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