Editing Oncoplastic breast surgery

== Principles ==

* Retain as much of the natural breast size and contour as possible
* Symmetry
* Perform the simplest procedure that gives an acceptable result
* Do not compromise oncologic outcomes
* Only perform techniques within your own skill set
* Aim for all necessary surgery to be completed at one operation

== When to consider oncoplastic techniques ==

* Significant area of the skin is to be resected with the tumour
* Large-volume resection expected
** >5-10% superiorly, medially or inferiorly
** >10-20% laterally
* Area with poor cosmetic outcomes - e.g. lower hemisphere below the nipple
* Resection may lead to nipple malposition
* High risk of a poor outcome with mastectomy and reconstruction:
** Need for radiotherapy
** Obese
** No good or acceptable reconstructive option

== Causes of deformity after BCS ==

* Collapse and contraction of the excision cavity
* Poor scar placement/orientation
* Radiotherapy - induces fibrosis
* High-risk areas - medial and superior
* Very fatty breast tissue (BIRADS 1 and 2) - prone to fat necrosis and scarring, hard to mobilise tissue

== Deformities to avoid ==

* Volumetric deformity from a large parenchymal resection
* Skin-pectoral muscle adherence deformity
* Lower pole deformity with downward turning of the nipple (bird beak deformity) caused by excision of a lower hemisphere tumour
* Correct deformities prior to radiotherapy - accentuates asymmetry, and makes it harder to correct in future

== Classification of oncoplastic techniques ==

* Level I
** Principles
*** Choose the correct incision
*** Accomplish dual plane mobilisation
*** Complete full-thickness excision of the breast
*** Volume displacement
*** Glanduloplasty
** Techniques
*** Skin undermining - facilitates wide excision and glandular mobilisation for reshaping
*** NAC undermining - avoids displacement of NAC towards excision defect
*** De-epithelialisation and NAC repositioning - re-centres NAC
* Level II

== Techniques ==

* Volume 
** Displacement (for larger breasts, where existing tissue can be rearranged)
*** Simple parenchymal advancement into a defect
*** Round block
*** Round block with nipple centralisation (tennis racquet)
*** Therapeutic mastopexy
*** Therapeutic reduction mammoplasty
** Replacement (when there is insufficient volume for displacement techniques - need to bring tissue from elsewhere)
*** Immediate lipofilling
*** Perforator flaps - ICAP, TDAP, LD
*** Free flap
**



[[Category:Breast]]