Improving Breast Cancer Surgery: A Classification and Quadrant per Quadrant Atlas for Oncoplastic Surgery


Background. Oncoplastic surgery (OPS) has emerged as a

new approach for extending breast conserving surgery

(BCS) possibilities, reducing both mastectomy and reexcision

rates, while avoiding breast deformities. OPS is

based upon the integration of plastic surgery techniques for

immediate reshaping after wide excision for breast cancer.

A simple guide for choosing the appropriate OPS procedure

is not available.

Objective. To develop an Atlas and guideline for oncoplastic

surgery (OPS) to help in patient selection and

choice of optimal surgical procedure for breast cancer

patients undergoing BCS.

Methods. We stratify OPS into two levels based on

excision volume and the complexity of the reshaping

technique. For resections less than 20% of the breast volume

(level I OPS), a step-by-step approach allows easy

reshaping of the breast. For larger resections (level II OPS),

a mammoplasty technique is required.

Results. We identified three elements that can be used for

patient selection and for determination of the appropriate

OPS technique: excision volume, tumor location, and

glandular density. For level II techniques, we defined a

quadrant per quadrant Atlas that offers a different mammoplasty

for each quadrant of the breast.

Conclusions. OPS is the ‘‘third pathway’’ between standard

BCS and mastectomy. The OPS classification and

Atlas improves patient selection and allows a uniform

approach for surgeons. It proposes a specific solution for

different scenarios and helps improve breast conservation


Article by
Albany General Surgeon