ABSTRACT

Reduction of the psychological distress accompanying breast cancer treatment is a primary aim in development of methods of breast conservation surgery and breast reconstruction post-mastectomy. Results of conservation surgery may deteriorate with time and a joint approach by plastic and oncological surgeons improves the longer-term cosmetic

results of conservation treatment for breast cancer. The criteria for breast preserving surgery are relative, and although initially confined to patients with smaller tumours (<3 cm), conservation surgery may be suitable for women with larger breasts in whom (i) tumours are up to 4 or 5 cm in diameter, (ii) multifocal tumours are confined to the same quadrant and (iii) large operable tumours have been downstaged by neoadjuvant chemotherapy.1-4 The size of the tumour relative to the breast volume is a

critical factor in determining feasibility of conservation surgery and ensuring an optimal cosmetic result. Close collaboration between oncological and plastic surgical teams may in some circumstances broaden the opportunities for successful conservation surgery. Large deficits of glandular tissue can be compensated for by using techniques such as local transposition of glandular tissue or myocutaneous flaps and symmetry can often be improved by a contralateral reduction mammoplasty. Moreover, the use of plastic surgical techniques not only improves the final cosmetic result, but also permits the cancer surgeon to remove the tumour with a greater volume of surrounding normal breast tissue, thus increasing the chance of microscopic clearance with tumour-free margins and improved local control rates.