**1. Introduction**

Surgical management of breast cancer has undergone significant evolutionary changes since Halstead's description of radical mastectomy in 1882. Although Halstead was not credited for discovering this technique, his seminal paper published in the Annals of Surgery in 1894 demonstrated a 20% survival benefit for the first time. Not surprisingly, the Halstead mastectomy became the standard of care for the next several decades [1]. It took almost 70 years before quadrantectomy was considered a safe alternative to sacrificing the whole breast with long-term follow-up confirmed in the NSABP-B06 and Veronesi's Milan I trial [2, 3].

© 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. © 2018 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

The term oncoplastic breast surgery (OPBS) was first coined by Werner Audretsch in the 1980s, to describe rearrangement of breast tissue to fill the defect following a partial mastectomy and recreate the breast shape, with emphasis on cosmesis. Over the last three decades, oncoplastic breast surgery has been established globally to encompass the 'quadrant-per-quadrant' approach to breast conservation advocated by Krishna Clough [4] and the Nottingham algorithm for therapeutic mammoplasty, championed by Douglas Macmillan and Stephen McCulley [5]. Introduction of biological mesh or acellular dermal matrix (ADM) in the mid-1990s defined another watershed period with increasing mastectomy rates and immediate reconstruction. Steven Kronowitz from the MD Anderson Cancer Center in Texas, USA, introduced the concept immediate-delayed reconstruction in 2002 to help women avoid the trauma of mastectomy after waking up from surgery [6].

invasive cancer. Traditional approach of scar placement over the tumour site, without adequate mobilisation of skin or approximation of breast parenchyma and leaving the cavity to fill with seroma, was responsible for poor cosmetic outcomes in the past [10]. Volume of excision relative to breast size, location of the tumour and re-excision surgery are independent

Oncoplastic Breast Surgery in the Treatment of Breast Cancer

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In a recent clinical study correlating resection volumes and tumour location with clinical photographs of patients 2 years after completing radiotherapy, was assessed by a panel and scored. Despite the small sample size, there was significant variation in the cosmetic results

Oncoplastic breast surgery involves careful preoperative planning with dedicated breast radiologists in the MDT to confirm adequate clearance of the tumour from the overlying skin.

between oncoplastic surgeon and general breast surgeons (**Figures 2** and **3**) [11].

risk factors for poor cosmesis (**Figure 1**).

**Figure 1.** Poor cosmetic results from breast conserving surgery.

**Figure 2.** Clinical study results poor cosmetic outcome.

Today, women diagnosed with a new breast cancer are offered a range of treatment options within a multidisciplinary setting [7]. Breast cancer surgery is no longer a two-operation discipline, based on cancer dimension relative to breast size or patient choice of mastectomy versus breast conservation. An oncoplastic approach to modern management of breast cancer involves careful preoperative planning with other specialists such as radiologists, pathologists and oncologists. A comprehensive breast assessment to determine the optimal breast conservation techniques is essential with emphasis on scar placement. All patients undergoing mastectomy should have a discussion around reconstruction options, where appropriate.

Good communication skills and additional time during consultation, helps safeguard patient's understanding of complex discussions around treatment. Early involvement of clinical psychologists in selected cases can help anxious patients and exclude underlying mental health concerns. Heightened anxiety at the time of diagnosis could impact decision-making and alter clinical management, with potential for decision-regret after completing treatment. Welltrained and dedicated breast care nurses are indispensable in a modern surgical breast unit [8]. Providing well designed and simple information leaflets to read outside the stressful environment of the doctor's office, can help patients navigate the complexity of the decision-making process. These combined efforts serve to demystify the various treatment options, empower women with the concept of 'patient choice' and ensure informed consent.

This chapter aims to present aspects of modern oncoplastic surgical approach in the treatment of breast cancer, with emphasis on implant-based reconstruction.
