Oncoplastic breast surgery

Oncoplastic techniques divide into volume displacement, where the remaining breast tissue is rearranged to fill the defect, often as a therapeutic mammaplasty that reshapes and lifts both breasts, and volume replacement, where tissue is brought in from the chest wall or back as a local perforator flap. The purpose is to widen the range of tumours that can be treated without mastectomy, and to avoid the deformity that follows a large excision in a small breast.

The evidence base is a level below the conservation trials, and that is the honest thing to say about it. There is no randomised comparison of oncoplastic conservation against standard conservation, or against mastectomy with reconstruction; what exists is prospective cohorts and registry series. So the case for these techniques rests on the conservation trials for the oncology and on surgical judgement for the appearance, and the costs are known rather than measured: a longer operation, and often a second, unaffected breast operated on to match it.

NICE NG101 refers to oncoplastic repair explicitly in one place, recommendation 1.4.2, which offers breast-conserving surgery with removal of the nipple and areola as an alternative to mastectomy for localised Paget's disease of the nipple and says to offer oncoplastic repair techniques to maximise the cosmetic result.