ABSTRACT

One of the most interesting areas in the surgery of breast cancer is the concept of breast reconstruction after breast conserving surgery. In fact, this is a broad subject which includes proper patient selection for breast conservation, proper planning for breast conservation, and management of complex and difficult situations for breast conservation. As breast conservation has become more widely applied in the treatment of breast cancer, the problems and challenges have become more complex. Perhaps the key to Chapter 10 and to this entire subject is the concept that patient selection, planning, and problem solving in breast conservation should include both an oncological breast surgeon and a plastic breast surgeon. In some environments this may be the same individual, but in many hospitals, in fact, this requires two different people with different perspectives and different expertise. The authors begin by describing what they feel to be the best incisions for breast conserving surgery. Essentially these are lower quadrant radial incisions and upper quadrant circumlinear incisions. They also emphasize the importance of avoiding long incisions, particularly ones above the bra line or extending into the axilla. They also emphasize the importance of a deep glandular repair when large amounts of tissue have been removed. This may require some undermining of the breast off the chest wall in order to mobilize the gland properly.