8 Chapter 1 Breast Cancer Breast cancer is, with a ten-year prevalence of 120.000, the most common type of cancer among women in the Netherlands.1 Approximately 1 in 8 women will develop breast cancer at some point in their life. On average, 87% of the women with breast cancer survive at least 5 years and over 77% survives at least 10 years.2 Because of improvements in early diagnosis and more efficient therapies, breast cancer becomes more a chronic condition than a life-threatening illness.3 The treatment for breast cancer is very personalized and depends on tumor subtype, tumor stage, genomic tests, the presence of known mutations in inherited breast cancer genes and patient characteristics. For treating early-stage and locally advanced breast cancer, the general recommendation is breast surgery to remove the tumor, and (neo-) adjuvant treatment depending on the tumor characteristics, such as radiotherapy, chemotherapy, immunotherapy and/or hormonal therapy.4,5 Breast Cancer Surgery Cosmetic results after breast cancer surgery have become increasingly important, partly because of the current favorable life expectancy after breast cancer treatment. While breast cancer surgery has developed over the years, the goals have remained the same: complete removal of the tumor obtaining negative margins, with the least degree of breast deformity. In breast-conserving surgery, the tumor is removed with a safe cancer-free margin and most of the healthy breast tissue is preserved. An oncoplastic procedure may be necessary to obtain an aesthetically pleasant result. Breast-conserving surgery is mostly followed by adjuvant radiotherapy. The alternative is a mastectomy, in which all breast tissue is removed. The breast mound can be restored with an autologous or implantbased breast reconstruction, or a combination of these two procedures.6 In some cases, adjuvant radiotherapy is necessary following mastectomy to eliminate microscopic disease. Oncoplastic Breast Surgery Oncoplastic breast surgery (OPS), which involves plastic surgery techniques to reconstruct the breast after breast-conserving surgery, has gained popularity over the last decades. It optimizes oncological safety and cosmetic outcomes at the same time, combining wide resection margins with the best principles of plastic reconstructive surgery.6 Therefore, compared to conventional breast-conserving surgery, OPS may be associated with fewer conversions to mastectomy and lower re-excision rates.7 There are two different approaches for OPS, based on the location of the tumor, the volume of the excised tissue and the size and ptosis of the patient’s breast.8 The volume replacement technique fills up the defect after excision of the tumor with tissue adjacent to the breast. The volume displacement technique uses the remaining tissue of the breast to reconstruct the defect. Volume replacement techniques are islanded or pedicled chest wall
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