Oncoplastic surgery for breast cancer: an alternative to mastectomy?.
Authors: P Rouanet, M Chateau, A Mourregot, M Gutowski, P Colombo
Journal: Cancer Research (2009)

Abstract Abstract #5154 Background:&amp;#x2028; The phrase “Oncoplastic breast surgery” originated with the concept of avoiding mastectomy by means of wide tumour excision coupled with breast reconstruction. Oncoplastic procedures (OP) have been standardised in our institution. The surgical technique was defined according to the quadrant and the breast consistence of the patient, the pathological conditioning associated specimen orientation and inked breast margins.&amp;#x2028; Material and methods:&amp;#x2028; Each woman with a potentially large partial breast removal and a consequent risk of mastectomy has an OP proposed. Pre operative explanations underlined the oncological problem, the technical procedure, the post operative potential morbidity, the necessity to obtain definitive pathologic reports, the timing of controlateral surgery for symmetrization. An independent phone questionnaire was made in order to evaluate the main disorders felt by the patients, the quality of pre operative explanations and the cosmetic and psychological impact.&amp;#x2028; 133 women were operated between 2001 and 2007, the mean age was 51, the mean Bra size 95, the initial TNM staging noticed 40% T0 – 17% T1 – 30% T2 – 13% T3. 40% of tumors were pure DCIS, 40% of patients have had preoperative chemotherapy.&amp;#x2028; Results:&amp;#x2028; The operative technique was an OP alone in 54%. For the external quadrants, we performed mainly a Durfourmentel technique (54%), for the upper quadrants the batwing procedure (10%) and for the inferior quadrants a classic mammoplastic surgery (36%). The mean weight of the specimen was 166 g (20-530), the mean operative time 84' for unilateral surgery, 130' for bilateral, the mean hospital stay 3.8 d. 20% of patients needed a second surgery, twice for post operative morbidity, 25 times for R1 resection. In these cases, 14 second mastectomies were performed, 6 tumorectomies and 2 second OP.&amp;#x2028; The mean diameter of the tumor evaluated on pathology reports was 24.6 mm; the rate of positive margins was 21% for DCIS removal and 28% after neoadjuvant setting. With 33 months FU, we noticed 2 deaths due to the cancer, 5 local recurrences and 12 patients treated for metastases.&amp;#x2028; The independent phone questionnaire revealed a favourable cosmetic result in 70%, bad in 13%. 36% of women wished a second time plastic surgery but relinquished. 48% evaluated the preoperative explanation unsatisfactory. The main reproaches voiced by the patients were the risk of second step surgery according to the final pathological reports and the length of the scars. 75% of women were not afraid to conserve their breast but all were satisfied. 60% were worried due to the follow-up but 83% think that the mastectomy is not less frightening. 17% hesitated to have the same surgical approach.&amp;#x2028; Conclusion&amp;#x2028; OP procedure is a safe alternative to mastectomy in selected cases with acceptable morbidity and good cosmetic results. Pre operative explanations are essential. Since April 2007, we have initiated a prospective multicentric trial in order to evaluate the free margin rate according to the indication and the quality of life of these women. Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 5154.