Oncoplastic breast surgery to prevent "Bird's beak" deformity in the breast: a comparative retrospective study.

PURPOSES: Breast deformity occurring in the lower pole after breast conserving surgery (BCS) is known as bird's beak (BB) deformity. This retrospective study evaluated the outcomes in breasts reconstructed with a conventional closing procedure (CCP) and a downward-moving procedure (DMP), respectively, after BCS. METHODS: In CCP, the inferomedial and inferolateral portions of breast tissues were reapproximated toward the midline after wide excision to repair the breast defect. In DMP, the retro-areolar breast tissue was detached from the nipple-areolar complex after wide excision, and the upper pole breast tissue was moved downward to refill the breast defect. RESULTS: CCP was performed in 20 patients (Group A), and DMP was performed in 28 patients (Group B). Although retraction of the lower part of the breast was postoperatively observed in 13 (72%) of 18 patients from Group A, it was observed in 7 (28%) of 25 patients in Group B (p < 0.05). The downward pointing of the nipple was observed in 8 (44%) of 18 patients from Group A and in 4 (16%) of 25 patients in Group B (p < 0.05). CONCLUSIONS: DMP is more useful for preventing BB deformity than CCP.

Practical oncoplastic surgery techniques needed for practice.

Oncoplastic breast surgery (OPS) is a form of breast conservation surgery that includes immediate breast reconstruction. OPS has previously been shown to be a safe and effective treatment for breast cancer. In a special series on Breast Reconstruction, we aimed to describe oncoplastic breast reconstruction options and the corresponding technical details. Sections were divided by descriptions of OPS specific preoperative workup, volume displacement techniques, volume replacement techniques, and postoperative considerations. In addition, to sharing expert surgical pearls gained through performing OPS procedures over the years. Innovations in breast reconstruction offer women treatment options that are both oncologically safe and aesthetically preferred. The rise in reconstructive procedures is changing how patients make decisions based on their diagnosis. The ultimate surgical decision should be determined by the patient's anatomy, patient's personal preferences, tumor characteristics, and clinical presentation in a shared decision-making fashion with a multidisciplinary team. However, with both volume displacement and volume replacement techniques, women of all breast sizes can achieve an aesthetic outcome without sacrificing oncologic resection.

Indocyanine green angiography in oncoplastic breast surgery, a prospective study.

INTRODUCTION: The use of Indocyanine green angiography (ICG-A) in oncoplastic breast-conserving surgery (OBCS) has not yet been investigated. This prospective trial applied ICG-A in volume displacement and replacement OBCS to localize perforators and determine tissue supplied by the perforator. Furthermore, to investigate and correlate the intraoperative ICG-A to postoperative surgical site infection, skin necrosis, epidermolysis, and timely onset of adjuvant therapy. METHODS: ICG-A was performed at three pre-set timepoints during surgery; after lumpectomy, upon dissection of possible perforators, and after wound closure. All patients were followed with clinical evaluations before surgery, 4 weeks, 4-6 months, and 12 months postoperatively. RESULTS: Eleven patients were included: seven volume displacement and four volume replacement OBCS. ICG-A located the tissue supplied by the perforator and demonstrated sufficient perfusion in all cases. The ICG-A corresponded to the surgeons' clinical assessment. One patient developed a postoperative infection and seroma and was treated conservatively. No patients had postoperative necrosis, loss of reconstruction, or lymphedema of the arm. Edema of the breast occurred in four patients (36.4%). Scar assessments were significantly worse at 4-weeks and 4-6 months. The quality of life improved significantly during follow-up. Adjuvant treatment was administered timely in all cases. CONCLUSION: ICG-A was feasible for OBCS in assessing intraoperative perfusion. Perfusion was sufficient in all patients and corresponded to the surgeon's clinical evaluation. No patients developed postoperative necrosis. Though edema of the breast occurred in 36.4%, a larger sample size is needed to investigate a possible correlation with ICG-A. Further studies, which includes patients requiring extensive tissue replacement challenging the borders of perfusion, are needed.

Oncoplastic level II volume displacement surgery for breast cancer: oncological and aesthetic outcomes.

Oncoplastic breast-conserving surgery (OBCS) is increasingly used to treat breast cancer with the dual purpose of performing a radical oncological resection while minimizing the risk of post-operative deformities. The aim of the study was to evaluate the patient outcomes after Level II OBCS as regards oncological safety and patient satisfaction. Between 2015 and 2020, a cohort of 109 women consecutively underwent treatment for breast cancer with bilateral oncoplastic breast-conserving volume displacement surgery; patient satisfaction was measured with BREAST-Q questionnaire. The 5-year overall survival and disease-free survival were 97% (95%CI 92, 100) and 94% (95%CI 90, 99), respectively. In two patients (1.8%), mastectomy was finally performed due to margin involvement. The median patient-reported score for "satisfaction with breast" (BREAST-Q) was 74/100. Factors associated with a lower aesthetic satisfaction index included: location of tumour in central quadrant (p = 0.007); triple negative breast cancer (p = 0.045), and re-intervention (p = 0.044). OBCS represents a valid option in terms of oncological outcomes for patients otherwise candidate to more extensive breast conserving surgery; the high satisfaction index also suggests a superiority in terms of aesthetic outcomes.

An analysis of complication rates and the influence on patient satisfaction and cosmetic outcomes following oncoplastic breast surgery.

INTRODUCTION: This study aimed to evaluate complication rates, patient satisfaction, and cosmetic outcomes after oncoplastic breast-conserving surgery (OPS). Furthermore, outcome differences between volume displacement and volume replacement techniques and the effect of postoperative complications on outcomes were evaluated. METHODS: This was a prospective single-center study addressing patients who underwent OPS from 2017 to 2020. The BREAST-Q was used to measure patient satisfaction, and cosmetic outcomes were assessed by patient self-evaluation and panel evaluation based on medical photographs. RESULTS: A total of 75 patients were included. The overall complication rate was 18.7%, of which 4% required invasive interventions. Median BREAST-Q scores ranged from 56 to 100 and cosmetic outcomes were scored good to excellent in 60-86%. No differences in complications were observed between volume replacement and volume displacement techniques. Following volume displacement techniques, patients-reported higher BREAST-Q scores for the domain "physical well-being of the chest" and lower cosmetic outcomes scores for "mammary symmetry." Patients with complications scored significantly lower on several domains of the BREAST-Q and in various cosmetic outcome categories. CONCLUSION: In this cohort, an overall complication rate of 18.7% was observed. Patients were generally satisfied, and most cosmetic outcomes were good to excellent. Volume displacement or replacement techniques were performed for different indications and generally showed comparable results. Expected differences in physical discomfort and symmetry between both techniques were observed. In addition, the occurrence of complications resulted in lower patient satisfaction and cosmetic outcomes. These findings emphasize the importance of thorough preoperative counselling.

Long-term oncological outcomes of oncoplastic breast-conserving surgery after a 10-year follow-up - a single center experience and systematic literature review.

Aim: While many studies reported the oncological outcomes of oncoplastic breast-conserving surgery (OBCS), there were inherent differences in the study population, surgeons' expertise, and classifications of techniques used. There were also limited studies with long term follow up oncological outcomes beyond 5 years. This current study aimed to compare long-term oncological outcomes of ipsilateral breast tumor recurrence (IBTR) disease-free survival (DFS) and overall survival (OS) following conventional and oncoplastic breast-conserving surgery using volume displacement and replacement techniques. Methods: Between 2009 and 2013, 539 consecutive patients who underwent breast conservation surgery including 174 oncoplastic and 376 conventional procedures were analysed. A systematic review of studies with at least five years of median follow up were performed to compare long term oncological outcomes. Results: At a median follow-up of 82.4 months, there were 23 (4.2%) locoregional recurrences, 17 (3.2%) metachronous contralateral breast cancer, 26 (4.8%) distant metastases, and 13 (2.4%) deaths. The hazard ratio of OBCS for IBTR, DFS and OS were 0.78 (95% confidence interval [CI] 0.21-2.94, p=0.78), 1.59 (95% CI, 0.88 to 2.87, p=0.12), and 2.1 (95% CI, 0.72 to 5.9, p=0.17) respectively. The 10-year IBTR-free, DFS and OS rate were 97.8%, 86.2%, and 95.7% respectively. Conclusion: There remained a dearth in well-balanced comparative studies with sufficient long-term follow-up, and our study reported long-term oncological outcomes for OBCS which were favourable of either VD or replacement techniques.

Resolving Pseudohyponatremia: Validation of Plasma Sodium on Radiometer ABL800 Blood Gas Analyzers for Immediate Reflex Testing.

OBJECTIVE: To perform validation of plasma sodium on blood gas analyzers to reflexively correct erroneous measurements by ion-selective electrodes (ISEs). METHODS: We compared remnant specimens of whole blood and plasma collected by lithium heparin vacutainer with normal protein concentrations and no lipemia. Whole-blood specimens were tested for sodium concentration on the ABL800 Flex blood gas analyzer, followed by centrifugation for plasma separation, and repeat sodium determination on an aliquot of the plasma only. Also, plasma specimens were analyzed by indirect ISE on the Cobas 8000 series and by direct ISE on the ABL800 Flex for instrument comparison. RESULTS: Plasma aliquots yielded comparable results to the parent whole-blood specimen, with an average change of -1.33 mmol/L (R2 = 0.9727). Comparison of indirect ISE to direct ISE similarly yielded comparable results, with an average change of + 0.8 mmol/L (R2 = 0.9016). CONCLUSION: Plasma is a valid specimen matrix for use on blood gas analyzers for sodium determination, eliminating the need for re-collection of whole-blood specimens from patients with pseudohyponatremia.

Outcomes in volume replacement and volume displacement techniques in oncoplastic breast conserving surgery: A systematic review.

INTRODUCTION: Volume Replacement (VR-OBCS) and Volume Displacement Oncoplastic Breast Conserving Surgery (VD-OBCS) are commonly used in the management of breast cancer. Many studies summarize the individual postoperative outcomes of these two procedures; however, there is a lack of research that compares outcomes of these approaches. This review summarizes the available VR and VD-OBCS literature in terms of oncological, cosmetic, and clinical outcomes. METHODS: An online literature search (MEDLINE, EMBASE, PubMed, and CINAHL) was performed. Studies were included if they were written in English, had more than 10 adult (18+) female patients who underwent VR-OBCS or VD-OBCS, and reported at least one well-described oncological, clinical, or cosmetic outcome RESULTS: Thirty-three studies (26 VR-OBCS and 7 VD-OBCS) were included in this review; VR-OBCS studies were separated based on the use of latissimus dorsi (LD) flaps. Studies utilizing VR-OBCS with LD flaps reported the highest rate of all oncological outcomes; VR-OBCS studies without LD flaps reported the lowest. Rates of hematoma, seroma, and wound dehiscence were highest in VR-OBCS with LD flaps; partial flap loss and fat necrosis were highest in VR-OBCS without LD flaps and infection was highest in VD-OBCS studies. Inconsistencies in methodology (cosmetic outcome measures, outcome definitions, and time horizons) were found in all procedural groups. CONCLUSION: Differences in outcomes for both OBCS procedures may be due to the heterogeneity of patient populations. "Doers" and "Users" of breast oncoplastic research should consider tumor size, laterality of tumor, breast size, measurement scales, and defensible time horizons before the application of a study's conclusions.

Simple kinetics, assay, and trends for soil microbial catalases.

In this report, we expand upon the enzymology and ecology of soil catalases through development and application of a simple kinetic model and field-amenable assay based upon volume displacement. Through this approach, we (A) directly relate apparent Michaelis-Menten terms to the catalase reaction mechanism, (B) obtain upper estimates of the intrinsic rate constants for the catalase community (k3'), along with moles of catalase per 16S rRNA gene copy number, (C) utilize catalase specific activities (SAs) to obtain biomass estimates of soil and permafrost communities (LOD, ~104 copy number gdw-1), and (D) relate kinetic trends to changes in bacterial community structure. In addition, this novel kinetic approach simultaneously incorporates barometric adjustments to afford comparisons across field measurements. As per our model, and when compared to garden soils, biological soil crusts exhibited ~2-fold lower values for k3', ≥105-fold higher catalase moles per biomass (250-1200 zmol copy number-1), and ~104-fold higher SAs per biomass (74-230 fkat copy number-1); whereas the highest SAs were obtained from permafrost and high-elevation soil communities (5900-6700 fkat copy number-1). In sum, the total trends suggest that microbial communities which experience higher degrees of native oxidative stress possess higher basal intracellular catalase concentrations and SAs per biomass.

Reconstruction in Breast Conservation Therapy-Single Tertiary Care Institution Experience with 472 Patients.

Breast conservation therapy (BCT) is now internationally accepted treatment for early breast cancer. Despite of high incidence of carcinoma breast in India, BCT rates are very low as compared to the west. In this article, we wish to share our experience of breast conservation with oncoplasty in Indian women. A retrospective analysis of case records of patients treated with oncoplastic breast conservation from January 2009 to June 2014 in a single surgical oncology unit in a tertiary cancer institute. Demographic patient data, stage of disease, location of primary tumour, use of neo-adjuvant chemotherapy if received, tumour size and breast size ratio, reconstruction method used, post-operative complications and aesthetic score of patients were analysed. Various methods of oncoplasty and partial breast reconstruction used are discussed. Four hundred and seventy-two patient records were found suitable for analysis. Most common stage of presentation was T2N0 in 189 patients (40%). Forty-one patients received neo-adjuvant chemotherapy (NACT). Tumour arising in upper outer quadrant was most common site, seen in 268 (56.7%). The most common method of reconstruction was volume displacement, done in 57.6% patients. Overall surgical complications included wound infection with or without dehiscence, seroma formation, partial flap necrosis and fat necrosis. Cosmesis was found to be excellent in 23.09% and good in 58.47% at 6-month follow-up. Breast conservation with oncoplasty is oncologically safe for early breast cancer treatment and has good cosmetic outcome with high patient satisfaction rates. Its practice should be encouraged in Indian set-up also.

Fate of inhaled Nano-CeO2 revisited: Predicting the unpredictable.

This paper compares the pulmonary kinetics of inhaled nano-CeO2 from two published repeated inhalation studies of 13-week duration in rats. This database was used to predict the outcome of a 2-year chronic inhalation study with a focus on the no observed adverse effect level (NOAEL) and range of conditions causing kinetic lung overload up to and beyond the maximum tolerated dose (MTD). Modeling identified nano-CeO2 to be typical poorly soluble, low-toxicity particles (PSLTs), although even partial dissolution may lead to interactions with pulmonary surfactant, eventually resulting in pulmonary phospholipidosis and fibrosis. An earlier model published in 2011 to surpass and replace the traditional Morrow approach focused on kinetic lung overload to simulate the pulmonary fate of inhaled micron-sized PSLT in rats. By misunderstanding or inaction, this earlier model was overlooked as a better hypothesis-based model for dosimetry selection of long-term inhalation studies with the aim of reducing study repetition and animal numbers. While it appears that the primary adverse pathway of the earlier model also applies to nano-CeO2, the updated model proposed here also accounts for phospholipid-like additional volume loads. Data from a heralded 2-year inhalation study in rats are not yet available, but the study was traditionally modeled to predict the toxicological NOAEL and MTD hallmarks. When completed, this study's data will clarify whether the advanced 21st century modeling proposed here may be more advantageous for design and execution of inhalation studies, compared to simplistic and outdated gross overload models.

Increasing Silicone Oil Viscosity Increases Resistance to Volume Displacement in an in vitro Retinal Detachment Model.

PURPOSE: To determine whether higher-viscosity silicone oils offer greater resistance to volume displacement in an in vitro eye model of retinal detachment and could subsequently be expected to generate stronger retinal tamponades in cases of recurrent or complex retinal detachments. METHODS: We used an eye model that included a membrane representing the retina. Silicone oils with different viscosities were injected, and oil displacement and resistance were measured. RESULTS: Membrane movement and volume changes in an eye model were proportional to the viscosity of the oil: the lower the viscosity, the faster volume changes and displacement occurred. CONCLUSIONS: Our results show that the volume change rate has a linear relationship with oil viscosity. Our findings suggest that in this eye model, silicone oil tamponades the retina against the retinal pigment epithelium mainly through volume displacement and that silicone oil viscosity may play an important role in preventing retinal displacement and in providing tamponade.

Kinetic modeling of the retention and fate of inhaled cerium oxide nanoparticles in rats: The cumulative displacement volume of agglomerates determines the outcome.

This paper compares the pulmonary kinetics of inhaled nano-CeO2 from published repeated inhalation studies of 1-, 4-, 13-, and 52-week duration using a previously published kinetic model to simulate the pulmonary kinetics of inhaled micron-sized poorly soluble, low toxicity particles (PSPs) in rats. This comparative analysis demonstrates that the kinetic hallmarks characterizing lung overload-related pulmonary inflammation are indistinguishable for PSPs and agglomerated nano-CeO2. Unlike PSPs, nano-CeO2 appears to dissolve within the lung as long as tissue saturation has not been attained. When saturation is reached, the accumulated retained particle displacement volume becomes the prominent unifying factor interrelating the retained volumetric particle dose and pulmonary inflammogenicity observed in inhalation studies of 1- to 52-weeks duration. In summary, the pulmonary kinetics of nano-CeO2 inhaled as micron-sized agglomerates exhibit kinetic and toxicological profiles similar to micron-sized PSPs. The coherence of modeled and empirical outcomes supports the hypothesis that the leading metric of pulmonary toxicity is the displacement volume of accumulated aggregated particles. Whereas agglomerated nano-CeO2 particles follow the typical kinetic of lung overload, evidence of dissolution of nano-CeO2 demonstrates a much shorter elimination half-time of t1/2 = 17 days. Thus, kinetic modeling approaches appear to not only deliver the highest degree of integrated mechanistic information, it also provides a validating feed-back loop to verify/refute the starting hypothesis of inhalation studies.

Roller compaction scale-up using roll width as scale factor and laser-based determined ribbon porosity as critical material attribute.

Due to the complexity and difficulties associated with the mechanistic modeling of roller compaction process for scale-up, an innovative equipment approach is to keep roll diameter fixed between scales and instead vary the roll width. Assuming a fixed gap and roll force, this approach should create similar conditions for the nip regions of the two compactor scales, and thus result in a scale-reproducible ribbon porosity. In the present work a non-destructive laser-based technique was used to measure the ribbon porosity at-line with high precision and high accuracy as confirmed by an initial comparison to a well-established volume displacement oil intrusion method. The ribbon porosity was found to be scale-independent when comparing the average porosity of a group of ribbon samples (n=12) from small-scale (Mini-Pactor®) to large-scale (Macro-Pactor®). A higher standard deviation of ribbons fragment porosities from the large-scale roller compactor was attributed to minor variations in powder densification across the roll width. With the intention to reproduce ribbon porosity from one scale to the other, process settings of roll force and gap size applied to the Mini-Pactor® (and identified during formulation development) were therefore directly transferrable to subsequent commercial scale production on the Macro-Pactor®. This creates a better link between formulation development and tech transfer and decreases the number of batches needed to establish the parameter settings of the commercial process.

Repeated inhalation exposure of rats to an anionic high molecular weight polymer aerosol: application of prediction models to better understand pulmonary effects and modes of action.

Opposed to the wealth of information available for kinetic lung overload-related effects of poorly-soluble, low-toxicity particles (PSP), only limited information is available on biodegradable high molecular weight (HMW) organic polymers (molecular weight >20,000 Da). It is hypothesized that such types of polymers may exert a somewhat similar volume displacement-related mode of action in alveolar macrophages as PSP; however, with a differing biokinetics of the material retained in the lung. This polyurethane polymer was examined in single and 2-/13-week repeated exposure rat inhalation bioassays. The design of studies was adapted to that commonly applied for PSP. Rats were nose-only exposed for 6h/day for the respective study duration, followed by 1-, 2- and 4-week postexposure periods in the single, 2- and 13-week studies, respectively. While the findings in bronchoalveolar lavage (BAL) and histopathology were consistent with those typical of PSP, they appear to be superimposed by pulmonary phospholipidosis and a much faster reversibility of pulmonary inflammation. Kinetic modeling designed to estimate the accumulated lung burden of biopersistent PSP was also suitable to simulate the overload-dependent outcomes of this biodegradable polymer as long as the faster than normal elimination kinetics was observed and an additional 'void space volume' was added to adjust for the phagocytosed additional fraction of pulmonary phospholipids. The changes observed following repeated inhalation exposure appear to be consistent with a retention-related etiopathology (kinetic overload). In summary, this study did not reveal evidence of any polymer-specific pulmonary irritation or parenchymal injury. Taking all findings into account, 7 mg polymer/m(3) (exposure 6h/day, 5-days/week on 13 consecutive weeks) constitutes the point of departure for lower respiratory tract findings that represent a transitional state from effects attributable to an overload-dependent pulmonary inflammation and phospholipidosis. In regard to extrapulmonary toxicity, no effects were found up to the maximum concentration of 107 mg/m(3) examined.

The metrics of MWCNT-induced pulmonary inflammation are dependent on the selected testing regimen.

Convincing evidence suggests that high-surface-activity nano-materials, such as MWCNT, exert two modes of action (MoA), in which one appears to be related to surface activity/area and occurs concurrent with deposition, and the other is related to cumulative lung burden. Pulmonary inflammation induced by the latter mode appears to be dependent on cumulative volumetric lung burden and on whether the accumulated particle displacement volume within the pool of alveolar macrophages is above or below the kinetic lung overload threshold. However, the relative importance and effect of each MoA are still controversial. In addition, the test protocol variables, which may predetermine the leading MoA, have not yet received increased attention. This study compares the respective outcome of previously published repeated-exposure inhalation studies with MWCNT (Nanocyl and Baytube) in rats. Modeling procedures were performed to compare post hoc the equivalence of empirical and modeled outcomes, including critical protocol variables. This comparison provided compelling evidence that the accumulated retained particle displacement volume was the most prominent unifying denominator linking the pulmonary retained volumetric particle dose to inflammogenicity and toxicity. However, conventional study designs may not always be appropriate to unequivocally dissociate the surface area/activity-related acute adversity from the cumulative retention volume-related adversity. Thus, in the absence of adequately designed studies, it may become increasingly challenging to differentiate substance-specific deposition-related acute effects from the more chronic retained cumulative dose-related effects. In summary, this analysis of existing data supports the conclusion that both the deposition and retention-related effects need to be judiciously dissociated to better understand the MoA of heightened concern. This exercise supports the conclusion that hypothesis-based computational study design delivers the highest degree of scientifically important information and may further reduce the number of experimental animals in repeated-exposure inhalation studies with low-toxicity, biopersistent, poorly soluble granular particles.

Intra-aortic balloon shape change: effects on volume displacement during inflation and deflation.

It has been observed that operating the intra-aortic balloon at an angle to the horizontal resulted in a reduction of the volume displaced toward the coronary arteries and compromised afterload reduction. Therefore, the aim of this work is to examine whether changing the current balloon shape, which has not been altered for 40 years, could compensate for the negative hemodynamic effects due to angulation. We tested two tapered balloons, increasing diameter (TID) and decreasing diameter (TDD), and compared the results with those obtained from a standard cylindrical balloon. The balloons were tested in vitro at 60 beats/min and a static pressure of 90 mm Hg. The balloons were operated at four angles (0°, 20°, 30°, 45°), and the pressure at three locations along the balloon (base, middle, and tip) was also measured. Flow rate upstream of the tip of the balloon was also measured to indicate the flow displaced toward the coronary circulation. The relative volume displaced toward (VUTVi) and suctioned away from (VUTVd) the simulated ascending aorta, during inflation and deflation, respectively, is reduced when a standard cylindrical balloon is operated at an angle to the horizontal. The TDD provided the greatest VUTVi and also produced the largest pulse pressure during deflation. Although the TID provided less VUTVi and VUTVd at smaller angles, it was not markedly affected by the change of angle. According to these results, different balloon shapes analyzed, with comparable volume to that of a cylindrical balloon, produced greater inflation and deflation benefits, at the horizontal and at a range of angles to the horizontal. Further investigations are required to optimize the shape of the tapered balloons to fit into the available physiological space.

Surgical techniques for personalized oncoplastic surgery in breast cancer patients with small- to moderate-sized breasts (part 1): volume displacement.

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.

Surgical Techniques for Personalized Oncoplastic Surgery in Breast Cancer Patients with Small- to Moderate-Sized Breasts (Part 1): Volume Displacement / 한국유방암학회지

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.

Surgical Techniques for Personalized Oncoplastic Surgery in Breast Cancer Patients with Small- to Moderate-Sized Breasts (Part 1): Volume Displacement / 한국유방암학회지

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.