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Recently, several breast surgeons have reported a new method for sentinel lymph node biopsy (SLNB) by using indocyanine green (ICG) with infrared camera. This study aimed to determine whether the lymph nodes (LNs) with ICG uptake are true SLNs and to assess the reliability of using only ICG for SLNB. Data were prospectively collected between April and September 2021. All palpable LNs were fat-trimmed and ordered from high to low signal of the gamma detector. The degree of radioisotope uptake and brightness of ICG staining of the axillary LNs detected with a fluorescent camera were compared and associated factors were analyzed. Discordance was defined as sentinel LNs (SLNs) showing a single uptake of radioisotope or fluorescence of ICG only, or when the orders of uptake and intensity degree were different between the 2 materials. A total of 79 SLNBs were performed on 78 patients with breast cancer. The breast cancer was classified as cTis-2N0-1. The discordance rate was 14/79 (17.7%) overall and 45/270 (16.7%) of the total retrieved axillary LNs. The first SLNs showed the lowest discordance rate of 6.3%, whereas the second and third SLNs showed higher discordance rates of 27.6% and 60.0%, respectively. There were no associated clinicopathologic factors that affected the discordance between uptake of radioisotope and fluorescence intensity of ICG. The use of ICG alone for SLNB may be insufficient because of the high discordance rates between radioisotopes and ICG uptake. However, the first SLN could be cautiously regarded as a true SLN.
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To date, many remote-access thyroid surgery techniques using endoscopic or robotic instruments have been developed. Transoral thyroidectomy has attracted great attention as a scarless thyroidectomy and is performed worldwide. Each surgical method has its advantages and disadvantages: selecting the optimal surgical method according to each patient's condition and preferences will possibly result in obtaining the best results and achieving patient satisfaction while minimizing complications after surgery.
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The goal of thyroid cancer surgery is the complete removal of the cancer, verification that patients receive appropriate treatment through accurate staging after surgery, minimization of local recurrence, and improvement of survival rate. However, maintaining the patient’s functional outcome and quality of life by minimizing postoperative complications as well as having good oncological outcomes is also important. To determine the optimal surgical extent, appropriate diagnosis and evaluation should be made on age, gender, tumor size, multiplicity, extrathyroidal extension, lymph node/distant metastasis, and biologic aggressiveness. In the low-risk group, lobectomy is required, and experienced high-volume surgeons may consider ipsilateral prophylactic central lymph node dissection because of the acceptable risk of hypoparathyroidism. In the intermediate-risk group, personalized decision-making should be determined according to the patient’s preferences and characteristics while also considering the pros and cons of lobectomy or total thyroidectomy. For the patient with high-risk factors, total thyroidectomy is considered. However, if a total thyroidectomy is not absolutely necessary and complications are expected, lobectomy could be a second option. If the patient has central lymph node metastasis, a therapeutic central lymph node dissection must be performed, and in the case of high-risk groups (T3/4 and N1b), ipsilateral prophylactic node dissection should be considered, and the contralateral parathyroid gland should be preserved. In the high-risk group (especially with massive ipsilateral lymph node metastasis or gross extrathyroidal involvement), the surgeon may consider bilateral central lymph node dissection if the ipsilateral parathyroid gland and the recurrent laryngeal nerve are well preserved, because of the risk of contralateral lymph node metastasis.
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Background and Objectives@#This study investigated predictive risk factors for cervical nodal recurrence or metastasis in papillary thyroid carcinoma (PTC). @*Materials and Methods@#From September 2014 to February 2015, a total of 321 PTC patients were enrolled retrospectively. Except for 154 N0 patients, the remaining 167 patients were divided into two groups as follows: Group I (n=140), central lymph node (LN) metastasis (pN1a); Group II (n=27), lateral LN metastasis (pN1b, n=23) or LN recurrence (n=4). The patients who had LN metastasis or recurrence underwent selective LN dissection or recurrent LN excision. @*Results@#Central LN metastases were found in 44.0% (142/321) of patients. Two hundred thirty patients (71.7%) were classified as being at low-risk for LN disease, as evidenced by N0 or fewer than five micrometastases. The mean size of central metastatic LNs was 0.37±0.34 cm. A total of 76 patients (46.6%) presented with micrometastasis, and ten (3.1%) presented with extranodal extension (ENE). The multiple/bilateral cancer, Extrathyroidal extension, size of metastatic LN, ENE, high risk LN disease (＞5, macrometastasis, ＞3.0 cm) and high thyroglobulin were significant risk factors in predicting LN recurrence or lateral LN metastasis (p＜0.05) in univariate analysis. Patients with ENE were 10.3 times more at risk for recurrence or metastasis than patients without ENE. @*Conclusion@#We consider the ENE was the most potent risk factors for LN recurrence or lateral LN metastasis in PTC.
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Background@#This study evaluated the usefulness of judgment of central lymph node (LN) metastasis by surgeon’s palpation in papillary thyroid cancer. @*Methods@#This study included 127 patients who underwent thyroidectomy and central compartment node dissection between October 2014 and February 2015. The criterion for suspicious LNs was hardness. @*Results@#Of the 20.5% (28/127) of suspicious for metastatic LNs according to surgeon determination, 92.8% (26/28) were confirmed to be metastatic in the final pathological examinations. Metastatic LNs were found in 38 (38.3%) of 99 patients without suspicious LNs, 29 of whom (76.3%) had micrometastases. The sensitivity, specificity, and positive and negative predictive values for the determination of LN metastasis by a surgeon were 40.6%, 96.8%, 92.9%, and 61.6%, respectively. @*Conclusion@#Determination of central LN metastasis by a surgeon’s palpation may be useful to evaluate LNs owing to the high specificity and positive predictive values, especially in macrometastasis or high-risk LN disease.
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Purpose@#In patients with locally advanced breast cancer, neoadjuvant chemotherapy is widely used. It has a distinct advantage in the downstaging of the primary tumor and provides important information about treatment response. With its increasing usage, concerns over the appropriate management of the axilla have emerged. In this study, we compared oncological outcomes of conventional axillary lymph node dissection (ALND) over axillary sampling (AS) with radiotherapy (RT) in patients who received neoadjuvant chemotherapy. @*Methods@#In this retrospective study, we included female patients with triple negative breast cancer (TNBC) and HER2 type breast cancer who underwent breast and axillary surgery after neoadjuvant chemotherapy between May 2011 to December 2016. A total of 89 patients’ medical records were eligible for analysis. We defined AS as removal of at least four axillary lymph nodes located near the sentinel lymph nodes without full exposure of the axillary vein, long thoracic nerve, and thoracodorsal nerve. @*Results@#The median follow-up period was 47.00 months. The disease-free survival was 69.66 months in the AS with RT group and 69.02 months in the ALND group (p=0.280). The invasive disease-free survival was 75.16 months in the AS with RT group and 78.44 months in the ALND group (p=0.218). @*Conclusion@#AS with radiotherapy might be a feasible surgical option in patients with TNBC and HER2 type breast cancer after neoadjuvant chemotherapy.
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Purpose@#In patients with locally advanced breast cancer, neoadjuvant chemotherapy is widely used. It has a distinct advantage in the downstaging of the primary tumor and provides important information about treatment response. With its increasing usage, concerns over the appropriate management of the axilla have emerged. In this study, we compared oncological outcomes of conventional axillary lymph node dissection (ALND) over axillary sampling (AS) with radiotherapy (RT) in patients who received neoadjuvant chemotherapy. @*Methods@#In this retrospective study, we included female patients with triple negative breast cancer (TNBC) and HER2 type breast cancer who underwent breast and axillary surgery after neoadjuvant chemotherapy between May 2011 to December 2016. A total of 89 patients’ medical records were eligible for analysis. We defined AS as removal of at least four axillary lymph nodes located near the sentinel lymph nodes without full exposure of the axillary vein, long thoracic nerve, and thoracodorsal nerve. @*Results@#The median follow-up period was 47.00 months. The disease-free survival was 69.66 months in the AS with RT group and 69.02 months in the ALND group (p=0.280). The invasive disease-free survival was 75.16 months in the AS with RT group and 78.44 months in the ALND group (p=0.218). @*Conclusion@#AS with radiotherapy might be a feasible surgical option in patients with TNBC and HER2 type breast cancer after neoadjuvant chemotherapy.
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Secretory carcinoma of the breast is an extremely rare, clinically and histologically distinct variant of invasive ductal carcinoma, with an indolent growth pattern and a more favorable prognosis than that of typical ductal carcinoma. Few studies have described its imaging features. Herein, we report on a secretory breast carcinoma with findings from various imaging modalities, especially including the MRI findings, which appears a well-defined complex cystic mass. Awareness of its imaging features using various modalities will be helpful for the differential diagnosis.
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PURPOSE: Although surgery is the most frequently implemented treatment modality for breast cancer, many older patients with breast cancer are under- or untreated because of their high incidence of postoperative complications. We assessed the efficacy and safety of breast surgery under procedural sedation in older patients (aged >70 years) by comparing selected clinical and oncologic factors after surgery for breast cancer under general anesthesia versus procedural sedation. METHODS: Of 79 older patients with breast cancer, 49 underwent breast-conserving surgery, 30 under general anesthesia and 19 under procedural sedation, and relevant clinical and oncologic variables were compared and analyzed between groups. RESULTS: The mean age was younger in the general anesthesia group and the mean operation time, hospital stay, and fasting time shorter in the procedural sedation group. There were no statistically significant differences in oncologic results between the two groups during follow-up. CONCLUSION: Breast surgery under procedural sedation is a safe and effective means of reducing tumor burden in older patients with breast cancer when their American Society of Anesthesiologists (ASA) physical status indicates a high risk of life-threatening perioperative complications associated with general anesthesia. And we also found that the oncologic results may be not inferior to same procedure under general anesthesia.
Subject(s)
Aged , Humans , Anesthesia, General , Breast Neoplasms , Breast , Fasting , Follow-Up Studies , Incidence , Length of Stay , Mastectomy, Segmental , Postoperative Complications , Tumor BurdenABSTRACT
In the bilateral axillo-breast approach (BABA), the camera is inserted through the areolar incision, and this raises the concern it might be difficult to identify the lymph nodes (LN). The purpose of this study is to evaluate the feasibility of the Firefly for central lymph node dissection (CLND) in robotic thyroidectomy using the BABA. This study evaluated 18 patients who underwent robotic surgery using Firefly between December 2015 and March 2016. For LN mapping, 0.05 ml of ICG was injected into the thyroid 3~4 minutes before CLND. Green-stained LN could be detected easily through a near-infrared camera. The number of retrieved LNs was 7.8±3.0 after CLND using the Firefly, which was higher than the 6.7±0.2 reported in previous surgeries. In addition, it helped to distinguish between the parathyroid and the LNs. The Firefly technology was helpful in identifying the LNs, guiding the CLND and performing a complete CLND.
Subject(s)
Humans , Fireflies , Indocyanine Green , Lymph Node Excision , Lymph Nodes , Thyroid Gland , ThyroidectomyABSTRACT
PURPOSE: This study evaluates the BRAF(V600E) test with fine-needle aspiration cytology (FNAC) for lateral lymph node (LN) metastasis in papillary thyroid carcinoma (PTC). METHODS: Ninety-one patients, including 95 lateral LNs with possible PTC metastasis, were consecutively entered into the study. We analyzed the accuracy of results for the BRAF(V600E) test and FNAC for lateral LN metastasis in PTC. RESULTS: Modified radical neck dissection was performed for 34 cases due to lateral LN metastasis. The sensitivity of FNAC was 88.2% , and the LN-BRAF(V600E) test 64.7%. The specificity and positive predictive value (PPV) were 100% for both tests. The negative predictive values (NPV) were FNAC, 93.8%, and LN-BRAF(V600E), 83.6%. For samples positive with either the BRAF(V600E) test or FNAC, the sensitivity was 94.1%, specificity 100%, PPV value 100%, and NPV 96.8%. CONCLUSION: This study suggests that the complementary LN-BRAF(V600E) test with FNAC is a supportive diagnostic method for PTC patients with indeterminate or non-diagnostic suspicious lateral LNs.
Subject(s)
Humans , Biopsy, Fine-Needle , Lymph Nodes , Methods , Neck Dissection , Neoplasm Metastasis , Sensitivity and Specificity , Thyroid Gland , Thyroid NeoplasmsABSTRACT
PURPOSE: The aims of this study were to investigate whether parathyroid score can predict hypocalcemia after total thyroidectomy with central lymph node dissection (CLND) and to determine clinical value of parathyroid score for treatment of hypocalcemia. METHODS: A prospective review of 209 patients who underwent total thyroidectomy with CLND for papillary thyroid cancer from January to December 2012 was conducted. Parathyroid score was designed based on the number and color of parathyroid preservation (Save and intact color of a parathyroid was 2; Save but mild discoloration was 1.5; Not identification was 1.2; Autotransplantation was 1.0; Sacrifice was -1). RESULTS: The mean numbers of parathyroid glands were as follows: save & intact color was 2.0; save & mild discoloration was 0.8; not identification was 0.8; autotransplantation was 0.4. The average parathyroid score was 6.54+/-0.69 (range 3.4~8.0). The average PTH was 16.3 at the 1st POD. Transient and permanent hypocalcemia were 33.4% (70/209) and 0.9% (2/209), respectively. Parathyroid score was 6.78+/-0.54 in patients without transient hypocalcemia, 5.93+/-0.67 with hypocalcemia, parathyroid score was significantly lower in transient hypocalcemia, abnormal PTH at the 1st POD (P<0.001, P<0.001). CONCLUSION: Parathyroid score may predict patients at risk of developing transient hypocalcemia after total thyroidectomy with CLND.
Subject(s)
Humans , Autografts , Hypocalcemia , Lymph Node Excision , Parathyroid Glands , Parathyroid Hormone , Prospective Studies , Thyroid Neoplasms , ThyroidectomyABSTRACT
PURPOSE: The aim of this study was to evaluate the safety of robotic or endoscopic thyroidectomy via bilateral axillo-breast approach (BABA) without a drainage procedure. METHODS: A total of 64 patients who underwent robotic or endoscopic thyroidectomy via BABA without a close suction drain between February and March 2012 were enrolled. We checked postoperative symptoms or signs including change of vital signs, dyspnea, swelling or fluctuation of anterior chest and neck and compression symptoms at 1, 6, 24, and 48 hours and 1 month after surgery. Postoperative ultrasonography was performed in patients with at least one or more postoperative symptoms or signs in order to confirm hematoma or fluid collection. RESULTS: None of the enrolled patients had dyspnea or change of vital signs. Two of 64 patients had swelling, 1 of 64 patients had fluctuation on the anterior chest, and 1 of 64 patients had compression symptoms. Fluid collection was confirmed in 2 of 4 of the above mentioned patients and the collected fluid was aspirated. The amounts of aspirated fluid were 25 mL and 8 mL. Thereafter, the follow up ultrasonography showed no more fluid collection in all patients. In addition, we rechecked the above mentioned symptoms or signs at 1 month after surgery; none of the enrolled patients had symptoms or signs. CONCLUSION: Robotic or endoscopic thyroidectomy via BABA without a closed suction drain shows no serious seroma or hematoma collection. Therefore, we expect that robotic or endoscopic thyroidectomy via BABA without a closed suction drain can reduce the pain, discomfort or longer hospital stay as a result of closed suction drain using this method.
Subject(s)
Humans , Drainage , Dyspnea , Follow-Up Studies , Hematoma , Length of Stay , Neck , Seroma , Suction , Thorax , Thyroidectomy , Ultrasonography , Vital SignsABSTRACT
Ectopic breast tissue can occur anywhere along the incompletely regressed mammary ridge. Among the various types of breast choristoma, ectopic breast tissue, which has only glandular tissue without a nipple or areola, is most commonly detected in axillary areas. However, ectopic breast cancer is often not detected until significant clinical symptoms have been revealed, or diagnosis is delayed. Furthermore, an examination of ectopic breast tissue tends to be omitted from a screening mammography. Especially, the microcalcifications of ectopic breast tissue are difficult to delineate on mammography. Herein, the authors report a case of ectopic breast carcinoma that showed clustered microcalcifications on screening mammography, and discuss the interpretation and implications of microcalcification in ectopic breast tissue.
Subject(s)
Breast Neoplasms , Breast , Carcinoma, Ductal , Choristoma , Diagnosis , Mammography , Mass Screening , NipplesABSTRACT
PURPOSE: Papillary thyroid carcinoma (PTC) is the most common malignant tumor of the thyroid and BRAFV600E mutation is the most frequent genetic alteration in PTC. BRAFV600E mutation has been demonstrated as a prognostic biomarker for prediction of poor clinicopathological outcomes, such as increased incidence of extrathyroidal extension, lymph node metastasis, and advanced stage. However, there is conflicting literature regarding the association of BRAFV600E mutation and aggressive clinicopathological features. In this study, we investigated the prevalence of BRAFV600E mutation in PTC and determined the association of BRAF mutation with indicators of poor prognosis for PTC. METHODS: We reviewed 1009 patients with PTC, who underwent thyroid surgery at Kyungpook National University Hospital between January 2013 and March 2014. BRAFV600E mutation analysis was performed using real-time polymerase chain reaction based amplification of DNA extracted from paraffin-embedded tumor specimens. RESULTS: BRAFV600E mutation was detected in 863 (85.5%) patients. In univariate analysis, histologic subtype, extrathyroidal extension, and advanced stage showed significant association with BRAFV600E mutation. In addition, concurrent Hashimoto's thyroiditis showed an association with low prevalence of BRAFV600E mutation. However, no statistically significant association was observed for age, gender, multifocal or bilateral tumor, and lymph node metastasis. Multivariate analysis showed an independent association of extrathyroidal extension with BRAFV600E mutation. CONCLUSION: In this study, extrathyroidal extension of PTC is an independent prognostic factor associated with BRAFV600E mutation status. However, conduct of further large scale studies with long term follow up is required before the BRAF mutation can be conclusively recommended as a prognostic biomarker.
Subject(s)
Humans , DNA , Incidence , Lymph Nodes , Multivariate Analysis , Neoplasm Metastasis , Prevalence , Prognosis , Real-Time Polymerase Chain Reaction , Thyroid Gland , Thyroid Neoplasms , ThyroiditisABSTRACT
PURPOSE: A more noninvasive evaluation of axillary lymph node in breast cancer is one of the principal challenges of breast cancer treatment. To detect axillary lymph node metastasis (ALNM) in T1 breast cancer, we have compared the axillary ultrasonography (AUS), contrast-enhanced magnetic resonance imaging (cMRI), and 18F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) to determine the most adequate test or a combination of tests. METHODS: Retrospectively, 349 T1 breast cancer patients who were preoperatively examined using AUS, cMRI, and PET/CT between 2008 and 2011 and whom underwent pathological evaluations of axillary lymph nodes were reviewed and analyzed. RESULTS: In total, 26.4% (92/349) of patients exhibited ALNM. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of AUS for determining ALNM were 44.6%, 88.7%, 58.6%, 81.7%, and 77.1%, respectively. cMRI was similar to AUS. The sensitivity, specificity, PPV, NPV, and accuracy of PET/CT were 44.5%, 94.2%, 73.2%, 82.6%, and 81.1%, respectively. The combination including cMRI and PET/CT was the most accurate with sensitivity, specificity, PPV, NPV, and accuracy values of 39.1%, 98.8%, 92.3%, 81.9%, and 83.1%, respectively. The mean number (3.5+/-4.2) of ALNMs in the patients who were positive based on cMRI and PET/CT and also pathologically proven to exhibit ALNM was significantly larger than the number (2.16+/-2.26) in other patients who exhibited ALNM (p=0.035). CONCLUSION: There are no definitive modalities for detecting ALNM in T1 breast cancers to replace sentinel lymph node biopsy (SLNB). If ALNM is suspected based on cMRI and PET/CT, the axillary dissection without SLNB might be a better option because it is related to high possibilities of ALNM and large axillary metastatic volumes.
Subject(s)
Humans , Axilla , Breast , Breast Neoplasms , Diagnostic Imaging , Electrons , Fluorodeoxyglucose F18 , Lymph Node Excision , Lymph Nodes , Magnetic Resonance Imaging , Neoplasm Metastasis , Nitriles , Pyrethrins , Retrospective Studies , Sensitivity and Specificity , Sentinel Lymph Node BiopsyABSTRACT
Chyle leakage is a rare complication of surgery for thyroid cancer that generally develops after lateral neck dissection. Here, we describe chyle leakages experienced after central neck dissection (CND). A total of 615 patients with thyroid cancer were treated by total thyroidectomy with CND between Jan 2012 and Dec 2012 at our facility, and three (0.49%) developed chyle leakages. The amounts of leakage were all less than 100 ml/day. One patient was resolved with conservative management, while the others were treated with conservative treatment and fibrin glue injection in chylous lymphocele. Chyle leakage after CND is very uncommon, and most cases involve minor leakage. Fibrin glue could be a treatment option for chyle leakage following CND.
Subject(s)
Humans , Chyle , Fibrin Tissue Adhesive , Lymphocele , Neck Dissection , Neck , Thyroid Neoplasms , ThyroidectomyABSTRACT
Despite the popularity of breast-conserving surgery (BCS), which constitutes 50-60% of all breast cancer surgeries, discussions regarding cosmetic results after BCS are not specifically conducted. The simple conservation of breast tissue is no longer adequate to qualify for BCS completion. The incorporation of oncological and plastic surgery techniques allows for the complete resection of local disease while achieving superior cosmetic outcome. Oncoplastic BCS can be performed in one of the following two ways: 1) volume displacement techniques and 2) volume replacement techniques. This study reports volume displacement surgical techniques, which allow the use of remaining breast tissue after BCS by glandular reshaping or reduction techniques for better cosmetic results. Thorough understanding of these procedures and careful consideration of the patient's breast size, tumor location, excised volume, and volume of the remaining breast tissue during the surgery in choosing appropriate patient and surgical techniques will result in good cosmetic results. Surgery of the contralateral breast may be requested to improve symmetry and may take the form of a reduction mammoplasty or mastopexy. The timing of such surgery and the merits of synchronous versus delayed approaches should be discussed in full with the patients. Because Korean women have relatively small breast sizes compared to Western women, it is not very easy to apply the oncoplastic volume displacement technique to cover defects. However, we have performed various types of oncoplastic volume displacement techniques on Korean women, and based on our experience, we report a number of oncoplastic volume displacement techniques that are applicable to Korean women with small- to moderate-sized breasts.
Subject(s)
Female , Humans , Breast , Breast Neoplasms , Cosmetics , Displacement, Psychological , Mammaplasty , Mastectomy, Segmental , Surgery, PlasticABSTRACT
Oncoplastic breast surgery has become a popular choice of treatment for breast reconstruction after mastectomy. There are two different techniques in oncoplastic surgery depending on the volume of the excised breast tissue. One is the volume displacement procedure, which combines resection with a variety of different breast-reshaping and breast-reduction techniques; the other is the volume replacement procedure in which the volume of excised breast tissue is replaced with autologous tissue. In this study, current authors performed various volume replacement techniques based on the weight of the excised tumor and its margin of resection. We used a latissimus dorsi myocutaneous flap for cases in which the resection mass was greater than 150 g, and for cases in which the resection mass was less than 150 g, we used a regional flap, such as a lateral thoracodorsal flap, a thoracoepigastric flap, or perforator flaps, such as an intercostal artery perforator flap or a thoracodorsal artery perforator flap. In the patients with small to moderate-sized breasts, when a postoperative deformity is expected due to a large-volume tumor resection, the replacement of non-breast tissue is required. Many of whom have small breasts, oncoplastic volume replacement techniques in breast-conserving surgery allow an extensive tumor excision without concern of compromising the cosmetic outcome and can be reliable and useful techniques with satisfactory aesthetic results.
Subject(s)
Female , Humans , Arteries , Breast , Breast Neoplasms , Congenital Abnormalities , Cosmetics , Displacement, Psychological , Mammaplasty , Mastectomy , Mastectomy, Segmental , Perforator FlapABSTRACT
Despite the popularity of breast-conserving surgery (BCS), which constitutes 50-60% of all breast cancer surgeries, discussions regarding cosmetic results after BCS are not specifically conducted. The simple conservation of breast tissue is no longer adequate to qualify for BCS completion. The incorporation of oncological and plastic surgery techniques allows for the complete resection of local disease while achieving superior cosmetic outcome. Oncoplastic BCS can be performed in one of the following two ways: 1) volume displacement techniques and 2) volume replacement techniques. This study reports volume displacement surgical techniques, which allow the use of remaining breast tissue after BCS by glandular reshaping or reduction techniques for better cosmetic results. Thorough understanding of these procedures and careful consideration of the patient's breast size, tumor location, excised volume, and volume of the remaining breast tissue during the surgery in choosing appropriate patient and surgical techniques will result in good cosmetic results. Surgery of the contralateral breast may be requested to improve symmetry and may take the form of a reduction mammoplasty or mastopexy. The timing of such surgery and the merits of synchronous versus delayed approaches should be discussed in full with the patients. Because Korean women have relatively small breast sizes compared to Western women, it is not very easy to apply the oncoplastic volume displacement technique to cover defects. However, we have performed various types of oncoplastic volume displacement techniques on Korean women, and based on our experience, we report a number of oncoplastic volume displacement techniques that are applicable to Korean women with small- to moderate-sized breasts.