Long-term oncological results of breast conservative treatment with oncoplastic surgery.

Oncoplastic surgery combining breast conservative treatment (BCT) and plastic surgery techniques may allow more extensive breast resections and improve aesthetic outcomes, but no long-term oncological results have been published. Long-term oncologic results of 148 consecutive BCT with concomitant bilateral plastic surgery have been analysed and were compared to historical data of BCT trials. Median follow-up was 74 months. Complete excision was obtained in 135 patients (91%); focally involved margins in 8 (5%); and close (<2 mm) margins in 5 (3%). Five patients developed ipsilateral recurrence (3%), 19 (13%) developed distant metastasis and 11 patients died (7.53%). Patients with tumours larger than 2 cm were at greater risk of local recurrences and distant metastasis. Long-term oncologic results of BCT with oncoplastic surgery are comparable with the results of BCT randomized trials.

A oncoplastia no tratamento conservador do câncer de mama / Oncoplastic and conservative treatment of the breast cancer

Os autores usam técnicas conhecidas de cirurgia plástica da mama para decidir e planejar o mais radical tratamento oncológico com melhores resultados estéticos. Realiza-se a cirurgia oncológica com margens de segurança, o linfonodo-sentinela é pesquisado e, se necessário, faz-se o esvaziamento axilar seguido de mamoplastia bilateral. Sistematizou-se para a abordagem oncoplástica da mama a associação de técnicas de cirurgia plástica com o tipo de mama e a localização do tumor em um de nove quadrados de uma divisão geométrica da mama. Para mamas tipo I e II, a técnica periareolar é usada para a retirada de tumor em qualquer quadrado da mama. Para as mamas do tipo III e IV com tumores localizados em quadrados superiores e laterais, a técnica usada é o quinto pedículo. Tumores localizados no quadrado central mediano têm abordagem pela técnica em ilha com posterior reconstrução do complexo aréolo-mamilar. Para a retirada dos tumores localizados em quadrados inferiores, são usadas as técnicas de Pitanguy ou de Gerardo Peixoto, dependendo do grau de ptose da mama. É imperativo que o profissional, hoje, domine as técnicas oncoplásticas.

The authors systematized oncoplastic surgery techniques for the approach of breast cancer regarding the type of breast and the location of the tumor in one of nine squares. Oncologic surgery is performed by removing the tumor area with safety margins and examining the sentinel lymph nodes when necessary, by axillary emptying at three levels, followed by bilateral mammoplasty. The authors used a geometrical division of the breast and, depending on tumor location and on the type of breast, decided on plastic surgery techniques for the breast and planned the most radical oncologic management with better esthetic results. For breast types I and II, a periareolar technique is used to remove the tumor from any square of the breast. For breast types III e IV with tumors located in lateral and upper squares, the 5th pedicle technique is used. For tumors located in the median central square, the island technique is used, with subsequent reconstruction of the areolo-mammillary complex. For the removal of tumors located in the lower squares the techniques of Pitanguy or Gerardo Peixoto are used, depending on the degree of ptosis of the breast. Today it is imperative for mastologists to dominate the oncoplastic techniques.