Breast Cancer Research and Treatment

, Volume 165, Issue 3, pp 505–516 | Cite as

A step-by-step oncoplastic breast conservation surgical atlas of reproducible dissection techniques and anatomically ideal incision placement

  • Sunny D. MitchellEmail author
Preclinical study



To develop an atlas for oncoplastic surgery (OPS) with template dissection techniques via anatomically ideal incisions for breast conservation surgery. The evolution of breast conservation techniques has evolved from placing an incision directly over the lesion to the incorporation of a thoughtful decision making process utilizing oncoplastic surgical (OPS) techniques to combining OPS with incision placement in anatomically advantageous sites. The high survival rates of breast cancer and effect of breast surgery on quality of life reinforce emphasis of optimal oncologic as well as aesthetic outcome. OPS results in greater patient satisfaction, fewer surgeries, and is oncologically safe. Today’s breast surgeon is tasked with optimizing both oncologic and aesthetic outcomes.


Presentation of reproducible dissection techniques and incision placement strategies to afford surgeons a step-by-step approach of OPS via anatomically ideal incisions in breast conservation surgery.


Demonstration of reproducible techniques to facilitate the decision making process of optimal breast conservation surgery, eliminate knowledge gaps for surgeons, optimize outcome for individuals undergoing breast conservation surgery, and decrease disparity of care.


Adoption of OPS techniques utilizing an anatomically ideal incision in breast conservation surgery is a feasible and reproducible practice for breast surgeons. Application of these techniques results in maintained optimal shape, size, and contour without the typical overlying skin envelope scars. OPS techniques performed under the skin envelope result in expected OPS oncologic and aesthetic outcomes with the addition of the resulting scar(s) in anatomically discrete position(s).


Dissection techniques Anatomically ideal incision placement Oncoplastic breast conservation surgery 



Oncoplastic surgery


Breast conservation surgery


Nipple areolar complex


Inframammary fold




Quality of life


Upper-outer quadrant


Sentinel lymph node biopsy


Axillary lymph node dissection


Compliance with ethical standards

Conflict of interest

Author has received honorarium and stock options from Invuity: participant in Advisory Council, Speaker, and Consultant.


  1. 1.
    Clough KB et al (2010) Improving breast cancer surgery: a classification and quadrant per quadrant atlas for oncoplastic surgery. Ann Surg Oncol 17:1375–1391CrossRefGoogle Scholar
  2. 2.
    Fitoussi A et al (2009) Oncoplastic and reconstructive surgery for breast cancer. The Institute Curie experience. Springer, BerlinCrossRefGoogle Scholar
  3. 3.
    El-Tamer MB (2013) Principles and techniques in oncoplastic breast cancer surgery. World Scientific, SingaporeGoogle Scholar
  4. 4.
    Losken A et al (2015) Evaluating outcomes after correction of the breast conservation therapy deformity. Ann Plast Surg 74(supplement 4):209–213CrossRefGoogle Scholar
  5. 5.
    Franceschini G et al (2015) New trends in breast cancer surgery: a therapeutic approach increasingly efficacy and respectful of the patient. G Chir 36(4):145–152PubMedPubMedCentralGoogle Scholar
  6. 6.
    Jagsi R et al (2015) Patient-reported quality of life and satisfaction with cosmetic outcomes after breast conservation and mastectomy with and without reconstruction: results of a survey of breast cancer survivors. Ann Surg 261(6):1198–1206CrossRefGoogle Scholar
  7. 7.
    Kim MK et al (2015) Effect of cosmetic outcome on quality of life after breast cancer surgery. EJSO 41:426–432CrossRefGoogle Scholar
  8. 8.
    Lee MC et al (2013) Therapy choices and quality of life in young breast cancer survivors: a short-term follow-up. Am J Surg 206(5):625–631CrossRefGoogle Scholar
  9. 9.
    Heil J et al (2012) Objective assessment of aesthetic outcome after breast conservation therapy: subjective third party panel rating and objective BCCT.core software evaluation. Breast 21:61–65CrossRefGoogle Scholar
  10. 10.
    Racz JM et al (2015) In search of a gold standard scoring system for the subjective evaluation of cosmetic outcomes following breast-conserving therapy. Breast J 21(4):345–351CrossRefGoogle Scholar
  11. 11.
    Cardoso MJ et al (2016) The breast cancer conservative treatment. Cosmetic results- BCCT.core- software for objective assessment of esthetic outcome in breast cancer conservative treatment: a narrative review. Comput Methods Programs Biomed 126:154–159CrossRefGoogle Scholar
  12. 12.
    Cardoso MJ, Oliveira H, Cardoso J (2014) assessing cosmetic results after breast conserving surgery. J Surg Oncol 110:37–44CrossRefGoogle Scholar
  13. 13.
    Brouwers P et al (2016) Factors associated with patient-reported cosmetic outcome in the young boost breast trial. Radiother Oncol 120:107–113CrossRefGoogle Scholar
  14. 14.
    Begic A, Stark B (2016) The Telemark Breast Score: a reliable method for the evaluation of results after breast surgery. Plast Reconstr Surg 138(3):390–400CrossRefGoogle Scholar
  15. 15.
    Soror T et al (2016) New objective method in reporting the breast cosmesis after breast-conservative treatment based on nonstandardized photographs: the objective breast cosmesis scale. Brachytherapy 15:631–636CrossRefGoogle Scholar
  16. 16.
    De La Cruz L, Blankenship SA, Chatterjee A et al (2016) Outcomes after oncoplastic breast-conserving surgery in breast cancer patients: a systematic literature review. Ann Surg Oncol 23(10):3247–3258CrossRefGoogle Scholar
  17. 17.
    Carter SA, Lyons GR, Kuerer HM et al (2016) 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):3190–3198CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  1. 1.Department of SurgeryWestchester Medical CenterValhallaUSA

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