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The management of breast disease requires an in-depth knowledge of not only surgery, but also breast imaging, pathology, reconstructive surgery, radiation oncology and medical oncology. Breast reconstruction is becoming increasingly important due to changes in patient expectations and demand. Nowadays mastectomy is not the surgery of choice in the vast majority of breast cancer patients. It can be said the “mastectomy era” is going to be finished.

Breast-conserving therapy (BCT), consisting of lumpectomy followed by radiotherapy, has become the standard treatment for invasive breast carcinomas and is increasingly being used for ductal carcinoma in situ. However, with traditional techniques of BCT introduced by Dr Verronesi and Dr Fisher, for large tumors, there can be difficulty in obtaining clear excision margins, and the cosmetic outcome is often poor. The tumor size in relation to the breast size is one of the most important factors when attempting to obtain a cosmetically favorable result. But there remain still a conflict, therefore, between performing a resection wide enough to obtain optimal oncologic control and not removing so much breast tissue as to leave a deformed breast or a large discrepancy compared with the other side. One way of resolving this conflict is to use plastic surgery techniques such as remodeling mammaplasty to reshape the breast immediately following lumpectomy.

Oncoplastic Breast Surgery (OBS): The novel approaches, called as “oncoplastic surgery” (W. Audretsch), has rapidly gained acceptance in Europe and is now widely practiced in some dedicated breast units. There is growing recognition that immediate reconstruction in appropriately selected women can combine an oncologic and aesthetic procedure in one operation with excellent results. Because most breast surgeries are performed by general surgeons, most reconstructions were performed as delayed procedures by plastic surgeons. Increasingly, breast surgery is being performed by breast surgeons trained in oncoplastic techniques who can offer immediate reconstruction with both therapeutic and economic benefits. On the other hand poor planning in breast-conserving surgery can result in unacceptable deformity. Thought must be given to the likely cosmetic result and the impact and timing of additional treatment. Plastic surgery techniques can be used to remodel the conserved breast and surgery to the opposite breast can be anticipated to achieve better symmetry. Sometimes when a remodeling mammaplasty is performed, because of the volume excised, contra-lateral symmetrization is indicated to reach symmetry. The use of implants to correct volume deficiency can lead to bad results. It should be taken into account that Oncoplastic surgical operations are often long and frequently complex. So like every other sophisticated surgical procedure, careful patient selection (which factors in both co-morbidity and patient expectation) is the key to success.

 

To sum up, OBS combines removal of the cancerous tumor with breast reshaping in one surgical procedure with benefits that include improved cosmetic outcome and reduced risk of complications. Oncoplastic techniques extend the scope for breast conserving surgery by combining an extensive local excision of the breast parenchyma with a simultaneous reconstruction of the defect to avoid local deformity. Dr Kaviani who is working in surgery department of Tehran University of Medical Sciences has pioneered this treatment option in the Islamic Republic of Iran.


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