Oncoplastic breast surgery.

Breast Surgery is now a recognized subspecialty of General Surgery abroad with structured training for designated 'Oncoplastic Breast Surgeons'. Oncoplastic Breast surgery is probably one of the most interesting and challenging new developments over the past 20 years. The aims of Oncoplastic surgery are wide local excision of the cancer coupled with partial reconstruction of the defect to achieve a cosmetically acceptable result. Avoidance of mastectomy and consequent reduction of psychological morbidity are the principal goals in the development of various oncoplastic techniques. The use of plastic surgical techniques not only ensures good cosmetic outcome, but also allows the cancer surgeon to remove the tumour with greater volume of surrounding tissue, thus extending the boundaries of breast conserving surgery. Proper patient selection and careful planning after proper radiological and clinical assessment are the two essential prerequisites before undertaking oncoplastic breast surgery. Oncoplastic surgery involves both volume displacement and volume replacement techniques. Some commonly used volume displacement procedures are described in the article. The need for adjustment of contralateral breast should also be anticipated at the time of planning breast conserving surgery, which can be done either at the same time as breast cancer surgery or as a delayed setting.

'Breast awareness' and 'breast self-examination' are not the same. What do these terms mean? Why are they confused? What can we do?

The terms 'breast self-examination' and 'breast awareness' are often used loosely, causing general confusion, with potential to cause women harm. To explore this confusion, we begin by defining their current meaning. We trace the history of these methods of early detection over the last half century, which has seen considerable cultural, social and attitudinal changes. Breast self-examination is not recommended. We caution that uncertainty exists about the value of practicing breast awareness: evidence is currently lacking to determine whether the benefits outweigh the harms: globally-aware research is needed. We believe that a clear and universally agreed definition of the term 'breast awareness' is needed, and that the confusion needs to be further exposed and debated. Meanwhile, we advocate 'sensible alertness'.