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Overview of Oncoplastic Breast Surgery Techniques for the Treatment of Breast Cancer with Review of Normal and Abnormal Postsurgical Imaging Findings

  • BREAST IMAGING (H OJEDA-FOURNIER, SECTION EDITOR)
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Abstract

Purpose of Review

This review aims to provide an overview of the role of oncoplastic breast surgery (OBS) in the current treatment of breast cancer, discuss common OBS techniques and review their postoperative imaging appearances.

Recent Findings

Oncoplastic breast surgery is an evolving set of techniques combining oncologic and plastic surgeries; it aims to effectively treat breast cancer while maintaining breast aesthetics. OBS techniques are used in both breast conservation surgery (BCS) and mastectomy. Factors that surgeons consider when choosing a technique include tumor size, location, and breast volume. The goal of OBS in breast conservation is to allow for wider tumor resection without compromising aesthetics. The goal of OBS with mastectomy is volume replacement with preserved cosmesis through breast reconstruction. Prosthetic and/or autologous reconstruction can be performed, and both skin-sparing and nipple-sparing techniques can be utilized. OBS has been found to be oncologically safe and has many benefits compared to traditional surgery; these benefits include a lower rate of positive margins with BCS through the creation of a wider resection, decreased surgical complications, and improved appearance. A main disadvantage is a more difficult re-excision in the occurrence of post-operative positive margins. Postsurgical complications include fat necrosis, fluid collections, and infection.

Summary

As OBS gains popularity, the objective of this article is to provide the radiologist with a synopsis of common OBS techniques and to provide a pictorial review of the common imaging findings that may be encountered after OBS.

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References

• Of importance •• Of major importance

  1. Cotlar AM, Dubose JJ, Rose DM. History of surgery for breast cancer: radical to the sublime. Curr Surg. 2003;60:329–37. https://doi.org/10.1016/s0149-7944(02)00777-8.

    Article  PubMed  Google Scholar 

  2. Hoover S, Bloom E, Patel S. Review of breast conservation therapy: then and now. ISRN Oncol. 2011;2011:1–13. https://doi.org/10.5402/2011/617593.

    Article  Google Scholar 

  3. Fisher B, Anderson S, Bryant J, Margolese RG, Deutsch M, Fisher ER, Jeong J-H, Wolmark N. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med. 2002;347:1233–41. https://doi.org/10.1056/nejmoa022152.

    Article  PubMed  Google Scholar 

  4. Vinh-Hung V, Verschraegen C. Breast-conserving surgery with or without radiotherapy: pooled-analysis for risks of ipsilateral breast tumor recurrence and mortality. JNCI J Natl Cancer Inst. 2004;96:115–21. https://doi.org/10.1093/jnci/djh013.

    Article  PubMed  Google Scholar 

  5. Tang L, Matsushita H, Jingu K. Controversial issues in radiotherapy after breast-conserving surgery for early breast cancer in older patients: a systematic review. J Radiat Res. 2018;59:789–93. https://doi.org/10.1093/jrr/rry071.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Fine N, O’Shaughnessy K. Latissimus Dorsi flap repair of the partial mastectomy defect. Oncoplast Surg Breast. 2009. https://doi.org/10.1016/b978-0-7020-3181-6.00013-6.

    Article  Google Scholar 

  7. Kaviani A, Sodagari N, Sheikhbahaei S, Eslami V, Hafezi-Nejad N, Safavi A, Noparast M, Fitoussi A. From radical mastectomy to breast-conserving therapy and Oncoplastic Breast Surgery: a narrative review comparing oncological result, cosmetic outcome, quality of life, and Health Economy. ISRN Oncol. 2013;2013:1–6. https://doi.org/10.1155/2013/742462.

    Article  Google Scholar 

  8. Qiu H, Xu W-H, Kong J, Ding X-J, Chen D-F. Effect of breast-conserving surgery and modified radical mastectomy on operation index, Symptom Checklist-90 score and prognosis in patients with early breast cancer. Medicine. 2020. https://doi.org/10.1097/md.0000000000019279.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Puls TJ, Fisher CS, Cox A, et al. Regenerative tissue filler for breast conserving surgery and other soft tissue restoration and reconstruction needs. Sci Rep. 2021;11:2711. https://doi.org/10.1038/s41598-021-81771-x.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Urban C, Lima R, Schunemann E, Spautz C, Rabinovich I, Anselmi K. Oncoplastic principles in breast conserving surgery. Breast. 2011. https://doi.org/10.1016/s0960-9776(11)70302-2.

    Article  PubMed  Google Scholar 

  11. •Corradini S, Reitz D, Pazos M, et al. Mastectomy or breast-conserving therapy for early breast cancer in real-life clinical practice: outcome comparison of 7565 cases. Cancers. 2019;11:160. https://doi.org/10.3390/cancers11020160. Helpful article to understand the efficacy of BCS vs. Mastectomy.

    Article  CAS  PubMed Central  Google Scholar 

  12. •de Boniface J, Szulkin R, Johansson AL. Survival after breast conservation vs Mastectomy adjusted for comorbidity and socioeconomic status. JAMA Surg. 2021;156:628. https://doi.org/10.1001/jamasurg.2021.1438Helpful article to understand the efficacy of BCS vs. Mastectomy.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Gerber B. Mastectomy - current challenges and questions. Breast Care. 2017;12:366–7. https://doi.org/10.1159/000485887.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Onitilo AA, Engel JM, Stankowski RV, Doi SA. Survival comparisons for breast conserving surgery and Mastectomy revisited: community experience and the role of radiation therapy. Clin Med Res. 2014;13:65–73. https://doi.org/10.3121/cmr.2014.1245.

    Article  PubMed  Google Scholar 

  15. Chen J-Y, Huang Y-J, Zhang L-L, Yang C-Q, Wang K. Comparison of oncoplastic breast-conserving surgery and breast-conserving surgery alone: a meta-analysis. J Breast Cancer. 2018;21:321. https://doi.org/10.4048/jbc.2018.21.e36.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Shaitelman S, Jeruss J, Pusic A. Oncoplastic surgery in the management of breast cancer. J Clin Oncol. 2020;38(20):2246–53. https://doi.org/10.1200/JCO.19.02795.

    Article  PubMed  Google Scholar 

  17. Galimberti V, Morigi C, Bagnardi V, Corso G, Vicini E, Fontana SKR, Naninato P, Ratini S, Magnoni F, Toesca A, Kouloura A, Rietjens M, De Lorenzi F, Vingiani A, Veronesi P. Oncological outcomes of nipple-sparing mastectomy: a single-center experience of 1989 patients. Ann Surg Oncol. 2018;25(13):3849–57. https://doi.org/10.1245/s10434-018-6759-0.

    Article  PubMed  Google Scholar 

  18. •Colwell AS, Taylor EM. Recent advances in implant-based breast reconstruction. Plast Reconstr Surg. 2020. https://doi.org/10.1097/prs.0000000000006510. Good guide for understanding indications for implant-based breast reconstruction, SSM vs. NSM and role of ADM.

    Article  PubMed  Google Scholar 

  19. Clough KB, Kaufman GJ, Nos C, Buccimazza I, Sarfati IM. Improving breast cancer surgery: a classification and quadrant per quadrant atlas for oncoplastic surgery. Ann Surg Oncol. 2010;17:1375–91. https://doi.org/10.1245/s10434-009-0792-y.

    Article  PubMed  Google Scholar 

  20. ••Kaufman CS. Increasing role of oncoplastic surgery for breast cancer. Curr Oncol Rep. 2019. https://doi.org/10.1007/s11912-019-0860-9. Good overview of what encompasses OBS.

    Article  PubMed  PubMed Central  Google Scholar 

  21. ••Bertozzi N, Pesce M, Santi PL, Raposio E. Oncoplastic breast surgery: comprehensive review. Eur Rev Med Pharmacol Sci. 2017;21(11):2572–85. Helpful review of OBS with in-depth discussion of volume displacement and replacement techniques

    CAS  PubMed  Google Scholar 

  22. Pinel-Giroux FM, El Khoury MM, Trop I, Bernier C, David J, Lalonde L. Breast reconstruction: Review of surgical methods and spectrum of imaging findings. Radiographics. 2013;33:435–53. https://doi.org/10.1148/rg.332125108.

    Article  PubMed  Google Scholar 

  23. Hurley CM, McArdle A, Joyce KM, O’Broin E. Skin-sparing mastectomy with immediate nipple reconstruction during autologous latissimus Dorsi Breast Reconstruction: a review of patient satisfaction. Arch Plast Surg. 2018;45:534–41. https://doi.org/10.5999/aps.2017.01725.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Toth BA, Lappert P. Modified skin incisions for mastectomy. Plast Reconstr Surg. 1991;87:1048–53. https://doi.org/10.1097/00006534-199106000-00006.

    Article  CAS  PubMed  Google Scholar 

  25. Lambert K, Mokbel K. Skin-sparing mastectomy: an update for clinical practice. Surg Sci. 2013;04:53–64. https://doi.org/10.4236/ss.2013.41010.

    Article  Google Scholar 

  26. Tremp M, di Summa P, Schaakxs D, Oranges C, Wettstein R, Kalbermatten D. Nipple reconstruction after autologous or expander breast reconstruction: a multimodal and 3-dimensional analysis. Aesthetic Surg J. 2017;37(2):179–87. https://doi.org/10.1093/asj/sjw181.

    Article  Google Scholar 

  27. ••Krisnan RN, Chotai N. Imaging spectrum of augmented breast and post-mastectomy reconstructed breast with common complications: a pictorial essay. Korean J Radiol. 2021. https://doi.org/10.3348/kjr.2020.0779. Comprehensive overview of postsurgical breast complications on imaging.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Loch-Wilkinson A, Beath KJ, Knight RJ, et al. Breast implant–associated anaplastic large cell lymphoma in Australia and New Zealand. Plast Reconstr Surg. 2017;140:645–54. https://doi.org/10.1097/prs.0000000000003654.

    Article  CAS  PubMed  Google Scholar 

  29. •Collett DJ, Rakhorst H, Lennox P, Magnusson M, Cooter R, Deva AK. Current risk estimate of breast implant–associated anaplastic large cell lymphoma in textured breast implants. Plast Reconstr Surg. 2019. https://doi.org/10.1097/prs.0000000000005567. Comprehensive recent overview of BIA-ALCL including risk factors and presentation.

    Article  PubMed  Google Scholar 

  30. Biggs TM, Yarish RS. Augmentation mammaplasty. Plast Reconstr Surg. 1990;85:368–72. https://doi.org/10.1097/00006534-199003000-00005.

    Article  CAS  PubMed  Google Scholar 

  31. Ter Louw RP, Nahabedian MY. Prepectoral breast reconstruction. Plast Reconstr Surg. 2017. https://doi.org/10.1097/prs.0000000000003942.

    Article  PubMed  Google Scholar 

  32. Srinivasa DR, Garvey PB, Qi J, Hamill JB, Kim HM, Pusic AL, Kronowitz SJ, Wilkins EG, Butler CE, Clemens MW. Direct-to-implant versus two-stage tissue expander/implant reconstruction. Plast Reconstr Surg. 2017;140:869–77. https://doi.org/10.1097/prs.0000000000003748.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Boudreau C, Boehm KS, MacDonald A, Williams J. Single-stage latissimus dorsi breast reconstruction using spectrum devices: Outcomes and technique. Plast Reconst Surg. 2021. https://doi.org/10.1097/gox.0000000000003282.

    Article  PubMed  Google Scholar 

  34. Kasem A, Choy C, Mokbel K. Skin-sparing mastectomy and breast reconstruction: an update for clinical practice. J Cancer Ther. 2014;05:264–80. https://doi.org/10.4236/jct.2014.53034.

    Article  Google Scholar 

  35. Sood R, Easow JM, Konopka G, Panthaki ZJ. Latissimus Dorsi flap in breast reconstruction. Cancer Control. 2018;25:107327481774463. https://doi.org/10.1177/1073274817744638.

    Article  Google Scholar 

  36. •Margolis NE, Morley C, Lotfi P, Shaylor SD, Palestrant S, Moy L, Melsaether AN. Update on imaging of the postsurgical breast. Radiographics. 2014;34:642–60. https://doi.org/10.1148/rg.343135059. Not a recent article but extremely important for understanding imaging findings in the postsurgical breast.

    Article  PubMed  Google Scholar 

  37. •Simonacci F, Bertozzi N, Grieco MP, Grignaffini E, Raposio E. Autologous fat transplantation for breast reconstruction: a literature review. Ann Med Surg. 2016;12:94–100. https://doi.org/10.1016/j.amsu.2016.11.012. Helpful article to understand fat grafting.

    Article  Google Scholar 

  38. Nahabedian MY. Acellular dermal matrices in primary breast reconstruction. Plast Reconstr Surg. 2012. https://doi.org/10.1097/prs.0b013e31825f2215.

    Article  PubMed  Google Scholar 

  39. Dialani V, Lai KC, Slanetz PJ. MR imaging of the reconstructed breast: what the radiologist needs to know. Insights Imaging. 2012;3(3):201–13. https://doi.org/10.1007/s13244-012-0150-7.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Franceschini G, Visconti G, Terribile D, Fabbri C, Magno S, Di Leone A, Salgarello M, Masetti R. The role of oxidized regenerate cellulose to prevent cosmetic defects in oncoplastic breast surgery. Eur Rev Med Pharmacol Sci. 2012;16(7):966–71.

    CAS  PubMed  Google Scholar 

  41. Rassu PC, Serventi A, Giaminardi E, Ferrero I, Tava P. Use of oxidized and regenerated cellulose polymer in oncoplastic breast surgery. Ann Ital Chir. 2013;84:1.

    Google Scholar 

  42. Lee J, Yang JD, Lee JW, Li J, Jung JH, Kim WW, Park CS, Lee JS, Park HY. Acellular dermal matrix combined with oxidized regenerated cellulose for partial breast reconstruction. Medicine. 2020. https://doi.org/10.1097/md.0000000000021217.

    Article  PubMed  PubMed Central  Google Scholar 

  43. J-ichi S, Fukuma E, Wadamori K, Higa K, Sakamoto N, Tsunoda Y. Volume replacement with polyglycolic acid mesh for correcting breast deformity after endoscopic conservative surgery. Clin Breast Cancer. 2005;6:175. https://doi.org/10.1016/s1526-8209(11)70718-2.

    Article  Google Scholar 

  44. •Schwartz J-CD. Use of a bioabsorbable implant-acellular dermal matrix construct to facilitate oncoplastic breast-conserving surgery. Plast Reconst Surg Glob Open. 2021. https://doi.org/10.1097/gox.0000000000003356. Helpful article for reviewing the use of ADM.

    Article  Google Scholar 

  45. Harms S, Lebovic G, Kaufman CS, Cross M. Mammographic imaging after partial breast reconstruction: impact of a bioabsorbable breast implant. J Clin Oncol. 2015;33:111–111. https://doi.org/10.1200/jco.2015.33.28_suppl.111.

    Article  Google Scholar 

  46. LePage MA, Kazerooni EA, Helvie MA, Wilkins EG. Breast reconstruction with TRAM flaps: normal and abnormal appearances at CT. Radiographics. 1999;19(6):1593–603. https://doi.org/10.1148/radiographics.19.6.g99no111593.

    Article  CAS  PubMed  Google Scholar 

  47. Upadhyaya VS, Uppoor R, Shetty L. Mammographic and sonographic features of fat necrosis of the breast. Indian J Radiol Imaging. 2013;23(04):366–72. https://doi.org/10.4103/0971-3026.125619.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Hines N, Slanetz PJ, Eisenberg RL. Cystic masses of the breast. Am J Roentgenol. 2010. https://doi.org/10.2214/ajr.09.3688.

    Article  Google Scholar 

  49. Juanpere S, Perez E, Huc O, Motos N, Pont J, Pedraza S. Imaging of breast implants—a pictorial review. Insights Imaging. 2011;2:653–70. https://doi.org/10.1007/s13244-011-0122-3.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Adrada BE, Whitman GJ, Crosby MA, Carkaci S, Dryden MJ, Dogan BE. Multimodality imaging of the reconstructed breast. Curr Probl Diagn Radiol. 2015;44:487–95. https://doi.org/10.1067/j.cpradiol.2015.04.006.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Lee J, Park HY, Kim WW, Lee JJ, Keum HJ, Yang JD, Lee JW, Lee JS, Jung JH. Natural course of fat necrosis after breast reconstruction: a 10-year follow-up study. BMC Cancer. 2021. https://doi.org/10.1186/s12885-021-07881-x.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Kerridge W, Kryvenko O, Thompson A, Shah B. Review article fat necrosis of the breast: a pictorial review of the mammographic, ultrasound, CT, and MRI findings with histopathologic correlation. Radiol Res Pract. 2015. https://doi.org/10.1155/2015/613139.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Krishnamurthy R, Whitman GJ, Stelling CB, Kushwaha AC. Mammographic findings after breast conservation therapy. Radiographics. 1999. https://doi.org/10.1148/radiographics.19.suppl_1.g99oc16s53.

    Article  PubMed  Google Scholar 

  54. Ramani SK, Rastogi A, Mahajan A, Nair N, Shet T, Thakur MH. Imaging of the treated breast post breast conservation surgery/oncoplasty: Pictorial Review. World J Radiol. 2017;9:321. https://doi.org/10.4329/wjr.v9.i8.321.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Chansakul T, Lai KC, Slanetz PJ. The postconservation breast: Part 1, expected imaging findings. Am J Roentgenol. 2012;198:321–30. https://doi.org/10.2214/ajr.10.7298.

    Article  Google Scholar 

  56. Venkataraman S, Hines N, Slanetz PJ. Challenges in mammography: Part 2, multimodality review of breast augmentation—imaging findings and complications. Am J Roentgenol. 2011. https://doi.org/10.2214/ajr.11.7216.

    Article  Google Scholar 

  57. Raj SD, Karimova EJ, Fishman MD, Fein-Zachary V, Phillips J, Dialani V, Slanetz PJ. Imaging of breast implant–associated complications and pathologic conditions: breast Imaging. Radiographics. 2017;37:1603–4. https://doi.org/10.1148/rg.2017170025.

    Article  PubMed  Google Scholar 

  58. de Faria Castro Fleury E, D’Alessandro GS, LordeloWludarski SC. Silicone-induced granuloma of breast implant capsule (SIGBIC): Histopathology and radiological correlation. J Immunol Res. 2018;2018:1–9. https://doi.org/10.1155/2018/6784971.

    Article  CAS  Google Scholar 

  59. Sharma B, Jurgensen-Rauch A, Pace E, Attygalle AD, Sharma R, Bommier C, Wotherspoon AC, Sharma S, Iyengar S, El-Sharkawi D. Breast implant–associated anaplastic large cell lymphoma: review and Multiparametric Imaging Paradigms. Radiographics. 2020;40:609–28. https://doi.org/10.1148/rg.2020190198.

    Article  PubMed  Google Scholar 

  60. Chang EI, Chang EI, Soto-Miranda MA, Zhang H, Nosrati N, Crosby MA, Reece GP, Robb GL, Chang DW. Comprehensive evaluation of risk factors and management of impending flap loss in 2138 breast free flaps. Ann Plast Surg. 2016;77:67–71. https://doi.org/10.1097/sap.0000000000000263.

    Article  CAS  PubMed  Google Scholar 

  61. Chansakul T, Lai KC, Slanetz PJ. The postconservation breast: Part 2, imaging findings of tumor recurrence and other long-term sequelae. Am J Roentgenol. 2012;198:331–43. https://doi.org/10.2214/ajr.11.6881.

    Article  Google Scholar 

  62. Drukteinis JS, Gombos EC, Raza S, Chikarmane SA, Swami A, Birdwell RL. Mr imaging assessment of the breast after breast conservation therapy: distinguishing benign from malignant lesions. Radiographics. 2012;32:219–34. https://doi.org/10.1148/rg.321115016.

    Article  PubMed  Google Scholar 

  63. Tartar M, Comstock CE, Kipper MS, editors. Breast cancer imaging: a multidisciplinary, multimodality approach. 3rd ed. Philadelphia: Mosby Elsevier; 2008. p. 614.

    Google Scholar 

  64. Alanwar AM, Osman AG, Abdelhamed MA, Ebrahim AN. Skin sparing mastectomy as an oncoplastic surgery technique for breast cancer treatment. QJM Int J Med. 2020. https://doi.org/10.1093/qjmed/hcaa050.025.

    Article  Google Scholar 

  65. Macmillan RD, McCulley SJ. Oncoplastic breast surgery: what, when and for whom? Curr Breast Cancer Rep. 2016;8:112–7. https://doi.org/10.1007/s12609-016-0212-9.

    Article  PubMed  PubMed Central  Google Scholar 

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  1. Departments of Radiology and Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health System, Manhasset, NY, 11030, USA

    Samantha C. Lee, Karen Mendez Broomberg, Anthony Baez, Nina S. Vincoff, Cindy Cen & Suzanne McElligott

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Lee, S., Mendez Broomberg, K., Baez, A. et al. Overview of Oncoplastic Breast Surgery Techniques for the Treatment of Breast Cancer with Review of Normal and Abnormal Postsurgical Imaging Findings. Curr Radiol Rep 10, 41–55 (2022). https://doi.org/10.1007/s40134-022-00394-w

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