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Annals of Surgical Oncology

, Volume 26, Issue 10, pp 3063–3070 | Cite as

An Oncoplastic Surgery Primer: Common Indications, Techniques, and Complications in Level 1 and 2 Volume Displacement Oncoplastic Surgery

  • Krishnabhai Patel
  • Joshua Bloom
  • Salvatore Nardello
  • Stephanie Cohen
  • Juliann Reiland
  • Abhishek ChatterjeeEmail author
Breast Oncology
  • 123 Downloads

Abstract

Oncoplastic surgery is a form of breast-conservation surgery that involves volume displacement and replacement techniques for optimal aesthetic results after oncologic resection with partial mastectomy. With growing emphasis on breast conservation, oncoplastic surgery is becoming a critical component in the approach to breast cancer in appropriately selected patients. Thus, it is paramount that surgeons are informed about oncoplastic surgery and its use in breast cancer treatment. This primer aims to provide key information regarding oncoplastic surgery. To accomplish this, we used supportive evidence from the literature, combined with clinical experience. The primer uses the American Society of Breast Surgeon’s consensus definition and classification system for oncoplastic surgery, focusing on level 1 and 2 volume displacement techniques. We outline procedures within these categories, review common indications, and provide a guide to approaching tumors based on their quadrant position. The paper also describes complications specific to these procedures, as well as their management. Understanding these concepts will allow surgeons to assist patients in making informed decisions using these breast-conservation techniques.

Notes

Disclosure

Krishnabhai Patel, Joshua Bloom, Salvatore Nardello, Stephanie Cohen, Juliann Reiland, and Abhishek Chatterjee have no disclosures to declare.

References

  1. 1.
    Bray F, Ferlay J, Soerjomataram I, Siegel R, Torre L, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394–424.CrossRefGoogle Scholar
  2. 2.
    SEER Cancer Statistics Review, 1975–2015. National Cancer Institute [cited 6 May 2019]. https://seer-cancer-gov.ezproxy.library.tufts.edu/csr/1975_2015/.
  3. 3.
    NAACCR Fast Stats: An interactive tool for quick access to key NAACCR cancer statistics. North American Association of Central Cancer Registries. http://www.naaccr.org/.
  4. 4.
    Jonczyk M, Jean J, Graham R, Chatterjee A. Surgical trends in breast cancer: a rise in novel operative treatment options over a 12 year analysis. Breast Cancer Res Treat. 2019;173(2):267–74.CrossRefGoogle Scholar
  5. 5.
    Chatterjee A, Gass J, Burke MB, Kopkash K, El-Tamer MB, Holmes DR, et al. Results from the American Society of Breast Surgeons Oncoplastic Surgery Committee 2017 Survey: current practice and future directions. Ann Surg Oncol. 2018;25(10):2790–4.CrossRefGoogle Scholar
  6. 6.
    Chatterjee A, Gass J, Patel K, Holmes D, Kopkash K, Peiris L, et al. A consensus definition and classification system of oncoplastic surgery developed by the American Society of Breast Surgeons. Ann Surg Oncol.  https://doi.org/10.1245/s10434-019-07345-4.
  7. 7.
    De La Cruz L, Blankenship S, Chatterjee A, Geha R, Nocera N, Czerniecki B, et al. Outcomes after oncoplastic breast-conserving surgery in breast cancer patients: a systematic literature review. Ann Surg Oncol. 2016;23(10):3247–58.CrossRefGoogle Scholar
  8. 8.
    Losken A, Dugal C, Styblo T, Carlson G. A meta-analysis comparing breast conservation therapy alone to the oncoplastic technique. Ann Plast Surg. 2014;72(2):145–9.CrossRefGoogle Scholar
  9. 9.
    Kelsall J, McCulley S, Brock L, Akerlund M, Macmillan R. Comparing oncoplastic breast conserving surgery with mastectomy and immediate breast reconstruction: case-matched patient reported outcomes. J Plast Reconstr Aesthet Surg. 2017;70(10):1377–85.CrossRefGoogle Scholar
  10. 10.
    Chatterjee A, Offodile AC II, Asban A, Minasian RA, Losken A, Graham R, et al. A cost-utility analysis comparing oncoplastic breast surgery to standard lumpectomy in large breasted women. Adv Breast Cancer Res. 2018;7(2):14.CrossRefGoogle Scholar
  11. 11.
    Asban A, Homsy C, Chen L, Fisher C, Losken A, Chatterjee A. A cost-utility analysis comparing large volume displacement oncoplastic surgery to mastectomy with single stage implant reconstruction in the treatment of breast cancer. Breast. 2018;41:159–64.CrossRefGoogle Scholar
  12. 12.
    Datta B, Prakash AK, Ford D, Tanwar PK, Goyal P, Chatterjee P, et al. Comparison of clinical and cost-effectiveness of two strategies using mobile digital X-ray to detect pulmonary tuberculosis in rural India. BMC Public Health. 2019;19(1):99.CrossRefGoogle Scholar
  13. 13.
    Audretsch W, Rezai M, Kolotas C. Oncoplastic Surgery: “Target” volume reduction (BCT mastopexy), lumpectomy reconstruction (BCT reconstruction) and flap supported operability in breast cancer. In: 2nd European Congress on Senology; 1994; Vienna, Austria; Bologna, Italy: Monduzzi.Google Scholar
  14. 14.
    Silverstein M. Cosmetic Quadrantectomy. In: Annual Miami breast cancer conference. Miami, FL; 1993.Google Scholar
  15. 15.
    Clough K, Nos CS, Salmon RJ, Soussaline M, Durand J. Conservative treatment of breast cancers by mammaplasty and irradiation: a new approach to lower quadrant tumors. Plast Reconstr Surg. 1995;96(2):363–70.CrossRefGoogle Scholar
  16. 16.
    Grisotti A. Immediate reconstruction after partial mastectomy. Oper Tech Plast Reconstr Surg. 1994;1(1):1–12.CrossRefGoogle Scholar
  17. 17.
    Clough K, Cuminet J, Fitoussi A, Nos C, Mosseri V. Cosmetic sequelae after conservative treatment for breast cancer: classification and results of surgical correction. Ann Plast Surg. 1998;41(5):471–81.CrossRefGoogle Scholar
  18. 18.
    Bulstrode N, Shrotria S. Prediction of cosmetic outcome following conservative breast surgery using breast volume measurements. Breast. 2001;10(2):124–6.CrossRefGoogle Scholar
  19. 19.
    Gainer S, Lucci A. Oncoplastics: techniques for reconstruction of partial breast defects based on tumor location. J Surg Oncol. 2011;103(4):341–7.CrossRefGoogle Scholar
  20. 20.
    Chatterjee A, Yao M, Sekigami Y, Liang Y, Nardello S. Practical perspective regarding patient selection and technical considerations in oncoplastic surgery. Curr Breast Cancer Rep. 2019;11(2):35–42.CrossRefGoogle Scholar
  21. 21.
    Kelsall JE, McCulley SJ, Brock L, Akerlund MTE, Macmillan RD. Comparing oncoplastic breast conserving surgery with mastectomy and immediate breast reconstruction: case-matched patient reported outcomes. J Plast Reconstr Aesthet Surg. 2017;70(10):1377–85.CrossRefGoogle Scholar
  22. 22.
    Clough K, Kaufman G, Nos C. Improving breast cancer surgery: a classification and quadrant per quadrant atlas for oncoplastic surgery. Ann Surg Oncol. 2010;17:1375–91.CrossRefGoogle Scholar
  23. 23.
    Anderson B, Masetti R, Silverstein M. Oncoplastic approaches to partial mastectomy: an overview of volume-displacement techniques. Lancet Oncol 2005;6(3):145–57.CrossRefGoogle Scholar
  24. 24.
    Clough KB, Kaufman GJ, Nos C, Buccimazza I, Sarfati IM. Improving breast cancer surgery: a classification and quadrant per quadrant atlas for oncoplastic surgery. Ann Surg Oncol. 2010;17(5):1375–91.CrossRefGoogle Scholar
  25. 25.
    Silverstein M, Mai T, Savalia N, Vaince F, Guerra L. Oncoplastic breast conservation surgery: the new paradigm. J Surg Oncol. 2014;110(1):82–9.CrossRefGoogle Scholar
  26. 26.
    Perez R. Incision patterns in breast oncoplastic surgery. 2015. https://repositorio.unican.es/xmlui/handle/10902/7059. Accessed June 2019.
  27. 27.
    Mansfield L, Agrawal A, Cutress R. Oncoplastic breast conserving surgery. Gland Surg. 2013;2(3):158–62.Google Scholar
  28. 28.
    Holmes D, Schooler W, Smith R. Oncoplastic approaches to breast conservation. Int J Breast Cancer 2011;2011:1–16.CrossRefGoogle Scholar
  29. 29.
    Rose M, Manjer J, Ringberg A, Svensson H. Surgical strategy, methods of reconstruction, surgical margins and postoperative complications in oncoplastic breast surgery. Eur J Plast Surg. 2014;37:205–14.CrossRefGoogle Scholar
  30. 30.
    Hammond DC. The interlocking Gore-Tex suture for control of areolar diameter and shape: P73. Plast Reconstr Surg. 2005;116(3):214.CrossRefGoogle Scholar
  31. 31.
    Chatterjee A, Khakpour N, Czerniecki B. Oncoplastic surgery: keeping it simple with 5 essential volume displacement techniques for breast conservation in a patient with moderate to large sized breasts. Cancer Control. 2017;24(4):1–11.CrossRefGoogle Scholar
  32. 32.
    Blomqvist L, Eriksson A, Brandberg Y. Reduction mammaplasty provides long-term improvement in health status and quality of life. Plast Reconstr Surg. 2000;106(5):991–7.CrossRefGoogle Scholar
  33. 33.
    Clough K, Gouveia P, Benyahi D, Massey E, Russ E, Sarfati I, et al. Positive margins after oncoplastic surgery for breast cancer. Ann Surg Oncol. 2015;22(13):4247–53.CrossRefGoogle Scholar
  34. 34.
    Chatterjee A. Long term effects of modern breast cancer surgery. Gland Surg. 2018;7(4):366–70.CrossRefGoogle Scholar
  35. 35.
    Chagpar AB, Killelea BK, Tsangaris TN, Butler M, Stavris K, Li F, et al. A randomized, controlled trial of cavity shave margins in breast cancer. N Engl J Med. 2015;373(6):503–10.CrossRefGoogle Scholar
  36. 36.
    Landercasper J. Why do reoperation rates vary so much after lumpectomy for breast cancer? Examining the reoperation puzzle at the Massachusetts General Hospital. Ann Surg Oncol. 2018;25(9):2506–8.CrossRefGoogle Scholar
  37. 37.
    Liang Y, Naber SP, Chatterjee A. Anatomic and terminological description and processing of breast pathologic specimens from oncoplastic large volume displacement surgeries. Mod Pathol. 2018;31(7):1004–11.CrossRefGoogle Scholar
  38. 38.
    Nakada H, Inoue M, Furuya K, Watanabe H, Ikegame K, Nakayama Y, et al. Fat necrosis after breast-conserving oncoplastic surgery. Breast Cancer. 2019;26(1):125–30.CrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2019

Authors and Affiliations

  • Krishnabhai Patel
    • 1
  • Joshua Bloom
    • 1
  • Salvatore Nardello
    • 1
  • Stephanie Cohen
    • 1
  • Juliann Reiland
    • 2
  • Abhishek Chatterjee
    • 1
    Email author
  1. 1.Department of SurgeryTufts Medical CenterBostonUSA
  2. 2.Department of SurgeryAvera Medical GroupSioux FallsUSA

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