastectomy with quadrantectomy, axillary dissection, and radiotherapy in early breast cancer: long term results. Eur J Cancer Clin Oncol. 1986;22:1085–9.

    Article  CAS  PubMed  Google Scholar 

  29. Gasperoni C, Salgarello M, Gasperoni P. A personal technique: mammaplasty with J scar. Ann Plast Surg. 2002;48(2):124–30.

    Article  PubMed  Google Scholar 

  30. Laronga C, Kemp B, Johnston D, et al. The incidence of occult nipple-areola complex involvement in breast cancer patients receiving a skin-sparing mastectomy. Ann Surg Oncol. 1999;6(6):609–13.

    Article  CAS  PubMed  Google Scholar 

  31. McCulley SJ, Durani P, Macmillan RD. Therapeutic mammaplasty for centrally located breast tumors. Plast Reconstr Surg. 2006;117(2):366–73.

    Article  CAS  PubMed  Google Scholar 

  32. Galimberti V, Zurrida S, Grisotti A, et al. Central small size breast cancer: how to overcome the problem of nipple and areola involvement. Eur J Cancer. 1993;29A(8)1093–6.

    Article  CAS  PubMed  Google Scholar 

  33. Huemer G, Schrenk P, Moser F, et al. Oncoplastic techniques allow breast-conserving treatment in centrally located breast cancers. Plast Reconstr Surg. 2007;120(2):390–8.

    Article  CAS  PubMed  Google Scholar 

  34. Veronesi U, Lunini A, Galimberti V, Zurrida S. Conservation approaches for the management of stage I/II carcinoma of the breast: Milan cancer institute trials. World J Surg. 1994;18(1):70–5.

    Article  CAS  PubMed  Google Scholar 

  35. Mariani L, Salvadori B, Veronesi U, et al. Ten year results of a randomized trial comparing two conservative strategies for small size breast cancer. Eur J Cancer. 1998;149(3):219–25.

    CAS  Google Scholar 

  36. Amichetti M, Busana L, Caffo O. Long term cosmetic outcome and toxicity in patients treated with quadrantectomy and radiation therapy for early-stage breast cancer. Oncology. 1995;52:177–81.

    Article  CAS  PubMed  Google Scholar 

  37. Giacalone PL, Roger P, Dubon O, et al. Comparative study of the accuracy of breast reconstruction in Oncoplastic surgery and quadrantectomy in breast cancer. Ann Surg Oncol. 2006;14(2):605–14.

    Article  PubMed  Google Scholar 

  38. Dewar JA, Benhamou E, Arrigada R, et al. Cosmetic results following lumpectomy, axillary dissection and radiotherapy for small breast cancer. Radiother Oncol. 1998;12(4):273–80.

    Article  Google Scholar 

  39. Petit J-Y, Regault L, Zekri A, et al. Poor aesthetic results after conservative treatment of breast cancer. Techniques of partial breast reconstruction. Ann Chir Plast Esthet. 1989;34:103–8.

    CAS  PubMed  Google Scholar 

  40. Clough KB, Thomas S, Fitoussi A, et al. Reconstruction after conservative treatment for breast cancer. cosmetic sequelae: classification revisited. Plast Reconstr Surg. 2004;114(7):1743–53.

    Article  PubMed  Google Scholar 

  41. Berrino P, Campora E, Leone S, Santi P. Correction of type II breast deformities following conservative cancer surgery. Plast Reconstr Surg. 1992;90:846–53.

    Article  CAS  PubMed  Google Scholar 

  42. Bostwick J, Paletta C, Hartampf CR. Conservative treatment for breast cancer: complications requiring reconstructive surgery. Ann Surg. 1986;203:481–90.

    Article  PubMed  Google Scholar 

  43. Schwartz GF, Veronesi U, Clough KB, et al. Proceedings of the consensus conference on breast conservation, April 28 to May 1, 2005, Milan, Italy. Cancer. 2006;107(2):242–50.

    Google Scholar 

  44. Staub G, Fitoussi A, Falcou MC, Salmon RJ. Breast cancer surgery: use of mammaplasty. Results. Series of 298 cases. Ann Chir Plast Esthet. 2007;53(2):124–34.

    Article  PubMed  Google Scholar 

  45. Rietjens M, Urban CA, Petit JY, et al. Long-term oncologic results of breast conservation treatment with oncoplastic surgery. Breast. 2007;16(4):387–95.

    Article  CAS  PubMed  Google Scholar 

  46. Brown FE, Sargernt SK, Cohen SR, Morain WD. Mammographic changes following reduction mammoplasty. Plast Reconstr Surg. 1987;80(5):691–8.

    Article  CAS  PubMed  Google Scholar 

  47. Munhoz AM, Montag E, Arruda EG, et al. Superior-medial dermoglandular pedicle reduction mammaplasty for immediate conservative breast surgery reconstruction: technical aspects and outcome. Ann Plast Surg. 2006;57(5):502–8.

    Article  CAS  PubMed  Google Scholar 

  48. Kronowitz SJ, Hunt KK, Kuerer HM, et al. Practical guidelines for repair of partial mastectomy defects using the breast reduction technique in patients undergoing breast conservation therapy. Plast Reconstr Surg. 2007;120(7):1755–68.

    Article  CAS  PubMed  Google Scholar 

  49. Losken A, Styblo TM, Carlson GW, et al. Management algorithm and outcome evaluation of partial mastectomy defects treated using reduction or mastopexy techniques. Ann Plast Surg. 2007;59(5):235–42.

    Article  CAS  PubMed  Google Scholar 

  50. Association of Breast Surgery at BASO. Oncoplastic breast-surgery: a guide to good practice. Eur J Surg Oncol. 2007;33(1)S1–23.

    Google Scholar 

  51. Skillman JM, Humzah MD. The future of breast surgery: a new subspecialty of oncoplastic breast surgeons? Breast. 2003;12(3):161–2.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, The Paris Breast Center (L’Institut du Sein), Paris, France

    Krishna B. Clough MD, Gabriel J. Kaufman MD, Claude Nos MD, Ines Buccimazza MD & Isabelle M. Sarfati MD

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  1. Krishna B. Clough MD
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  2. Gabriel J. Kaufman MD
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  3. Claude Nos MD
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  4. Ines Buccimazza MD
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  5. Isabelle M. Sarfati MD
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Correspondence to Krishna B. Clough MD.

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Clough, K.B., Kaufman, G.J., Nos, C. et al. Improving Breast Cancer Surgery: A Classification and Quadrant per Quadrant Atlas for Oncoplastic Surgery. Ann Surg Oncol 17, 1375–1391 (2010). https://doi.org/10.1245/s10434-009-0792-y

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  • DOI: https://doi.org/10.1245/s10434-009-0792-y

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