Reconstruction

The widespread popularity of breast-conserving surgery coupled with frequency of cosmetic failure has led to the development of new oncoplastic techniques, which can avoid a poor cosmetic outcome. These techniques provide a 'third option' to wide excision or mastectomy in three different ways. Firstly, they extend a very wide excision of breast tissue without risk of major deformity. Secondly, they extend the scope of conservation to patients with larger tumours, avoiding mastectomy without compromising adequate resection. Thirdly, they can be used to avoid mastectomy in patients with local recurrence and correct unacceptable deformities following previous breast-conserving surgery.

When mastectomy is unavoidable, a skin-sparing approach minimises scarring and optimises the cosmetic result without compromising oncological principles or disease control. The breast can be resected and reconstructed through a small central aperture, using the native skin envelope to mimic a breast of life-like shape, size and ptosis. In future, new approaches to preoperative assessment are likely to identify patients who will benefit most from these new oncoplastic procedures. The UK has launched a unique programme for training in all aspects of diagnosis, resection, reconstruction and clinical management. This exciting new development heralds the birth of the oncoplastic breast surgeon.