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ONCOPLASTIC BREAST SURGERY

Breast cancer basics

  • Demographics

    • The most common cancer in females in the UK

    • Around 55,200 new breast cancer cases in the UK are diagnosed every year

    • Incidence in increasing

    • Male breast cancer represents 1% of all breast cancers

  • Histopathologic markers​

    • Oestrogen receptor (ER)​

    • Progesterone receptor (PR)

    • HER2/neu oncoprotein

  • Risk factors​

    • Early age of menarche​

    • Late menopause

    • First full-term pregnancy after age of 30 years

    • History of premenopausal breast cancer in 2 or more 1st-degree relatives

    • Personal history of breast cancer

    • BRCA1 and BRCA2 mutations (represent about 5% of breast cancers)

      • Carriers have about 60-80% lifetime risk​

  • Diagnosis​​

    • Triple assessment​

      • History and examination​

      • Imaging (mammography, ultrasound or MRI)

      • Histopathology (core biopsy or fine needle aspiration cytology)

Breast cancer basics

History of oncoplastic surgery

  • Breast conserving therapy - Combination of breast conserving surgery and radiotherapy

    • In early-stage breast cancer, it has been shown to have comparable overal or distant disease-free survival survival to mastecomy in prospective trials​

  • "Oncoplastic surgery" term introduced​ in 1993 by Audretch et al

  • These technique draw from a number of principles inherent to plastic surgery procedures on the breast such as breast reduction or mastopexy

  • Balancing the resection with breast landmarks and shape to preserve breast aesthetics are the fundamentals

  • The most common cause of an unfavourable result is removal of a large amount of breast parenchyma in a small volume breast or excision in an unfavourable location

History of oncoplastic surgery

Patient selection

  • Partial breast reconstruction indicated in patients in whom a standard lumpectomy would lead to gross asymmetry or breast deformity

  • Concerns regarding oncological margin control during resective surgery may affect type of resective surgery and reconstruction choices

  • Timings can be divided into immediate, delayed-immediate and delayed

    • Immediate has risks of positive margins​

    • Delayed has risks of operating in surgically scarred tissue and wound healing problems secondary to radiotherapy

Patien selection

Surgical management

  • Volume displacement techniques

    • Parenchymal remodeling​

      • Advancement, rotation or transposition of a large area of breast to fill a small or moderate-sized defect​

    • Volume reduction

    • Therapeutic mammoplasty

  • Volume replacement techniques

    • Involves adjacent or distan tissue transfer​

    • Volume preserving

    • Implant augmentation

    • Local or perforator flaps

    • Regional or distant flaps

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