ジャーナル形成外科と美容学

Update on Oncoplastic Breast Surgery

Mohammad Ahmad Yousef Abd El-Rahim

Breast Surgery is now a recognized subspecialty of General Surgery with structured training for designated Breast Surgeons. Over the past few years, breast cancer care has been enhanced by the emergence of breast surgeon specialist with Oncoplastic Surgical Skills training – called as the Oncoplastic Breast Surgeon.
The term oncoplasty surgery refers to surgery based on oncological principles during which plastic surgery techniques are used, mainly for reconstructive and cosmetic reasons.The advantage of oncoplastic surgery for breast cancer is the possibility of performing a wider excision of the tumor with a good cosmetic result. Oncoplastic surgery combines the latest techniques in plastic surgery with oncology of the breast surgery. When a large lumpectomy is required that will distort the breast, the remaining tissue is sculpted to realign the nipple and areola and restore the breast to a natural appearance. Also the opposite breast is changed to create symmetry.
Randomized controlled trials (RCTs) over the past two decades have now established that radical mastectomy and breast conserving surgery are equivalent in terms of survival provided local recurrence rates after breast conservation surgery are kept at about 1 % per annum.
A careful evaluation of mammographic, ultrasound and sometimes MRI extent of the disease, its nearness to the nipple and the distribution of the cancer in either radial or circumferential manner are all essential to the planning and the eventual success of the oncoplastic procedures.
The criteria for breast conserving surgery are relative. Contrary to the traditional teaching, breast conserving surgery is feasible every time it is judged possible to achieve complete surgical excision with good cosmesis. The size of the tumour relative to the breast volume is the deciding factor in determining the suitability of breast conserving surgery.