Oncoplastic breast surgery

By
Dr. George Ezzat Fahmy Hanna
Supervised by
Professor Dr. Mohamed El Zoheiry

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 Aim
• The goals of treatment are to :
1. Provide optimal local oncologic control.
2. Maintaining or reconstructing a cosmetically
acceptable breast.
3. Symmetrising the contra-lateral breast if
feasible.

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 Techniques
• The majority of reconstruction techniques are:
1. Breast tissue advancement flaps (BAF)
2. Lateral thoracodorsal flap (LTDF)
3. Bilateral mastopexy (BM)
4. Bilateral reduction mammaplasty (BRM)
5. Latissimus dorsi myocutaneous flap (LDMF)
6. Abdominal flaps.

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 Types
Level I OPS
Definition:
The excision of less than 20% of the breast
volume during breast-conserving surgery in
small- to moderate-sized breasts with
minimal ptosis.

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Level II OPS
Definition:
Excision of 20% to 50% of the breast tissue during
partial mastectomy in moderate- to large-sized
breasts with moderate-to-severe ptosis.

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Oncoplastic Breast-Conserving Surgery for
Upper or Central Breast Tumors
1- Crescent Mastopexy Resection
Location and indication
• It is suitable for a superior central tumor that
does not involve the nipple or areola. The
ideal lesion is located between the periareolar
1 to 10 o’clock position.

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Crescent Mastopexy
Drew by Turgay Şimşek

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2- Batwing Resection

• Location and indication

It is used for wider excisions of the upper
central regions within a few centimetres of the
nipple but does not involve the nipple. Unlike
crescent mastopexy, breast surgeons usually
prefer to use this technique or hemi batwing
resection when the areola is smaller and the
tumor is more extensive.

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Batwing resection
Drew by Turgay Şimşek

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 3- Donut Mastopexy Resection (Round Block Technique)

• Location and indication

Surgeons prefer this technique to treat
tumours in the upper and lateral quadrants.
Its disadvantage is that the NAC will be de-
nerved when the full-thickness skin excision is
performed.

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Donut resection
Drew by Turgay Şimşek

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 4- B-Flap Resection (Grisotti Mastopexy Technique)

Location and indication

This method is ideal for reconstructing the
central breast when NAC resection is required
because of the tumour’s proximity in women
with sufficient breast volume and moderate
breast ptosis.

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Grisotti Mastopexy
Drew by Turgay Şimşek

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 Oncoplastic Breast-Conserving Surgery for
Lower Quadrant Breast Tumors
1-Triangular Resection
• Location and indication
Cosmetic problems, such as a “bird beak” deformity,
may develop after the tumours’ excision is located in the
breast’s lower quadrants. However, the breast’s lower
pole may be reformed with the surrounding tissues’
dislocating to the lumpectomy cavity. Relatively larger
lesions located in that region may also be ressected with
this technique in which the total thickness wedge-
shaped skin specimen and glandular tissue are ressected.

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Triangular resection
Drew by Turgay Şimşek

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 2- Infra-mammary Resection

• Location and indication

This is suitable in resection of tumours in
the lower and posterior breast regions. The
resection is performed from an incision
applied to the infra-mammary fold hidden
below the breast.

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Infra-mammarian resection
(Drew by Turgay Şimşek

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 3- Reduction Mammoplasty (RM) “Wise
pattern” incision
A procedure that combines performing
reduction mammoplasty and wide local tumor
excision particularly at 4–8 o’clock level, in
addition to retro-areolar or supra-areolar
lesions, in a patient who requires breast
reduction.

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Wise Pattern resection
Drew by Turgay Şimşek

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THANK YOU

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