19 Outcomes following oncoplastic breast surgery INTRODUCTION While breast cancer surgery has evolved over the years, the goals have remained the same: complete removal of the tumor acquiring negative margins, with the least degree of breast deformity. The cosmetic results after breast cancer surgery have become increasingly important, partly because of the current favorable life expectancy after breast cancer treatment.1 Therefore, oncoplastic breastconserving surgery (OPS) has rapidly gained popularity over the last decade. It optimizes oncological safety and cosmetic outcomes, combining the best principles of surgical oncology with the possibility of larger resection margins with plastic reconstructive surgery.2 As a result, OPS might be associated with less conversions to mastectomy and lower re-excision rates compared to breast-conserving surgery alone.3 In addition, breast-conserving surgery plus radiotherapy might even result in an improved survival compared to mastectomy in early breast cancer.4 By combining OPS with neoadjuvant chemotherapy, leading to preoperative tumor reduction, more patients are eligible for this technique. This implies that OPS can be a cosmetically acceptable alternative to breastconserving surgery or mastectomy without compromising local oncological safety, even in tumors that are relatively large compared to the breast size.5, 6 OPS can be categorized in two different approaches, based on tumor location and excised volume, in combination with the volume and ptosis of the patient’s breast.7 Volume replacement is a technique using tissue adjacent to the breast, to fill up the gap that is left behind after tumor removal. Volume displacement is a technique that uses the remaining breast tissue to fill up the defect.8 Volume replacement techniques are required in patients with small and non-ptotic breasts. Most suitable techniques are islanded or pedicled chest wall fasciocutaneous perforator flaps like the lateral or anterior intercostal artery perforator flap (LICAP or AICAP)9 or the thoracodorsal artery perforator (TDAP) flap.10 For volume displacement, only possible in patients with some degree of ptosis, the Wise pattern mammoplasty using different nipple areola complex pedicles is the most common approach.11 The objectives of this study were to assess complication rates, patient satisfaction and cosmetic outcomes after OPS, investigate the influence of complications on patient satisfaction and cosmetic outcomes, and compare these results between volume replacement and volume displacement techniques. 2
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