Breast conservation therapy (BCT) is a popular treatment option for women with breast cancer, and that trend continues to rise.1 This is in part driven by equivalent survival rates and by preservation of body image, quality of life, and reduced psychological morbidity with breast-sparing surgery.2,3 However, there remains an innate conflict between the goals of oncology and cosmesis, with the former being to eliminate all locoregional disease, and the latter relying on preservation of as much breast tissue as possible for optimal aesthetic outcome. The wider the margin of resection, the lower the risk of local recurrence,4,5 and it often becomes a dilemma for the surgeon to meet both these end points. Breast shape becomes compromised and significant contour deformities, breast asymmetry, and poor aesthetic outcomes are not uncommon. Up to 30% of women will have a residual deformity that may require surgical correction,6 the correction of which is often difficult.7
In order to support the complex nature of the ever-expanding criteria for breast conservation, there has been a surge of reconstructive techniques for the partial mastectomy defect prior to breast irradiation, often referred to as the oncoplastic approach. This approach is intended to improve outcomes from both an oncologic as well as a cosmetic standpoint by combining the principles of oncology and plastic surgery.
The 2 main options available include (1) volume displacement techniques using parenchymal remodeling (volume shrinkage) and (2) volume replacement techniques using local or distant tissue (volume preserving). The decision is usually based on tumor characteristics (size and location), breast characteristics (size and shape), and patient desires. Large- or moderate-sized breasts, or ptotic breasts with sufficient parenchyma remaining following resection are amenable to reshaping procedures. When additional tissue (volume and skin) is required to maintain the desired breast size or shape (ie, smaller or nonptotic breasts), volume replacement procedures are required. The focus of this chapter is volume displacement (parenchymal modeling) techniques using local breast tissue.
Breast reshaping procedures all essentially rely on advancement, rotation, or transposition of a large area of breast to fill a small- or moderate-sized defect. This absorbs the volume loss over a larger area. In its simplest form, it entails mobilizing the breast plate from the area immediately around the defect in a breast flap advancement technique as proposed by Anderson et al.8
Other local breast options include dermatoglandular flaps to fill small defects that might otherwise have caused an unfavorable result due to skin or parenchymal deficiency being inadequately reconstructed.
The use of reduction or mastopexy techniques to reconstruct the partial mastectomy defect prior to breast irradiation has recently become more popular, and will be discussed in detail below. This approach initially became popular in Europe for reconstructing quadrantectomy defects in the lower pole.9 In the United States, the popularity likely evolved out of frustration in the management of breast cancer ...