Optimizing Delivery of Breast Conservation Therapy: A Multidisciplinary Approach to Oncoplastic Surgery

Purpose: Breast conservation therapy, when possible, has become the preferred method for the surgical management of breast cancer. Despite preservation of the breast, many women remain dissatisfied with their aesthetic outcome. Thus, a new field, oncoplastic surgery, has been developed to offset many of the aesthetic pitfalls of lumpectomy and radiation alone. Questions remain regarding oncologic safety, potential complications, and patient selection. We report our experience with oncoplastic surgery, patient outcomes, and complication rate.

Methods: An IRB-approved, retrospective chart review was performed including all patients undergoing oncoplastic breast surgery at our institution from March 2003 to September 2009. Mean follow-up period was 38 months. All patients received preoperative breast MRI and were referred for oncoplastic approach by our multidisciplinary breast team.

Results: Forty-five female patients underwent 46 oncoplastic breast reconstructions. Immediate reconstruction was performed in 21 patients, delayed-immediate (within 9 to 73 days of final tumor resection) in 18, and delayed (following completion of radiation) in 6. Three patients (14%) who underwent immediate oncoplastic reconstruction proceeded to mastectomy due to positive pathologic margins. Eight patients and nine breasts in the delayed-immediate group required at least one re-excision for complete tumor resection. No local cancer recurrence was seen. Two patients developed distant metastatic disease. Twelve complications occurred in 11 patients; by group, 2 (10%)--immediate, 7 (39%)--delayed-immediate group, and 2 (33%)--delayed. Immediate oncoplastic reconstruction, performed as a single-stage procedure, was inversely related to the development of complications (p=0.059). No other risk factor was correlated with presence of complications.

Conclusions: Oncoplastic surgery is an emerging field in the treatment of breast cancer and strives for optimal aesthetic breast preservation. Our review suggests this multi-disciplinary approach is safe as there were no local recurrences of breast cancer. Interestingly, women undergoing immediate oncoplastic reconstruction trended towards a lower rate of complications. This may be because the oncoplastic intervention occurred prior to other surgery and/or radiation therapy. Proper patient counseling is required as the benefit of immediate reconstruction must be balanced by the risk of positive tumor margin on permanent pathologic section and the subsequent necessity for completion mastectomy. This risk–benefit balance is best delivered by a multi-disciplinary team focused on all aspects of breast cancer including patients' wishes as well as technical feasibility and oncologic safety.