gms | German Medical Science

49. Jahrestagung der Deutschen Gesellschaft für Plastische und Wiederherstellungschirurgie (DGPW)

Deutsche Gesellschaft für Plastische und Wiederherstellungschirurgie e. V.

06.10.-08.10.2011, Ulm

Preoperative planning of oncoplastic procedures – technical and oncological aspects

Meeting Abstract

  • corresponding author Elke Von Haeften - University Hospitals of Leicester, Dept of Breast Surgery, Leicester
  • Jaroslaw Krupa - University Hospitals of Leicester, Dept of Breast Surgery, Leicester
  • Ioannis Michalakis - University Hospitals of Leicester, Dept of Breast Surgery, Leicester

Deutsche Gesellschaft für Plastische und Wiederherstellungschirurgie. 49. Jahrestagung der Deutschen Gesellschaft für Plastische und Wiederherstellungschirurgie (DGPW). Ulm, 06.-08.10.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. Doc11dgpw103

DOI: 10.3205/11dgpw103, URN: urn:nbn:de:0183-11dgpw1038

Published: December 7, 2011

© 2011 Von Haeften et al.
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Outline

Text

Introduction of oncoplastic techniques opened new possibilities in surgical management of breast cancer. Combination of radical cancer excision with plastic surgery techniques to enhance cosmetic outcome, became interesting alternative to the standard breast conserving surgery and mastectomy. Various procedures were popularized within last two decades, including: therapeutic mammoplasties (superior and inferior pedicle reduction mammoplasty, lateral mammoplasty, "bat wing" mammoplasty), dermoglandular rotational flaps (Grisotti flap), Benelli round block technique and volume replacement techniques (thoracoepigastric flap, thoracodorsal flap). These procedures are particularly useful, when significant (over 20%) breast volume excision is anticipated. They should be also considered, when postoperative deformity is likely due to cancer location in "high-risk areas" (medial and lower quadrants, close proximity to nipple-areola complex etc.).

Successful outcome of surgery depends on careful preoperative planning, considering both oncological and cosmetic aspects. Use of neoadjuvant chemotherapy and endocrine treatment can also expand indications for breast conservation in selected cases.

Technical details of surgical plan should include:

  • preoperative marking of skin incisions,
  • extent of defect after cancer excision
  • type of repair (i.e. use of local glandular flaps, mammoplasty, replacement techniques etc.),
  • need for nipple-areola complex repositioning
  • anticipated breast shape/size after repair
  • contralateral breast management
  • reconstructive options in case of failure (e.g. incomplete cancer excision, breast deformity)

The choice of surgical approach depends on various factors, including tumour location, size of the breast, extent of parenchymal resection and surgeon's experience in oncoplastic surgery.

The decision as to which procedure to recommend for a patient with breast cancer can be sometimes difficult, especially for sizeable tumours. The risk of local recurrence and tumour biology should be also taken into account, as some patients would benefit from mastectomy and reconstruction, rather than oncoplastic surgery and breast conservation.

Our poster will present various oncoplastic techniques currently available and preoperative planning will be discussed in details.