Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on sleep in brain health

LIVE: Thursday 2nd May 2024, 18:00-19:30 (CEST)

Quality sleep is essential for health. But what happens to our brains when sleep patterns are disturbed? Join our experts to explore the interplay between sleep disruption and neurological diseases, and the questions that you need to be asking your patients to help you prevent the harmful effects of sleep deprivation.
ADVANCED SEARCH
Log in
Top
Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 5/2010

01-05-2010 | Breast Oncology

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

Authors: Krishna B. Clough, MD, Gabriel J. Kaufman, MD, Claude Nos, MD, Ines Buccimazza, MD, Isabelle M. Sarfati, MD

Published in: Annals of Surgical Oncology | Issue 5/2010

Login to get access

Abstract

Background

Oncoplastic surgery (OPS) has emerged as a new approach for extending breast conserving surgery (BCS) possibilities, reducing both mastectomy and re-excision 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 outcomes.
Literature
1.
Clough KB, Soussaline M, Campana F, Salmon RJ. Mammoplasty combined with irradiation: conservative treatment of cancers located in the lower quadrants. Ann Chir Plast Esthet. 1990;35(2):117–22.PubMed
2.
Cothier-Savey I, Otmezguine Y, Calitchi E, et al. Value of reduction mammoplasty in the conservative treatment of breast neoplasm. A propos of 70 cases. Ann Chir Plast Esthet. 1996;41(4):346–53.PubMed
3.
Petit JY, Rietjens M, Garusi C, et al. Integration of plastic surgery in the course of breast-conserving surgery for cancer to improve results and radicality of tumor excision. Recent Results Cancer Res. 1998;152:202–11.PubMed
4.
Spear SL, Pelletiere CV, Wolfe AJ, et al. Experience with reduction mammoplasty combined with breast conservation therapy in the treatment of breast cancer. Plast Reconstr Surg. 2002;111(3):1102–09.CrossRef
5.
Rainsbury R. Surgery insight: oncoplastic breast-conserving reconstruction-indications, benefits, choices and outcomes. Nat Clin Pract Oncol. 2007;4(11):657–64.CrossRefPubMed
6.
Bulstrode NW, Shortri S. Prediction of cosmetic outcome following conservative breast surgery using breast volume measurements. Breast. 2001;10:124–6.CrossRefPubMed
7.
Kaur N, Petit JY, Rietjens M, et al. Comparative study of surgical margins in oncoplastic surgery and quadrantectomy in breast cancer. Ann Surg Oncol. 2005;12(7):539–45.CrossRefPubMed
8.
American College of Radiology. Breast imaging reporting and data systems (BI-RADS), American College of Radiology, Reston, VA; 2003.
9.
McCulley SJ, Macmillan RD. Therapeutic mammaplasty: analysis of 50 consecutive cases. Br J Plast Surg. 2005;58(7):902–7.CrossRefPubMed
10.
Kraissl CJ. The selection of appropriate lines for elective surgical incisions. Plast Reconstr Surg. 1951;8(1):1–28.CrossRef
11.
Schlenz I, Rigel S, Schemper M, Kuzbari R. Alteration of nipple and areola sensitivity by reduction mammaplasty: a prospective comparison of five techniques. Plast Reconstr Surg. 2005;115(3):743–51.CrossRefPubMed
12.
Petit JY, De Lorenzi F, Rietjens M, et al. Technical tricks to improve the cosmetic results of breast-conserving treatment. Breast. 2007;16(1):13–6.CrossRefPubMed
13.
O’Dey D, Prescher A, Pallua N. Vascular reliability of the nipple-areola complex-bearing pedicles: an anatomical microdissection study. Plast Reconstr Surg. 2007;119(4):1167–77.CrossRefPubMed
14.
Smith ML, Evans GR, Gurlek A, et al. Reduction mammaplasty: its role in breast conservation surgery for early-stage breast cancer. Ann Plast Surg. 1998;41(3):234–9.CrossRefPubMed
15.
Clough KB, Nos C, Salmon RJ, et al. Conservative treatment of breast cancers by mammaplasty and irradiation: a new approach to lower quadrant tumors. Plast Reconstr Surg. 1995;96(2):363–70.CrossRefPubMed
16.
Vlajcic Z, Zic R, Stanec S, Stanec Z. Omega and inverted omega incision: a concept of uniform incisions in breast surgery. Ann Plast Surg. 2004;53(1)31–8.CrossRefPubMed
17.
Nos C, Fitoussi A, Bourgeois D, et al. Conservative treatment of lower pole breast cancers by bilateral mammoplasty and radiotherapy. Eur J Surg Oncol. 1998;24(6):508–14.CrossRefPubMed
18.
Clough KB, Lewis J, Couturaud B, et al. Oncoplastic Techniques allow extensive resections for breast-conserving therapy of breast carcinomas. Ann Surg. 2003;237(1):26–34.CrossRefPubMed
19.
Lejour M. Reduction of mammaplasty scars: from a short inframammary scar to a vertical scar. Ann Chir Plast Esthet. 1990;35(5):369–79.PubMed
20.
Lassus C. A 30-year experience with vertical mammaplasty. Plast Reconstr Surg. 1996;97(2):373–80.CrossRefPubMed
21.
Renouvel F, Nos C, Clough KB, Lecuru F. Preliminary outcome of breast cancer located at the lower quadrant treated with a thoracomammary flap. Bull Cancer. 2008;95(7):773–8.PubMed
22.
Clough KB, Kroll S, Audretsch W. An approach to the repair of partial mastectomy defects. Plast Reconstr Surg. 1999;104(2):409–20.CrossRefPubMed
23.
Anderson BO, Masetti R, Silverstein MJ. Oncoplastic approaches to partial mastectomy: an overview of volume-displacement techniques. Lancet Oncol. 2005;6:145–57.CrossRefPubMed
24.
Spear SL, pelletiere CV, Wolfe AJ, et al. Experience with reduction mammoplasty combined with breast conservation therapy in the treatment of cancer. Plast Reconstr Surg. 2003;111(3):1102–9.CrossRefPubMed
25.
Benelli L. A new periareolar mammaplasty: the “round block” technique. Aesthetic Plast Surg. 1990;14(2):93–100.CrossRefPubMed
26.
Hammon DC. Short scar periareolar inferior pedicle reduction (SPAIR) mammoplasty. Plast Reconstr Surg. 1999;103(3):890–901.CrossRef
27.
Veronesi U, Banfi A, Saccozzi R, et al. Conservative treatment of breast cancer. A trial in progress at the cancer institute of Milan. Cancer. 1977;39(6)2822–6.CrossRefPubMed
28.
Veronesi U, Banfi A, del Vechhio M, et al. Comparison of Halsted mastectomy with quadrantectomy, axillary dissection, and radiotherapy in early breast cancer: long term results. Eur J Cancer Clin Oncol. 1986;22:1085–9.CrossRefPubMed
29.
Gasperoni C, Salgarello M, Gasperoni P. A personal technique: mammaplasty with J scar. Ann Plast Surg. 2002;48(2):124–30.CrossRefPubMed
30.
Laronga C, Kemp B, Johnston D, et al. The incidence of occult nipple-areola complex involvement in breast cancer patients receiving a skin-sparing mastectomy. Ann Surg Oncol. 1999;6(6):609–13.CrossRefPubMed
31.
McCulley SJ, Durani P, Macmillan RD. Therapeutic mammaplasty for centrally located breast tumors. Plast Reconstr Surg. 2006;117(2):366–73.CrossRefPubMed
32.
Galimberti V, Zurrida S, Grisotti A, et al. Central small size breast cancer: how to overcome the problem of nipple and areola involvement. Eur J Cancer. 1993;29A(8)1093–6.CrossRefPubMed
33.
Huemer G, Schrenk P, Moser F, et al. Oncoplastic techniques allow breast-conserving treatment in centrally located breast cancers. Plast Reconstr Surg. 2007;120(2):390–8.CrossRefPubMed
34.
Veronesi U, Lunini A, Galimberti V, Zurrida S. Conservation approaches for the management of stage I/II carcinoma of the breast: Milan cancer institute trials. World J Surg. 1994;18(1):70–5.CrossRefPubMed
35.
Mariani L, Salvadori B, Veronesi U, et al. Ten year results of a randomized trial comparing two conservative strategies for small size breast cancer. Eur J Cancer. 1998;149(3):219–25.
36.
Amichetti M, Busana L, Caffo O. Long term cosmetic outcome and toxicity in patients treated with quadrantectomy and radiation therapy for early-stage breast cancer. Oncology. 1995;52:177–81.CrossRefPubMed
37.
Giacalone PL, Roger P, Dubon O, et al. Comparative study of the accuracy of breast reconstruction in Oncoplastic surgery and quadrantectomy in breast cancer. Ann Surg Oncol. 2006;14(2):605–14.CrossRefPubMed
38.
Dewar JA, Benhamou E, Arrigada R, et al. Cosmetic results following lumpectomy, axillary dissection and radiotherapy for small breast cancer. Radiother Oncol. 1998;12(4):273–80.CrossRef
39.
Petit J-Y, Regault L, Zekri A, et al. Poor aesthetic results after conservative treatment of breast cancer. Techniques of partial breast reconstruction. Ann Chir Plast Esthet. 1989;34:103–8.PubMed
40.
Clough KB, Thomas S, Fitoussi A, et al. Reconstruction after conservative treatment for breast cancer. cosmetic sequelae: classification revisited. Plast Reconstr Surg. 2004;114(7):1743–53.CrossRefPubMed
41.
Berrino P, Campora E, Leone S, Santi P. Correction of type II breast deformities following conservative cancer surgery. Plast Reconstr Surg. 1992;90:846–53.CrossRefPubMed
42.
Bostwick J, Paletta C, Hartampf CR. Conservative treatment for breast cancer: complications requiring reconstructive surgery. Ann Surg. 1986;203:481–90.CrossRefPubMed
43.
Schwartz GF, Veronesi U, Clough KB, et al. Proceedings of the consensus conference on breast conservation, April 28 to May 1, 2005, Milan, Italy. Cancer. 2006;107(2):242–50.
44.
Staub G, Fitoussi A, Falcou MC, Salmon RJ. Breast cancer surgery: use of mammaplasty. Results. Series of 298 cases. Ann Chir Plast Esthet. 2007;53(2):124–34.CrossRefPubMed
45.
Rietjens M, Urban CA, Petit JY, et al. Long-term oncologic results of breast conservation treatment with oncoplastic surgery. Breast. 2007;16(4):387–95.CrossRefPubMed
46.
Brown FE, Sargernt SK, Cohen SR, Morain WD. Mammographic changes following reduction mammoplasty. Plast Reconstr Surg. 1987;80(5):691–8.CrossRefPubMed
47.
Munhoz AM, Montag E, Arruda EG, et al. Superior-medial dermoglandular pedicle reduction mammaplasty for immediate conservative breast surgery reconstruction: technical aspects and outcome. Ann Plast Surg. 2006;57(5):502–8.CrossRefPubMed
48.
Kronowitz SJ, Hunt KK, Kuerer HM, et al. Practical guidelines for repair of partial mastectomy defects using the breast reduction technique in patients undergoing breast conservation therapy. Plast Reconstr Surg. 2007;120(7):1755–68.CrossRefPubMed
49.
Losken A, Styblo TM, Carlson GW, et al. Management algorithm and outcome evaluation of partial mastectomy defects treated using reduction or mastopexy techniques. Ann Plast Surg. 2007;59(5):235–42.CrossRefPubMed
50.
Association of Breast Surgery at BASO. Oncoplastic breast-surgery: a guide to good practice. Eur J Surg Oncol. 2007;33(1)S1–23.
51.
Skillman JM, Humzah MD. The future of breast surgery: a new subspecialty of oncoplastic breast surgeons? Breast. 2003;12(3):161–2.CrossRefPubMed
Metadata
Title
Improving Breast Cancer Surgery: A Classification and Quadrant per Quadrant Atlas for Oncoplastic Surgery
Authors
Krishna B. Clough, MD
Gabriel J. Kaufman, MD
Claude Nos, MD
Ines Buccimazza, MD
Isabelle M. Sarfati, MD
Publication date
01-05-2010
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 5/2010
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-009-0792-y

Other articles of this Issue 5/2010

Annals of Surgical Oncology 5/2010 Go to the issue

Pancreatic Tumors

Distal Pancreatectomy Combined with Celiac Axis Resection in Treatment of Carcinoma of the Body/Tail of the Pancreas: A Single-Center Experience

Emerging Therapeutic Approaches to Hepatocellular Carcinoma

Intra-Arterial Therapies for Hepatocellular Carcinoma: Where Do We Stand?

Breast Oncology

Topoisomerase 2 Alpha and the Case for Individualized Breast Cancer Therapy

Gastrointestinal Oncology

Advanced Gastric Cancer with Early Cancer Macroscopic Appearance: Is It Worthy of D2 Lymphadenectomy?

Translational Research and Biomarkers

EMAP II-Based Antiangiogenic-Antiendothelial In Vivo Combination Therapy of Pancreatic Cancer

Colorectal Cancer

Anterior Perineal PlanE for Ultralow Anterior Resection of the Rectum (The APPEAR Technique): A Video Demonstration