The dynamic field of oncoplastic breast surgery seeks to combine the goals of both oncology and plastic surgery, utilizing recent innovations and new techniques to provide patients with the best possible outcomes. Oncoplastic Surgery of the Breast, 2nd Edition, offers fully revised content, new expert contributors, and up-to-date instructional videos to keep you current with today’s best approaches to aesthetic closure of the breast after tumor removal. International authorities in breast and plastic surgery cover everything from indications and patient selection to the techniques and allied issues related to breast tumor surgery, including oncoplastic reduction, mammaplasty, mastectomy with nipple areolar preservation, perforator flaps, and effects of radiation therapy, as well as complications and controversies.
Key Features
Contains sections on Getting Started, Surgical Techniques, and Outcomes, written by authors who have made significant contributions to the field.
Includes new instructional videos of step-by-step procedures narrated in real time. Procedures include thoraco-dorsal artery perforator flap (TDAP flap), oncoplastic breast augmentation technique, split reduction with intraoperative radiation therapy (IORT), and more.
Offers clear visual guidance with hundreds of full-color clinical photographs and line drawings.
Includes all-new chapters and fully updated content on breast augmentation technique (bi-planar approach to oncoplasty), the breast surgeon’s approach to oncoplastic breast surgery, extreme oncoplasty, local recurrence and survival following oncoplastic breast surgery, lipofilling and oncoplasty, the plastic surgeon’s approach to oncoplastic breast surgery, local and free flap techniques, and surveillance and imaging following oncoplastic breast surgery.
Follows a consistent chapter format with summary information highlighted in key point boxes and clinical pearls for quick and easy access.
Enhanced eBook version included with purchase. Your enhanced eBook allows you to access all of the text, figures, and references from the book on a variety of devices.
Author(s): Maurice Y. Nahabedian
Edition: 2
Publisher: Elsevier
Year: 2019
Language: English
Commentary: TRUE PDF
Tags: Breast Surgery; Cosmetic & Reconstructive Surgery; Plastic Surgery; Oncology
Cover
Oncoplastic Surgery of the Breast
Copyright
Preface
List of Contributors
Dedication
Section I
1 - Introduction to Oncoplastic Breast Surgery
History of Mastectomy
History of Breast Conservation
History of Oncoplasty
Safety and Efficacy of Oncoplastic Surgery
Immediate Reconstruction of the Partial Mastectomy Deformity
Volume Displacement with Reduction Mammaplasty
Volume Displacement with Adjacent Tissue Rearrangement
Volume Replacement with Local and Remote Flaps
Combining Volume Displacement and Replacement
Conclusion
2 - Safety of Oncoplastic Breast Reconstruction
Introduction
Margins in Oncoplastic Surgery
Local Recurrence, Distant Recurrence, Disease-Free Survival, and Overall Survival Following Oncoplastic Breast Conservation
Complications Following Oncoplastic Breast Reconstruction
Cancer Surveillance Following Oncoplastic Reconstruction
Conclusions
3 - Indications and Patient Selection for Oncoplastic Breast Surgery
Introduction
Indications
Patient Selection
Tumor Characteristics
Invasive Breast Carcinoma
Ductal Carcinoma In-Situ (DCIS)
The Impact of the Tumor-to-Breast Size Ratio on Oncoplastic Breast Surgery
Extent and Location of the Anticipated Breast/Skin Excision
Immediate versus Delayed Reconstruction
Impact of Intraoperative Radiation Therapy
Indications for Nipple-Sparing Mastectomy
Conclusion
4 - Oncoplasty versus Mastectomy: Decisions and Outcomes
Introduction
Safety of Oncoplastic Breast Surgery
Benefits of Oncoplastic Surgery
Radiation and Oncoplastic Surgery
Conclusions
5 - Breast Surgeons and Oncoplastic Surgery
Hidden Incisions
Volume Displacement Techniques Involving Local Tissue Rearrangement
Volume Displacement Techniques Involving a Reduction in the Skin Envelope
Contralateral Equalization for Symmetry
Moving Forward: Training Breast Surgeons
6 - Plastic Surgeon’s Approach to Oncoplastic Breast Surgery
Introduction
Role of Plastic Surgery
Vascular Anatomy
Patient Selection
Technique Consideration
Reduction Mammaplasty with Parenchymal Flaps
Oncoplasty in Patients with Small Breast Volume
Autologous Flaps
Biplanar Oncoplasty
Immediate versus Delayed Oncoplastic Surgery
Management of Complications
Section II
7 - Volume Displacement and Volume Replacement Techniques
Introduction
Timing of Repair
Classification of Partial Breast Defects
Partial Mastectomy Reconstruction Techniques
Volume Displacement Techniques
Volume Replacement Techniques
Conclusion
8 - Reduction Mammaplasty Techniques for Oncoplastic Surgery
Introduction
Patient Assessment
Tumor Location
Need for Adjuvant Therapy
Goals of the Patient
Operative Technique
Skin Pattern
Superomedial Pedicle
Inferior Pedicle
Alternative Pedicles
Inverted T Technique
Management of the Contralateral Breast
Conclusion
9 - Mastopexy Techniques
10 - Local Flap Techniques for Oncoplastic Breast Reconstruction
Introduction
Oncoplastic Surgery: Displacement Techniques versus Local Flaps
Local Flaps for Breast Reconstruction
Introduction, Indications, and Contraindications
Types of Local Flaps
Random Pattern Flaps
Rhomboid Flap
Subaxillary Flap
Lateral Thoracodorsal Flap
Musculocutaneous Flaps
LD Flap
Flap Characteristics
Preoperative Preparation
Surgical Technique
Endoscopic LD
Locoregional Perforator Flaps
Introduction
Thoracodorsal Artery Perforator Flap (Video 10.1)
Flap Characteristics
Preoperative Preparation
Surgical Technique
Intercostal Artery Perforator Flaps (ICAP: LICAP, AICAP)
IMAP
Characteristics of the Flap
Surgical Technique
The Importance of Timing: When to Perform Breast Reconstruction with Local Flap Techniques in Breast-Conserving Therapy
Conclusions
11 - Free Flap Techniques
Introduction
Timing of Partial Breast Reconstruction
Indications of Delayed Partial Breast Reconstruction
Patient Selection
Preoperative History and Considerations
Indications and Contraindications
Operative Approach
Principles
Preoperative Planning
Free Flap Selection
Surgical Technique
Postoperative Care
Outcome
Complications and Side Effects
Conclusion
Clinical Cases
Case #1
Case #2
12 - Breast Augmentation Technique (Biplanar) for Oncoplasty
Conflict of Interest Statement
Introduction
Patient Selection
Indications and Contraindications
Operative Approach (Video 12.1)
Outcome
Complications
Conclusion
13 - Oncoplastic Breast Reconstruction Using a Three-Dimensional Absorbent Coil
Introduction
Patient Selection
Beginning the Operation
Technique of Coil Placement
Technique of Oncoplastic Tissue Rearrangement
Postoperative Care
Complications
Outcomes
Conclusions
14 - Lipofilling and Oncoplasty
Funding Sources/Financial Disclosures
Contributor’s Statement
Introduction
Patient Selection
Preoperative History and Information
Patient Evaluation and Considerations
Indications and Contraindications
Indications and Timing
Contraindications and Limitations
Operative Approach
Breast Defect Classification
Operative Techniques: Classic Oncoplastic Procedures and AFG
Operative Techniques: AFG Procedure
AFG Technique
Outcome
Oncologic Safety
Complications and Side Effects
Postoperative Care
Conclusions
15 - Extreme Oncoplasty
Introduction
Patient Selection
Preoperative History and Consideration
Indications and Contraindications
Operative Approach
Outcome
Complications and Side Effects
Conclusion
16 - Oncoplastic Variations Based on Tumor Location
Introduction
Problem Areas in Oncoplastic Reconstruction
Summary
Section III
17 - Complications of Oncoplastic Breast Surgery
Acute Complications Following Oncoplastic Reconstruction
Local Tissue Rearrangement
Oncoplastic Reduction Mammaplasty
Local/Regional Flaps
Oncologic Outcomes
Recurrence
Positive Margins
Need for Completion Mastectomy
Delay of Adjuvant Therapy
Conclusion
18 - Local Recurrence and Reconstructive Options Following Oncoplastic Breast Surgery
Determinants of Local Recurrence
Indications and Techniques for Second Oncoplastic Breast Surgery
Reconstructive Options Following Salvage Mastectomy for Recurrence
Conclusions
19 - Surveillance and Imaging Following Oncoplastic Breast Surgery
Overview
Imaging in Women 40–70 Years of Age
The Argument Against Imaging
Policy Implications for Women 40–70 Years of Age
Breast Imaging After 70 Years of Age
High-Risk Screening
Conclusions and Current Imaging Guidelines Per Society
20 - Radiation Therapy Considerations and Oncoplastic Breast Surgery
Introduction
Biological Basis of Radiation in Treatment of Breast Cancer
Radiation in Breast Conservation Therapy and Invasive Ductal Carcinoma
Early Stage Tumor/Tumor Size
Unifocal Disease
Patient Preference/Compliance
Inability to Achieve Clear Margins
Pregnancy
Prior Chest Irradiation
Collagen Vascular Disease
Inadequate Aesthetic Outcome
Prior Breast Augmentation
Age
Nodes
Extensive Intraductal Component
Large Breasts
Whole Breast Irradiation
External Beam Radiation Therapy (Whole Breast Irradiation)
Timing after Surgery
Radiation Dosage: Standard Fractionation versus Hypofractionation
Radiation Boost
Partial Breast Irradiation
Accelerated Partial Breast Irradiation
3D Conformal Therapy
Intensity Modulated Radiation Therapy
ASTRO Recommendations
Intraoperative Radiation
Management of Side Effects
Summary
21 - Patient Satisfaction and Outcomes Following Oncoplastic Breast Surgery
Introduction
Breast Conservation
Outcomes after Oncoplastic Surgery
Patient Outcomes
Cosmetic Outcomes and Patient Satisfaction
Current Practices
Delayed or Two-Stage Oncoplastic Surgery
Intraoperative Margin Assessment
Re-excision after Oncoplastic Breast Surgery
Conclusion
