Arch Plast Surg Search

CLOSE


Arch Plast Surg > Volume 43(2); 2016 > Article
Carmichael and Mokbel: Evolving Trends in Breast Surgery: Oncoplastic to Onco-Aesthetic Surgery
The term oncoplastic surgery was first coined by Gabka and Bohmert [1], reflecting a recognition that the cosmetic outcome of breast surgery is an important part of patient outcomes. With the publication of practice guidelines, the principles of oncoplastic surgery were embedded in the management of breast cancer [[0-9]+,[0-9]+,[0-9]+,[0-9]+,6]. The evidence that poor aesthetic outcomes after breast surgery adversely impacted the quality of life led surgeons to seek out and refine surgical techniques that would preserve the size, volume, shape, and cosmetic appearance of breasts treated for breast cancer [7]. This led to the evolution of surgical procedures that utilize fibroglandular flap advancement to fill the surgical defect left after the excision of the breast, and therapeutic mammoplasty to excise large tumours or tumours located at cosmetically unforgiving sites on the breast such as the lower and medial quadrants of the breast [[0-9]+,9]. Various techniques have been described for reconstructing large-volume breast excisions [[0-9]+,[0-9]+,12]. Increased awareness regarding the availability of these techniques has led women of today to be well informed and to expect an aesthetically acceptable breast form after the conservative treatment of breast cancer.
Advancements in reconstruction techniques after mastectomy using latissimus dorsi flaps, transverse rectus abdominus muscle flaps, and deep inferior epigastric perforator flaps, as well as improvements in implant-based reconstruction, contributed to an increase in the demand for and uptake of post-mastectomy reconstruction; moreover, the safety of nipple sparing mastectomy has been demonstrated in large-scale cohort studies [[0-9]+,14]. The evidence that post-mastectomy radiotherapy can contribute to patient survival compelled breast surgeons to revise the reconstruction options offered to women after mastectomy. Delayed reconstruction with autologous flaps or two-staged reconstruction deploying a tissue expander during radiotherapy, followed by a fixed-volume implant or autologous flap reconstruction, became the reconstruction of choice for patients who were likely to need chest wall radiotherapy after mastectomy [14].
The literature regarding potential comorbidities associated with silicone-based breast implants led to declining patient acceptance of silicone-based implants. After safety statements by the Food and Drug Administration, the uptake of silicone-based resumed in North America, and silicone and saline-based implants are more commonly used implants [15]. The advent of acellular dermal matrix (ADM) dramatically increased the number of options and techniques available for breast reconstruction, and the increasing use of ADM diminished the surgical challenge of donor site morbidity, enhancing patient acceptance. Guidelines for the optimal use of ADM are still evolving and are the focus of intense research and training [16]. Advancements in liposuction techniques that yield a high success rate after autologous fat transplant have led to the development of lipo-modelling techniques as an adjunct in restoring cosmetic defects after breast-conserving surgery and enhancing the cosmetic appearance of a reconstructed breast [[0-9]+,[0-9]+,19].
Oncoplastic breast surgery has come of age: the technical skills of surgeons have advanced, the technology of reconstructive mechanical adjuncts has improved, and a better scientific understanding of restorative and reconstructive breast surgery has been achieved. The new frontiers of aesthetic enhancement after breast cancer surgery in terms of restoring normal anatomical appearance and symmetry have been reached by breast surgeons. Indeed, most modern oncoplastic-trained surgeons are able and willing to undertake surgery on the contralateral side to enhance the aesthetics and cosmetic appearance of the breast treated for cancer. One could perhaps argue that surgical treatment that involves the techniques of flap formation, reconstruction with pedicled grafts, liposuction, lipo-modelling, and the use of ADM now deserves to be called onco-aesthetic surgery, which is a significant and rewarding step forward from oncoplastic surgery!

CONFLICTS OF INTEREST

No potential conflict of interest relevant to this article was reported.

References

1. Gabka CJ, Bohmert H. Future prospects for reconstructive surgery in breast cancer. Semin Surg Oncol 1996;12:67–75. PMID: 8821412.
crossref pmid
2. National Mastectomy and Breast Reconstruction Audit 2011 [Internet]. Leeds: NHS Information Centre; 2011.cited 2015 Oct 12. Available from: http://www.hscic.gov.uk/catalogue/PUB02731/clin-audi-supp-prog-mast-brea-reco-2011-rep1.pdf.

3. Association of Breast Surgery at BASO1. Association of Breast Surgery at BAPRAS. Training Interface Group in Breast Surgery. . Oncoplastic breast surgery: a guide to good practice. Eur J Surg Oncol 2007;33(Suppl 1):S1–S23.

4. Oncoplastic breast reconstruction: guidelines for best practice [Internet]. London: ABS; BAPRAS; 2012.cited 2015 Oct 12. Available from: http://www.associationofbreastsurgery.org.uk/media/23851/final_oncoplastic_guidelines_for_use.pdf.

5. Association of Breast Surgery at Baso 2009. Surgical guidelines for the management of breast cancer. Eur J Surg Oncol 2009;35(Suppl 1):1–22.
crossref
6. Cutress RI, Summerhayes C, Rainsbury R. Guidelines for oncoplastic breast reconstruction. Ann R Coll Surg Engl 2013;95:161–162. PMID: 23827284.
crossref pmid pmc
7. Baildam AD. Oncoplastic surgery of the breast. Br J Surg 2002;89:532–533. PMID: 11972541.
crossref pmid
8. Clough KB, Ihrai T, Oden S, et al. Oncoplastic surgery for breast cancer based on tumour location and a quadrant-per-quadrant atlas. Br J Surg 2012;99:1389–1395. PMID: 22961518.
crossref pmid
9. Anderson BO, Masetti R, Silverstein MJ. Oncoplastic approaches to partial mastectomy: an overview of volume-displacement techniques. Lancet Oncol 2005;6:145–157. PMID: 15737831.
crossref pmid
10. Losken A, Pinell-White X, Hart AM, et al. The oncoplastic reduction approach to breast conservation therapy: benefits for margin control. Aesthet Surg J 2014;34:1185–1191. PMID: 25121787.
crossref pmid
11. Losken A, Dugal CS, Styblo TM, et al. A meta-analysis comparing breast conservation therapy alone to the oncoplastic technique. Ann Plast Surg 2014;72:145–149. PMID: 23503430.
crossref pmid
12. Rietjens M, Urban CA, Rey PC, et al. Long-term oncological results of breast conservative treatment with oncoplastic surgery. Breast 2007;16:387–395. PMID: 17376687.
crossref pmid
13. Endara M, Chen D, Verma K, et al. Breast reconstruction following nipple-sparing mastectomy: a systematic review of the literature with pooled analysis. Plast Reconstr Surg 2013;132:1043–1054. PMID: 23924650.
crossref pmid
14. Patani N, Devalia H, Anderson A, et al. Oncological safety and patient satisfaction with skin-sparing mastectomy and immediate breast reconstruction. Surg Oncol 2008;17:97–105. PMID: 18093828.
crossref pmid
15. Berbers J, van Baardwijk A, Houben R, et al. 'Reconstruction: before or after postmastectomy radiotherapy?' A systematic review of the literature. Eur J Cancer 2014;50:2752–2762. PMID: 25168640.
crossref pmid
16. Krishnan NM, Chatterjee A, Van Vliet MM, et al. A comparison of acellular dermal matrix to autologous dermal flaps in single-stage, implant-based immediate breast reconstruction: a cost-effectiveness analysis. Plast Reconstr Surg 2013;131:953–961. PMID: 23629077.
crossref pmid
17. Wazir U, Kasem A, Mokbel K. The clinical implications of poly implant prothese breast implants: an overview. Arch Plast Surg 2015;42:4–10. PMID: 25606483.
crossref pmid pmc
18. Petit JY, Maisonneuve P, Rotmensz N, et al. Safety of lipofilling in patients with breast cancer. Clin Plast Surg 2015;42:339–344. PMID: 26116939.
crossref pmid
19. Kasem A, Wazir U, Headon H, et al. Breast lipofilling: a review of current practice. Arch Plast Surg 2015;42:126–130. PMID: 25798382.
crossref pmid pmc
TOOLS
Share :
Facebook Twitter Linked In Google+ Line it
METRICS Graph View
  • 3 Crossref
  • 2 Scopus
  • 2,217 View
  • 60 Download

Response to Letter: Evolving Trends in Breast Surgery: Oncoplastic to Onco-Aesthetic Surgery2017 January;44(1)

Oncoplastic to Onco-Aesthetic Surgery: A Movement toward Overtreatment?2017 January;44(1)



ABOUT
ARTICLE CATEGORY

Browse all articles >

BROWSE ARTICLES
AUTHOR INFORMATION
Editorial Office
101-2003, Lotte Castle President, 109, Mapodaero, Mapo-gu, Seoul 04146, Korea
Tel: +82-2-3472-8252    Fax: +82-2-3472-4254    E-mail: apsedit@gmail.com                

Copyright © 2019 by Korean Society of Plastic and Reconstructive Surgeons. All rights reserved.

Developed in M2community

Close layer
prev next