الفهرس 
Introduction and Aim of the workOnly 14 pages are availabe for public view
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Abstract
There has been major progress in breast cancer surgery over the past few decades. Conceptually, it must now be performed with special attention to cosmetic results and the quality of life of the patients. Disfiguring and mutilating surgical procedures can no longer be biologically and oncologically justified for most patients under screening programs. In this way, oncoplastic surgery is a necessary evolution and a final refinement of breast cancer surgery. It combines oncologic and plastic surgery techniques in order to improve the final aesthetic outcomes. It includes appropriate oncologic surgery, immediate reconstruction using the full range of all available plastic surgery techniques, and immediate correction of contralateral breast symmetry, whenever indicated.
The original concept of oncoplastic surgery and the philosophy of work is already consolidated since there are no significant changes in basilar oncologic principles. Local control in terms of margins and surgical care is the same as in breast-conserving treatment and mastectomy. This advance is now the standard practice in many centers in different countries.
Three important facts are considered as the main reasons for a change in the system of breast surgery training. The first one is that most breast cancer patients do not receive any kind of breast reconstruction. The classic model ‘‘breast surgeon-plastic surgeon working together in all cases’’ works very well but is clearly not sufficient to cover all of the new breast cancer cases. The second one is that immediate breast reconstruction with volume displacement and replacement techniques has better oncologic results in breast-conserving surgery in terms of margins, lower index of re-excisions, better local control of disease, and positive results regarding radiotherapy planning, particularly for the group of patients with gigantomastias. Although there have been few studies in oncoplastic surgery (most of them are series of cases or retrospective cohorts of patients), it is clear that the combination of plastic surgery techniques and breast-conserving surgery do not compromise clear excision margins nor the long-term oncologic results.
Moreover, immediate breast reconstruction has better aesthetic outcomes than delayed breast reconstruction after conservative surgery and mastectomies. The third one, and perhaps the most important of them, is the cultural and psychological representation of the breast in postmodern society. Patients with pronounced asymmetry after breast cancersurgery are more likely to feel significantly stigmatized. They have more fear of death, increased psychosocial problems due to loss of their femininity, more depressive symptoms, and, consequently, more harm to their quality of life independent of their chances of cure. So, this new arrangement is perfectly well justified. Fellowships need to expand the current curriculum in order to create a new specialist surgeon who performs all kinds of reconstructions-the so-called oncoplastic surgeon. Of course, a single surgeon with both oncologic and reconstructive backgrounds requires special training in cross specialty techniques to undertake all these procedures to the highest standard and with new responsibilities and new medicolegal implications. The aim is to address the qualifications and limits in oncoplastic surgery training and practice.