الفهرس 
Surgical Anatomy of the BreastOnly 14 pages are availabe for public view
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Abstract
Breast is a mass of glandular, fatty and connective tissue. The breast is made up of:
Lobules: glands that produce milk
Ducts: tubes that carry milk from the lobules to the nipple
Fatty and connective tissue: surrounds and protects the ducts and lobules and gives shape to the breast
Areola: the pink or brown, circular area around the nipple that contains small sweat glands, which release (secrete) moisture as a lubricant during breast-feeding
Nipple: the area at the centre of the areola where the milk comes out
Breast cancer is the most commonly diagnosed cancer among women, with approximately 182,000 women diagnosed with breast cancer annually, accounting for approximately 26% of all incident cancers among women. Each year, 40,000 women die of breast cancer, making it the second-leading cause of cancer deaths among women after lung cancer. The lifetime risk of dying of breast cancer is approximately 3.4%.
Summary
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Breast cancer is a malignant tumour that starts in the cells of the breast. Malignant means that it can spread, or metastasize, to other parts of the body. Cells in the breast sometimes change and no longer grow or behave normally. These changes may lead to benign breast conditions such as atypical hyperplasia and cysts. They can also lead to benign tumours such as intraductal papillomas. Benign conditions and tumours are not cancerous. But in some cases, changes to breast cells can cause breast cancer.
When treating breast cancer, a doctor’s goal is to remove all of the cancer or as much of it as possible. Surgery is one of the mainstays of treatment, and a procedure called modified radical mastectomy (MRM) is now a standard surgical treatment for early-stage breast cancers. It’s especially helpful for treating early-stage breast cancer that has spread to the lymph nodes. Studies show MRM is as effective as a traditional radical mastectomy, but takes much less of a toll on a woman’s appearance. Because of the success with MRMs, traditional radical mastectomies are rarely done today. During the procedure, the surgeon removes the breast, including the skin, breast tissue, areola, and nipple, and most of the lymph nodes under the arm. The lining over the large muscle in the chest is also removed, but the muscle itself is left in place.
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Breast-conserving surgery is sometimes called lumpectomy, quadrantectomy, partial mastectomy, or segmental mastectomy. In this surgery, only the part of the breast containing the cancer is removed. The goal is to remove the cancer as well as some surrounding normal tissue. How much of the breast is removed depends on the size and location of the tumor and other factors. Breast-conserving surgery (BCS) is a good option for many women with early-stage cancers. The main advantage is that a woman keeps most of her breast. However, she will in most cases also need radiation therapy. Women who have their entire breast removed (mastectomy) for early-stage cancers are less likely to need radiation.
The field of oncoplastic surgery has greatly evolved over the past several years. The incorporation of oncological and plastic surgery techniques allows for the complete resection of local disease while achieving superior cosmetic outcome. As previously described, the choice of oncoplastic surgical technique resulting in better cosmetics depends on the patient’s breast size, tumor location, the excised volume, and the volume of the remaining breast tissue after surgery Oncoplastic breast-conserving surgery (BCS) can be performed in one of the following two ways: First, volume replacement technique combines resection with glandular reshaping or reduction mammoplasty. Second, volume
Summary
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replacement technique combines resection with immediate reconstruction using an autologous tissue flap. Volume displacement techniques have some advantages over volume replacement techniques. The surgery is shorter in duration, it is less extensive, and there is no donor-site morbidity. However, in patients with small breast size or a higher tumor-to-breast-volume ratio, there is a limitation on satisfactory cosmetic results using this technique. In these cases, volume replacement techniques may be useful. Because Korean women have relatively small breast sizes compared to Western women, it is not very easy to apply the oncoplastic volume displacement technique to cover defects. However, we have performed various types of oncoplastic volume displacement techniques on Korean women, and based on our experience, we report a number of oncoplastic volume displacement techniques that are applicable to Korean women with small- to moderate-sized breasts.
Surgical complications: There were 5/20 (25.0%) postoperative complications. Three (60.0%) patients with LD reconstruction had back seroma at the donor site, which was treated by aspiration, while a fourth (20.0%) patient had partial flap loss. One (20.0%) patient with inferior pedicle reconstruction had a partial skin dehiscence, which required secondary sutures. However, only the last 2 (10%) of our
Summary
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patients had a delay in their adjuvant treatment for four and two weeks, respectively.
Oncoplastic surgery (OP) represents a major advance in breast cancer surgery. It is based on three principles: ideal oncology surgery with free margins and adequate local control of disease, immediate breast reconstruction and symmetry, with the transposition of plastic surgery techniques into breast cancer surgery. Its original focus was to improve the quality of life of patients undergoing oncological treatments that can be more effective from the aesthetic-functional point of view than the traditional breast conserving techniques. As it happens with all changes of paradigms, it brings new challenges for the traversal formation of all involved in the treatment of breast cancer.
Besides that, it opens to new perspectives of surgical research related to the aesthetic results, quality of life and local control, as well as optimization of operative timing and reduction of both adverse effects and costs. The aim of this review was to present the principles of this approach and the main techniques applied, evaluating its indications and limits in conservative breast cancer surgery.
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The goals of breast conserving surgery (BCS) and radiation therapy are to provide the survival equivalent of mastectomy, a cosmetically acceptable breast, and a low rate of recurrence in the treated breast.
Oncoplastic surgical techniques allow resection of a breast cancer with wide surgical margins while preserving the shape and appearance of the breast. Patients with either a large tumor relative to their breast size or a central tumor are candidates for oncoplastic resections
Oncoplastic techniques are appropriate for most BCS candidates. Patients undergoing oncoplastic resections are selected, evaluated, and treated similarly to standard BCS patients, except that plastic surgery consultation may be necessary for complex oncoplastic procedures.
The choice of oncoplastic surgical technique is based upon the location of the cancer in the breast. Long-term outcomes of oncoplastic surgery are comparable or superior to standard breast conservation surgery.
Surgeon’s safety checklist for oncoplastic surgery: To avoid surgical complications, the breast surgeon should review and assess the patient’s medical status. A preoperative checklist is a good way to assure that all safety issues have been addressed.