Current situation and prospect of breast-conserving surgery using oncoplastic surgery technique in breast cancer / 中华内分泌外科杂志

Breast cancer is the most common malignant tumor in the population, and the incidence of young breast cancer patients is gradually increasing. With the increasing requirements of patients for cosmetic effect after tumor resection, the traditional breast conserving surgery can no longer meet the treatment needs of patients. Breast-conserving plastic surgery for breast cancer has been proved to be safe in oncology, but there are still many deficiencies. Therefore, it is very important for surgeons and patients to develop unified and repeatable standard guidelines for breast-conserving plastic surgery of breast cancer.

Factors influencing decisions on contralateral symmetrisation procedure among patients with breast cancer

INTRODUCTION@#Oncoplastic breast-conserving surgery (OBCS) can cause breast asymmetry. Although contralateral breast surgery to achieve symmetry was offered to these patients, the uptake of symmetrisation was variable. We aimed to determine the factors that deter patients with breast cancer undergoing OBCS from opting for symmetrisation.@*METHODS@#All patients with breast cancer who underwent OBCS of displacement type with no symmetrisation were prospectively surveyed to explore the social, economic, psychological and physical reasons against symmetrisation.@*RESULTS@#A total of 28 patients participated in a survey administered at a mean 21.6 (range 2-47) months after OBCS. A combination of factors, such as worry and desire to treat breast cancer first (67.9%), not being overly concerned about breast cosmesis (57.1%) and fear of pain from additional operation (28.6%), deterred patients from immediate symmetrisation. Worry and desire to treat breast cancer first was the most important single factor for 50% of the patients. Reasons for no delayed symmetrisation included not being overly concerned about breast cosmesis (70.4%), fear of breast cancer recurrence (48.1%) and being happy with current breast cosmesis (33.3%), with the former two reasons equally cited as the single most important deterrent by 30% of patients each.@*CONCLUSION@#A combination of factors may deter patients from symmetrisation. The most significant factors deterring OBCS among patients were worry and desire to treat breast cancer first for immediate symmetrisation, and not being overly concerned about breast cosmesis and fear of breast cancer recurrence for delayed symmetrisation. Reassuring these patients may increase their uptake of symmetrisation, thereby improving patient cosmesis and satisfaction.

Reconstrucción mamaria inmediata en el Instituto Nacional de Oncología y Radiobiología de Cuba / Immediate Breast Reconstruction at the National Institute of Oncology and Radiobiology of Cuba

RESUMEN Introducción: La reconstrucción mamaria inmediata disminuye el impacto psicológico del cáncer de mama y mejora la calidad de vida de las pacientes. Objetivo: Evaluar la simetría en la reconstrucción mamaria inmediata en el Instituto Nacional de Oncología y Radiobiología de Cuba. Método: Se realizó un estudio analítico y prospectivo, de cohorte incidente, en el Servicio de Cirugía Reconstructiva del Instituto Nacional de Oncología y Radiobiología de 2014 al 2017. Se incluyeron 41 pacientes que consintieron participar en el estudio. Se recogieron variables demográficas y onco-reconstructivas. Se utilizó un software creado en la institución para evaluar la simetría mamaria. Los datos se recogieron de la historia clínica. Se aplicaron el test de Chi-cuadrado corregido y la razón de momios para el análisis estadístico. Resultados: El 30,2 por ciento de mujeres reconstruidas pertenecieron al grupo de 30 a 39 años; el 46,3 por ciento tenían sobrepeso. La mejor simetría se encontró con las técnicas oncoplásticas (31,7 por ciento), seguida de la mastectomía ahorradora de piel. La técnica de expansión tisular con la mastectomía presentó mayores complicaciones (63,6 por ciento) y menor simetría. La necrosis parcial de piel fue la mayor complicación en 7,3 por ciento y estuvo relacionadas con las técnicas ahorradoras de piel. Conclusiones: Evaluar de forma objetiva la simetría mamaria permitió conocer la efectividad de las técnicas quirúrgicas reconstructivas. Con las técnicas de cirugía oncoplástica y mastectomía ahorradora de piel se obtuvieron los mejores resultados estéticos y pocas complicaciones. La expansión mamaria inmediata con una mastectomía radical modificada no ofrece ninguna ventaja(AU)

ABSTRACT Introduction: Immediate breast reconstruction reduces the psychological impact of breast cancer and improves the quality of life of patients. Objective: To assess symmetry in immediate breast reconstruction at the of Cuba. Method: An analytical and prospective study of incident cohort was carried out in the reconstructive surgery service at the National Institute of Oncology and Radiobiology (INOR), from 2014 to 2017. Forty-one patients who consented to participate in the study were included. Demographic and oncoreconstructive variables were collected. A software created in the institution was used to assess breast symmetry. The data were collected from the medical histories. The corrected chi-square test and odds ratio were applied for statistical analysis. Results: 30.2 percent of women who received reconstruction belonged to the age group 30-39 years; 46.3 percent were overweight. The best symmetry was found with oncoplastic techniques (31.7 percent), followed by skin-sparing mastectomy. The tissue expansion technique with mastectomy presented greater complications (63.6 percent) and less symmetry. Partial skin necrosis was the major complication, accounting for 7.3 percent of the cases, and was related to skin-sparing techniques. Conclusions: Objectively evaluating breast symmetry allowed us to know the effectiveness of reconstructive surgical techniques. With oncoplastic surgery and skin-sparing mastectomy techniques, the best aesthetic outcomes and few complications were obtained. Immediate breast expansion with a modified radical mastectomy offers no benefit(AU)

Thoracodorsal artery perforator flap in immediate breast reconstruction: a series of twenty cases

Background: The management of breast cancer has shown a progressive change, from radical ablative surgery, to breast conserving techniques. Traditionally, the mini latissimus dorsi flap has been used for reconstruction; which is associated with donor site morbidity. Vascular research has now allowed the use of perforator-based flaps for reconstruction, which reduce donor site morbidity.Methods: Twenty thoracodorsal perforator flaps in twenty early breast cancer patients were studied between January 2018 and December 2018. Parameters studied were adequacy of volume, ease and time taken for flap elevation, and final aesthetic outcome.Results: Flap volume was adequate to fill defect. One of twenty cases had flap loss due to venous congestion secondary to pedicle kinking. Average time taken for flap elevation was 70.45 minutes. All patients were satisfied with cosmetic outcome.Conclusions: The TDAP flap is a safe and reliable flap which provides adequate volume for partial breast reconstruction.

Update in clinical research on oncoplastic breast surgery in China / 中国肿瘤临床

the survival of patients with breast cancer has remarkably improved. In particular, oncoplastic breast surgery has gained momentum due to its positive impact on patients' quality of life. Oncoplastic breast conservation surgery and postmastectomy breast reconstruction are the two main branches of this frontier discipline. Although oncoplastic breast surgery gained scholarly attention in China later than in Western countries, considerable development and progress has been made over the last few decades. Here, we aimed to summarize the academic achievements of Chinese oncoplastic surgeons in implant-based breast reconstruction, autologous tissue breast reconstruction, mammoplasty by lipofilling, endoscope-assisted breast reconstruction, and nipple-areola reconstruction. we also summarized patient-reported outcomes. The drawbacks of the current investigations will be discussed along with the directions for future clinical practice and research.

Retrospective study of omentum based oncoplastic breast reconstruction / 中华整形外科杂志

Oncoplastic breast surgery (OBS) using omentum has been developed in the past 20 years. This study reviewed related clinical researches at home and abroad. It summarized the surgical indications, criteria of cosmetic evaluation for omentum mammary tumor, the methods of harvesting omentum and the selection of tissue flaps. Meanwhile, postoperative complications, tumor safety, advantages and disadvantages of different methods were evaluated.

Thoughts on breast reconstruction after breast cancer surgery in China / 中国实用外科杂志

Oncoplastic breast reconstruction has become an important component of comprehensive therapy for breast cancer.Strong collaborations of physicians,patients and society are warranted to build a normalized and professional mode and pathway for oncoplastic breast reconstruction in China.Both oncological safety and cosmetic well-being are key requirements for the design,procedure and assessment of oncoplastic breast reconstruction.The principles of comprehensive therapy and oncological considerations should not be compromised and should always take precedence.Breast surgeons should recommend and perform the oncoplastic breast reconstructions with objective understanding and cautious assessment,and strictly follow the recommendations of professional consensus as well as the principles of personalized treatment.Closely multidisciplinary collaborations with plastic surgeons are recommended to achieve a balanced oncoplastic safety and cosmetic "well-being.

Oncoplastia en cirugía conservadora de la mama / Oncoplasty in breast-conserving treatment

Introducción En el presente trabajo se considera a la cirugía conservadora como abordaje efectivo para el tratamiento del cáncer de mama. Se describe el surgimiento de la cirugía oncoplástica para la reparación de secuelas derivadas del tratamiento conservador. Se presenta una reseña de la anatomía de la mama: la glándula mamaria desde la conformación de su parénquima, su localización, vascularización e inervación. Luego, se considera la segmentación de la mama: descripción de la segmentación clásica de la mama y la más reciente elaborada por Acea B y cols., para la identificación de zonas críticas en el abordaje quirúrgico y la predicción de potenciales secuelas del mismo. Desarrollo El desarrollo de este trabajo se organiza en torno a los siguientes temas: Consideraciones en el tratamiento oncoplástico del cáncer de mama. Factores a tener en cuenta ante la indicación de una cirugía conservadora: el volumen mamario, la localización y volumen tumoral. Toma de decisiones y aplicabilidad de una técnica reconstructiva adecuada a la paciente en un tiempo adecuado. Reconstrucción mamaria. Descripción de las principales técnicas de acuerdo con la localización tumoral. Reconstrucción mamaria con colgajos locales: técnicas e indicaciones de cirugía reconstructiva con colgajos de vecindad. Secuelas del tratamiento quirúrgico conservador. Clasificación de las mismas y técnicas de reparación. Conclusiones Se resumen las observaciones finales en cuanto a la aplicabilidad de la cirugía oncoplástica y su articulación con el tratamiento conservador.

Introduction Conservative surgery as an effective approach for breast cancer treatment. The emergence of oncoplastic surgery to repair sequelae derived from conservative treatment. Breast anatomy: the conformation of mammary gland´s parenchyma, its location, vascularization and innervation. Breast segmentation: description of the classical segmentation, and the most recent one elaborated by Acea B et al., to identify critical areas in the surgical approach as well as to predict possible sequelae. Development Considerations of the oncoplastic treatment of breast cancer. Factors to consider in the indication of breast-conserving treatment: breast volume, location and tumor volume. Decision making and the application of a suitable reconstructive technique for each patient at an appropriate time. Breast reconstruction. Description of the main techniques according to the tumor location. Breast reconstruction with local flaps: techniques and indications of reconstructive surgery with neighborhood flaps. Breast-conserving treatment's sequelae. Classification and repairment techniques. Conclusions Final observations regarding the application of oncoplastic surgery and its articulation with conservative treatment.

TRENDS AND ATTITUDES TOWARD ONCOPLASTICS TRAINING IN MASTOLOGY IN BRAZIL / Tendências e atitudes para o treinamento oncoplástico em Mastologia no Brasil

Introduction: There is a growing interest in, and an increasing demand for, oncoplastic (OP) and reconstructive surgery training by breast surgeons. However, until now there has been a lack of a specific model for training in this field in most countries and no data with respect to learning curves. Mastology has been a medical specialty in Brazil since 1978. It is fully dedicated to studying, preventing, diagnosing, and managing all diseases of the breast. Incorporation of OP and reconstructive surgery in Mastology presents a number of challenges, and there are some controversial issues to overcome. Objective: The purpose of this study, therefore, was to analyze how OP and reconstructive techniques are being incorporated into surgical training in Mastology in Brazil. Methods: A specific survey was designed to cover all surgical residents who concluded their regular program in Mastology in Brazil in 2015 and 2016. Results: One hundred twenty-four residents from 49 breast units were included, with the majority having their training for all 2 years of their residence, as recommended by the Brazilian Society of Mastology. In addition, most of the respondents were able to perform partial breast reconstructions and reconstructions using expanders and implants, but 20% of them had a lack of specific training in these techniques. Conclusion: As adequate local control of disease and quality of life are related to surgical decisions, it is expected that breast surgeons expand their limits and responsibilities in order improve the reality of most breast cancer patients.

Introdução: Existe um interesse e uma demanda crescente de treinamento oncoplástico (OP) e cirurgia reconstrutiva por cirurgiões de mama. No entanto, até agora tem faltado um modelo específico de treinamento neste campo na maioria dos países, sem dados com relação à curva de aprendizado. A Mastologia tem sido uma especialidade médica no Brasil desde 1978. É totalmente dedicada a estudar, prevenir, diagnosticar e gerenciar todas as doenças da mama. A incorporação de OP e cirurgia reconstrutiva na Mastologia apresenta uma série de desafios, e há algumas questões controversas a serem superadas. Objetivo: O objetivo deste estudo, portanto, foi analisar como a OP e as técnicas reconstrutivas estão sendo incorporadas no treinamento cirúrgico em Mastologia no Brasil. Métodos: uma pesquisa específica foi projetada para cobrir todos os residentes cirúrgicos que concluíram seu programa regular em Mastologia no Brasil em 2015 e 2016. Resultados: Foram incluídos 124 residentes de 49 unidades mamárias, com a maioria treinada durante todos os 2 anos de residência, conforme recomendado pela Sociedade Brasileira de Mastologia. Além disso, a maioria dos entrevistados foi capaz de realizar reconstruções e reconstruções mamárias parciais usando expansores e implantes. Mas ainda 20% deles apresentaram falta de treinamento específico nestas técnicas. Conclusão: uma vez que o controle local adequado da doença e da qualidade de vida está relacionado às decisões cirúrgicas, espera-se que os cirurgiões de mama ampliem seus limites e responsabilidades para melhorar a realidade da maioria dos pacientes com câncer de mama.

Cirugía oncoplástica de la mama. Experiencia inicial en el Centro Clínico de Estereotaxia CECLINES, Caracas / Breast oncoplastic surgery. initial experience at Centro Clínico de Estereotaxia, CECLINES. Caracas

La cirugía preservadora (CP) puede algunas veces generar deformi-dades en la mama conservada. La cirugía oncoplástica (COP) pre-tende entonces mejorar nuestros resultados estéticos aun en loscasos con grandes resecciones de tejido mamario. Objetivo:Elpropósito de este estudio es dar una evaluación objetiva de nues-tra experiencia inicial con COP, principalmente basado en nivelesde satisfacción por parte de los pacientes y cirujanos Métodos:Este estudio prospectivo fue realizado en CECLINES en Caracas,durante el periodo enero 2011 y octubre 2012, el cual involucró107 pacientes consecutivos en 2 grupos: 52 pacientes ­ nivel IIde COP vs 55 pacientes ­cirugía preservadora "tradicional" (CPT).Evaluamos el nivel de satisfacción y el resultado estético a los 6 y12 meses post operatorio utilizando una puntuación distribuidadesde 1 (malo) hasta 5 (excelente). La puntuación estética fuerecopilada durante el seguimiento clínico por parte de los ciruja-nos, por llamadas telefónicas y fotografías fueron evaluadas por unpanel de 4 observadores. Resultados:La participación en el nivelde satisfacción y resultado estético fue del 100% a los 6 meses y96.2 % a los 12 meses. El tamaño tumoral promedio fue 23 mm(DE 13.5) para el grupo de COP vs 17.6 mm (DE 8.3) para el grupode CPT (p=0.017). El peso promedio de la pieza quirúrgica fue 01 gr (rango 30 gr­512 gr) grupo COP vs 60.4 gr (rango 20gr­135gr) grupo CPT (p=0.004). Las técnicas de COP más utilizadasfueron mamoplastia circular 40.3% (21/52), mamoplastia en Tinvertida 26.8% (14/52) y mamoplastia vertical 15.3%(8/52). A51.9% (27/52) de las pacientes se les realizó un procedimiento desimetrización distribuido de acuerdo al período de estudio de lasiguiente manera: 77.2% (17/22) en 2011, 56.6% (17/30) en2012 y 18.1%(6/33) en 2013. Las complicaciones fueron 5.7%(3/52) en el grupo de COP y 0% para el grupo de CPT (p<0.005).La puntuación estética promedio a los 6 meses por las pacientespara el grupo de COP fue 4.4, siendo la puntuación 4 (bien) y5(excelente) 88.4 %. En el grupo de CPT la puntuación promedioa los 6 meses para las pacientes fue 4.2, siendo 4-5 el 83.4 %(p = 0,644). a puntuación estética para los cirujanos en el grupode COP a los 6 meses fue 4.5, representando la puntuación 4-5 el 94.2 %. En el grupo de CPT la puntuación promedio para loscirujanos a los 6 meses fue 4.1 con 84.5 %, siendo 4 ó 5 (p <0,005). La puntuación estética final por las pacientes en el grupode COP a los 12 meses fue 4.5, siendo el nivel de satisfacción(4-5) el 90.4 %. En el grupo de CPT la puntuación estética final alos 12 meses por las pacientes fue 4.2, siendo 77.5% puntos 4o 5 (p < 0,005). La puntuación estética final por los cirujanos enel grupo de COP a los 12 meses fue 4.5, siendo el nivel de satis-facción (4-5) el 92.3 %. En el grupo de CPT la puntuación finalpor parte de los cirujanos a los 12 meses fue de 4.1, 84.5 % delos puntos fueron 4 ó 5 (p < 0,005) Conclusión:La COP generabuenas tasas de satisfacción. Cuando una COP no está indicada,una CPT retribuye buenos niveles de satisfacción y resultados esté-ticos. Usualmente los resultados se mantienen estables después delos 6 meses. La utilización de COP permite la extirpación de lesio-nes y piezas quirúrgicas más voluminosas. Los procedimientos desimetrización no siempre son necesarios. Con la adecuada selec-ción de las pacientes la tasa de complicaciones es baja tanto enel grupo de COP como de CPT(AU)

Breast conservative surgery (BCS) may sometimes lead to deformi-ties in the remaining breast. Oncoplastic surgery (OPS) pretends toimprove our aesthetic results even in the case of major volumeresections. Objective:The purpose of this study is to give anobjective evaluation of our initial experience with OPS, mainlybased on levels of satisfaction by both patients and surgeons.Methods:This prospective study was performed at CECLINES inCaracas-Venezuela during the period January 2011-October 2012,which involved 107 consecutive patients in two groups: 52patients - level II OPS vs 55 patients -'Standard' BCS (SBCS). Weevaluated the level of satisfaction and cosmetic outcome at 6 and12 months post op using a score from 1(bad) to 5(excellent). Thecosmetic score was recorded during the follow-up by the surgeon,by phone calls and photographs were reviewed by a panel of fourobservers. Results: The participation rate in the cosmetic outco-me/level of satisfaction evaluation was 100% at 6 months and96.2% at 12 months. The average tumor size was 23mm (SD 13.5)OPS group vs 17.6 mm (SD 8.3) SBCS group (p=0.017). The ave-rage weigth for the surgical specimen was 101gr (range 30gr­512gr) OPS group vs 60.4gr (range 20gr­135gr) SBCS group(p=0.004). The OPS techniques most performed were round block40.3% (21/52), inverted T mammoplasty 26.8% (14/52) and ver-tical scar mammoplasty 15.3%(8/52). 51.9% (27/52) of patients had simetrization procedures performed distributed according tothe period of the study: 77.2% (17/22) in 2011, 56.6% (17/30) in2012 and 18.1 % (6/33) in 2013. Complications were 5.7%(3/52) in the OPS group and 0% for SBCS group (p<0.005). Theaverage cosmetic score at 6 months by patients in the OPS groupwas 4.4, patient ́s satisfaction scores of 4(good) and 5 (excellent)were 88.4 %. In the SBCS group at 6 months the mean score bypatients were 4.2 being scores 4-5 83.4 % (p = 0,644). The cos-metic score by surgeons in the OPS group at 6 months was 4.5,surgeon ́s satisfaction scores of 4-5 were 94.2 %. In the SBCS sur-geon ́s mean score at 6 months were 4.1 with 84.5 % of scoresbeing 4 or 5 (p < 0,005). The final cosmetic score by patients inthe OPS group at 12 months was 4.5, patient ́s satisfaction scoresof 4-5 were 90.4 %. In the SBCS group the final mean score at 12months by patients were 4.2, 77.5% of scores being 4 or 5 (p <0,005). The final cosmetic score by surgeons in the OPS group at12 months was 4.5, surgeon ́s satisfaction scores of 4-5 were92.3%. In the SBCS surgeon ́s final mean score at 12 months were4.1, 84.5% of scores being 4 or 5 (p < 0,005). Conclusion: OPSprovides good satisfaction rates. A SBCS when an OPS is not indi-cated, mostly retributes good satisfaction levels and cosmetic sco-res. Usually the results remain stable after 6 months. The use ofOPS allows the excision of bigger lesions and surgical specimens.Simmetrization procedures are not always required. With the appro-priate patient selection the rate of complications is low for bothOPS and SBCS(AU)

Comparison of Outcomes of Standard and Oncoplastic Breast-Conserving Surgery / 한국유방암학회지

PURPOSE: The aim of this study is to determine and to compare the oncological outcomes of bilateral reduction mammoplasty to standard breast-conserving surgery for breast cancer. METHODS: One hundred sixty-two patients who received a quadrantectomy because of breast cancer (group 1) and 106 breast cancer patients with macromastia who underwent breast-conserving surgery via bilateral reduction mammoplasty (group 2) between 2003 and 2010 were enrolled in this study. RESULTS: The mean follow-up time was 37 months for group 1 and 33 months for group 2. Surgical margins were wider than 2 mm in 82.7% and 10 mm in 76.5% of the patients in group 1. Eleven percent of patients had positive surgical margins in this group. When compared to group 2, the rates were 89%, 84%, and 8.4%, respectively. Three patients (1.8%) in group 1 and one patient (0.9%) in group 2 had local recurrence of the disease and received a mastectomy. No statistical significances were noted for either local recurrence or overall survival between the two groups. CONCLUSION: Bilateral reduction mammoplasty has some advantages as compared to the standard conventional breast-conserving surgery techniques without having any unfavorable effects on surgical margin confidence, local recurrence, and survival rates.

Patrones oncoplásticos en el tratamiento conservador del cáncer de mama y lesiones de riesgo / Ncoplastic patterns in the conservative treatment of breast cancer and high risk lesions

Objetivo: Demostrar la eficacia de la utilización de patrones oncoplásticos por el cirujano de la mama en la realización de la tumorectomía adecuada con resultados cosméticos satisfactorios en el Centro Clínico Familia, Puerto Ordaz. Pacientes y método: Estudio prospectivo en pacientes con cáncer de mama o lesiones benignas de riesgo entre septiembre 2009 y diciembre 2011, en quienes la tumorectomía convencional ocasionaría acentuados defectos cosméticos y ésto determinado por tamaño, localización, relación volumen tumor/mama, multicentricidad y/o bilateralidad de la lesión. Resultados: Se operaron 11 pacientes. Ocho pacientes con cáncer. Carcinoma infiltrante: siete pacientes (63,7%), carcinoma lobulillar in situ: un paciente (9%), y con hiperplasia ductal atípica: tres pacientes (28,1%). El patrón oncoplástico más utilizado fue la mamoplastia vertical de pedículo inferior de rama única: seis paciente (54,5%). La mamoplastia vertical de pedículo superior de rama única y la técnica de Grisotti: dos pacientes (18%), respectivamente. La mamoplastia circunareolar un caso (9%). Se practicó biopsia del ganglio centinela en cinco pacientes, sin complicaciones atribuibles a la inyección de azul patente subareolar. Los resultados cosméticos fueron satisfactorios. Una paciente presentó discreta asimetría de altura de complejo areola ­ pezón y otra paciente un hematoma que se drenó ambulatoriamente. Conclusión: Los patrones oncoplásticos son técnicas quirúrgicas eficaces en el tratamiento conservador del cáncer de mama logrando la extirpación oncológica con excelentes resultados cosméticos. Estos procedimientos pueden ser practicados por el cirujano de la mama sin entrenamiento formal en cirugía plástica, pero sí fundamentado en una minuciosa planificación y técnicas sin excesiva complejidad(AU)

Objective: To demonstrate the effectiveness of oncoplastic techniques by the breast surgeon performing the lumpectomy with satisfactory cosmetic outcomes, at the Centro Clínico Familia, Puerto Ordaz. Patients and method: A prospective study in patients with breast cancer and risk lesions, between September 2009 - December 2011, in whom conventional lumpectomy would cause cosmetic defect and this was determined by the size, location, and relation tumor/breast volume, multicentric or bilateral lesion. Results: Eleven patients were operated. Eight with diagnosed breast cancer. Invasive carcinoma: seven patients (63.7%), lobular in situ carcinoma: one patient (9%) and with atypical ductal hyperplasia: three patients (28.1%). The oncoplastic technique more used was the vertical mamoplasty with inferior single branch pedicle: six patients (54.5%). The vertical mammoplasty with superior branch single pedicle and Grisotti´s technique: two patients (18%) respectively. periareolar mamoplasty: one case (9%). Sentinel lymph node biopsy was performed on five patients without complications due to the subareolar injection of patent blue. The cosmetic results were satisfactory. One patient presented a little asymmetry of height of complex areola - nipple and another patient presented a hematoma that was drained ambulatory. Conclusion: Oncoplastic techniques are effective surgical techniques in the conservative treatment of breast cancer and allow extensive resection with excellent cosmetic results. These procedures can be performed by the breast surgeon without formal training in plastic surgery, but based on a thorough planning of techniques without excessive complexity(AU)

Cirugía oncoplástica para cáncer mamario: mejorando estéticamente la resecabilidad / Oncoplastic surgery for breast cancer: cosmetically improving resectability

ANTECEDENTES: En la cirugía del cáncer mamario, asociando técnicas de mamoplastía reductiva a la resección oncológica, ha permitido aumentar la extensión de las resecciones previniendo las deformidades secundarias. Es lo que llamamos oncoplástica mamaria o reconstrucción mamaria tumor específica. OBJETIVO: Presentar una serie descriptiva retrospectiva de 60 pacientes en quienes usamos oncoplástica mamaria como alternativa a la mastectomía. RESULTADOS: Un 86% consideró el resultado cosmético como satisfactorio. La mediana de seguimiento fue de 48 meses. Dos pacientes presentaron recurrencia local, una asociada a falla sistémica sincrónica a los 18 meses; otra paciente se diseminó a los 6 años. Ambas fallecieron. Una tercera se encuentra en tratamiento hormonal por metástasis óseas. No hubo complicaciones importantes en la serie, ni retardo significativo de las terapias secuenciales. CONCLUSIÓN: Esta técnica permite evitar mastectomías y prevenir deformidades en cirugía conservadora estándar.

BACKGROUND: In breast cancer surgery, the association of reductive mammoplasty to oncological excisión, allows more extensive excisions, reducing radical surgery and preventing secondary deformities. This is called oncoplastic or tumor specific mammary reconstruction. OBJECTIVE: To report 60 patients in whom oncoplastic surgery was used. METHODS: Retrospective descriptive series of 60 patients aged 34 to 65 years, subjected to oncoplastic mammary surgery, that were followed for a median of 48 months. RESULTS: Eighty six percent of patients considered the cosmetic result of surgery as satisfactory. Two patients had a local relapse, one associated to systemic dissemination at 18 months and die. Another patient died with systemic disease and other is under hormonal treatment for bone metastases. No significant complications or delays in oncological therapies were recorded. CONCLUSIONS: Oncoplastic surgery may avoid mastectomy and prevent deformities in breast cancer surgery.

Oncoplastic Surgical Techniques for Personalized Breast Conserving Surgery in Breast Cancer Patient with Small to Moderate Sized Breast / 한국유방암학회지

Oncoplastic surgery has revolutionized the field of breast conserving surgery (BCS). The final aims of this technique are to obtain an adequate resection margin that will reduce the rate of local recurrence while simultaneously improving cosmetic outcomes. To obtain successful results after oncoplastic surgery, it is imperative that patients be risk-stratified based on risk factors associated with positive margins, that relevant imaging studies be reviewed, and that the confirmation of negative margins be confirmed during the initial operation. Patients who had small- to moderate-sized breasts are the most likely to be dissatisfied with the cosmetic outcome of surgery, even if the defect is small; therefore, oncoplastic surgery in this population is warranted. Reconstruction of the remaining breast tissue is divided into volume displacement and volume replacement techniques. The use of the various oncoplastic surgeries is based on tumor location and excised breast volume. If the excised volume is less than 100 g, the tumor location is used to determine which technique should be used, with the most commonly used technique being volume displacement. However, if the excised volume is greater than 100 g, the volume replacement method is generally used, and in cases where more than 150 g is excised, the latissimus dorsi myocutaneous flap may be used to obtain a pleasing cosmetic result. The local recurrence rate after oncoplastic surgery was lower than that of conventional BCS, as oncoplastic surgery reduced the rate of positive resection margins by resecting a wider section of glandular tissue. If the surgeon understands the advantages and disadvantages of oncoplastic surgery, and the multidisciplinary breast team is able to successfully collaborate, then the success rate of BCS with partial breast reconstruction can be increased while also yielding a cosmetically appealing outcome.

Cirugía oncoplástica de la mama: cómo mejorar la resecabilidad en cirugía conservadora asegurando la estética / Oncoplastic surgery for breast cancer

Background: In breast cancer surgery, the association of reductive mammoplasty to oncological excisión, allows more extensive excisions, reducing radical surgery and preventing secondary deformities. This is called oncoplastic or tumor specific mammary reconstruction. Aim: To report 37 patients in whom oncoplastic surgery was used. Material and Methods: Retrospective descriptive series of 37 patients aged 38 to 65 years, subjected to oncoplastic mammary surgery, that were followed for a median of 42 months. Results: Eighty six percent considered the cosmetic result of surgery as satisfactory. One patient had a local relapse associated to systemic dissemination at 16 months. One patient died and one is under hormonal treatment for bone metastases. No significant complications or delays in oncological therapies were recorded. Conclusions: Oncoplastic surgery may avoid mastectomy and prevent deformities in breast cancer surgery.

Conservar la mama se considera uno de los objetivos importantes en el tratamiento del cáncer. Frecuentemente la relación entre el tamaño y la localización tumoral impide la cirugía conservadora con un buen resultado estético u obliga a realizar una mastectomía, lo que empobrece la calidad de la sobrevida. Asociar técnicas de mamoplastía reductiva a la resección oncológica ha permitido aumentar la extensión de las resecciones, disminuyendo las cirugías radicales o previniendo las deformidades secundarias. Es lo que llamamos oncoplástica mamaria (OPM) o reconstrucción mamaria tumor específica. Presentamos una serie descriptiva retrospectiva de 37 pacientes en quienes usamos OPM como alternativa a la mastectomía. Un 86 por ciento consideró el resultado cosmético como satisfactorio. La mediana de seguimiento fue 42 meses. Una paciente ha tenido recurrencia local asociada a diseminación sistémica a los 16 meses. Una paciente falleció y otra está en tratamiento hormonal por metástasis óseas. No hubo complicaciones importantes en la serie ni retardo significativo de las terapias secuenciales. Concluimos que esta técnica permite evitar mastectomías y prevenir deformidades en cirugía conservadora estándar.

The Use of a Corrective Procedure with Vicryl Mesh for Oncoplastic Surgery of the Breast / 한국유방암학회지

PURPOSE: In addition to the oncological results, cosmetic results are very important to cancer patients. Currently, the use of oncoplastic surgery is an emerging approach. In this study, we examined the clinical outcomes of the use of a corrective procedure with an absorbable implant, a Vicryl mesh(R), as compared with the use of conventional breast conserving surgery (BCS). METHODS: Fifty six patients who completed questionnaire were enrolled in the study. For 33 cases, BCS was performed concurrently with the use of a Vicryl mesh and for the other 23 cases, conventional BCS alone was performed. Contraindications of the use of corrective procedure were a patient age over 60 year, diabetes, neoadjuvant chemotherapy and a previous excisional biopsy performed on the same breast. Patients rated their cosmetic outcomes by use of a four point scale. RESULTS: For one of 34 cases, the Vicryl mesh was removed due to infection and this patient was excluded from the study. Twenty seven of the remaining 33 patients (82%) who underwent the corrective procedure with Vicryl mesh were satisfied with their outcome. For patients that received conventional BCS only ten of 23 patients (43%) were satisfied with their outcome (p=0.05). Patient age, body mass index (BMI) and tumor location did not affect the cosmetic outcomes of the corrective procedure. When the resection area of the breast was 40-70 cm2, 88% of the patients were satisfied with their outcome. CONCLUSION: This study suggested that the use of Vicryl mesh correction was superior to the use of conventional BCS alone for cosmesis. This method appears to provide a satisfactory outcome for oncoplastic surgery of the breast.