Foreword
Preface
Contents
About the Editor
1: Oncoplastic and Reconstructive Anatomy of Breast
1.1 Introduction
1.2 Surface Anatomy
1.3 Structure
1.4 Arterial Supply
1.4.1 Blood Supply to NippleâAreolar Complex
1.5 Venous Drainage
1.6 Lymphatic Drainage
1.7 Nerve Supply
1.8 Muscles in Relation to Breast
1.9 Inframammary Fold
1.10 Breast Aesthetics
1.11 Breast Ptosis
References
2: Applied Aspects of Breast Imaging in Oncoplasty and Reconstruction
2.1 Basics of Breast Cancer Imaging: Work-Up of Patient with Suspected Breast Cancer
2.2 Applied Aspects of Breast Imaging Issues Pertaining to BCS
2.3 Oncoplasty, Reconstruction: Pre-operative, Post-operative, and Follow-Up Issues
References
3: Principles of Planning Incisions for Breast Oncoplasty and Reconstruction
3.1 General Principles of Incision Planning for Breast Conservation Surgery and Oncoplasty
3.2 Incision Planning for Mastectomy
3.3 Conclusion
References
4: Oncologic Principles of Breast Conservation and Oncoplastic Breast Surgery
4.1 Introduction
4.2 Clinical Evaluation and Staging
4.3 Local Imaging
4.4 Patient Selection for Breast Conservation Surgery
4.4.1 Absolute Contra-indications for BCT
4.4.1.1 Contra-indication at Presentation
4.4.1.2 Contra-indication Based on Past-history
4.4.1.3 Contra-indication on Clinical Examination
4.4.1.4 Contra-indication on Investigation
4.4.1.5 Contra-indication Detected On-table During Surgery (Frozen)/Post-Surgery (Paraffin Sections)
4.4.2 Relative Contra-indications to BCT
4.4.2.1 Connective Tissue Diseases
4.4.2.2 Tumor Breast Ratio
4.4.2.3 Pendulous Breast
4.4.3 Factors No Longer Contra-indication to BCT
4.4.3.1 Age
4.4.3.2 Tumor Location
4.4.3.3 Invasive Lobular Carcinoma
4.4.3.4 Extensive Intraductal Component (EIC)
4.4.3.5 Family History of Breast Cancer
4.4.3.6 Lymph Node Positivity
4.4.4 Principles of Neoadjuvant Chemotherapy Followed by BCT
4.5 Surgical Principles
4.5.1 Breast Conservation Surgery â Margin Status
4.5.2 Metal Marker Placement on the Resection Cavity
4.5.3 Oncoplastic Techniques and Wound Closure
4.5.4 Specimen Orientation and Pathology Requisition
4.6 Conclusion
References
5: Margin Assessment in Breast Conserving Surgery
5.1 Introduction
5.2 Definition of Negative Margin
5.3 Predictors of Positive Margins in Breast Conservative Surgery
5.4 Preoperative Imaging
5.5 Margin Assessment for Nonpalpable Breast Lesions
5.6 Intraoperative Margin Assessment Techniques
5.7 Management Algorithm Based on Margin Status
References
6: General Principles of Oncoplastic Breast Surgery
6.1 Introduction
6.2 Principles of Oncoplasty
6.3 Types of OBS
6.4 Conclusion
References
7: Patient Counselling for Breast Oncoplasty and Reconstruction
7.1 Aspects of Pre-operative Counselling
7.1.1 Breast Conservation or Mastectomy
7.1.2 Partial Breast Reconstruction
7.1.3 Total Breast Reconstruction
7.1.4 Nipple Preservation
7.1.5 Types of Reconstruction
7.1.6 Sensory Changes
7.1.7 Anaplastic Large Cell Lymphoma
7.1.8 Implant Reconstruction and Mesh
7.1.9 Effect of Adjuvant Radiotherapy
7.1.10 Revisional and Symmetrising Procedures
7.1.11 Recovery Following Surgery
References
8: Applied Aspects of Systemic Therapy in Breast Oncoplasty and Reconstruction
8.1 Introduction
8.2 Indications and Types of NAT
8.3 Multidisciplinary Approach and Role of Surgeon in Planning NAT
8.4 Neoadjuvant Therapy in HER2-Negative Breast Cancer
8.5 Neoadjuvant Therapy in HER2 Positive Breast Cancer
8.6 Neoadjuvant Endocrine Therapy
8.7 Assessment of Response to Neoadjuvant Therapy
8.8 Impact of Systemic Therapy on Wound Healing
8.9 Timing of Adjuvant Systemic Therapy
References
9: Perioperative Management of Breast Cancer Patients: Anesthesiologist Perspectives
9.1 Introduction
9.1.1 Preoperative Period
9.2 Intraoperative Management
9.3 Postoperative Management
9.4 Enhanced Recovery after Surgery (Eras) and Breast Surgery
9.5 Key Points
References
10: Role of Breast Anthropometry in Oncoplasty and Reconstruction
10.1 Introduction
10.2 The Magnitude of Breast Cancer and Its Impact on Women
10.3 Breast Anthropometry Methods
10.4 Natural Shape Methods
10.5 Stereological Methods
10.6 Geometrical Methods
10.7 Mathematical Models
10.8 3D Surface Imaging
10.9 Breast Shape
10.10 Ptosis
10.11 Mammographic Density
References
11: Principles of Radiotherapy in Breast Oncoplasty and Reconstruction
11.1 Challenges in Patients Undergoing Oncoplasty: Difficulty in Delineating Boost Volume
11.2 Target Definition and Delineation After Oncoplastic Surgery
11.2.1 GEC ESTRO Recommendation [15, 16]
11.2.2 Optimal Type of Reconstruction in the Setting of Planned Adjuvant Radiotherapy
11.2.3 What Is the Optimal Timing of Reconstruction in the Setting of Planned Adjuvant Radiotherapy
11.2.4 Managing Margin Positivity
11.2.5 Implant Related Complications
11.2.5.1 Implant Related Complications: Reconstructed Breast [Zachary Brownlee]
11.2.5.2 Implant Related Complications: Conserved Breast and APBI
11.2.6 Newer Techniques of RT
References
12: Preoperative Preparation for Good Oncoplastic Breast Surgery
12.1 Factors for Decision-Making
12.2 Examination of the Breasts
12.3 Shared Decision-Making
12.4 Preoperative Visual Documentation
12.5 Marking
12.6 Conclusion
References
13: Type 1 Oncoplasty in Breast Cancer
13.1 Types of Oncoplasty
13.2 Factors Determining the Type of Surgery
13.3 Principles of Type 1 OPS: The Rule of âTenâ
13.4 Complications
References
14: Round Block Breast Oncoplasty
14.1 Introduction
14.2 Eligibility for Round Block Oncoplasty
14.3 The Technique
14.4 For Tumors Close to the Skin
14.5 Complications of Round Block Technique
References
15: General Principles of Therapeutic Mammoplasty
15.1 Introduction
15.2 Assessments
15.2.1 Breast Factors
15.2.2 Tumour Factors
15.2.3 Other Factors
15.2.3.1 Breast Factors
15.2.3.2 Tumour Factors
15.2.3.3 Other Factors
15.3 Moderate Sized Breasts
15.4 Central Tumours
15.5 Upper Tumours
15.6 UO Tumours
15.7 UI Tumours
15.8 Lower Tumours
15.9 LO Tumours
15.10 LI Tumours
15.10.1 Larger Breasts
15.11 Central Tumours
15.12 Upper Tumours
15.13 UO Tumours
15.14 UI Tumours
15.15 Lower, LO and LI Tumours
15.16 Complications
15.17 Summary
References
16: Therapeutic Mammoplasty Surgical Techniques
16.1 Evolution of Therapeutic Mammoplasty
16.2 Patient Selection and Surgical Planning
16.3 Types of Therapeutic Mammoplasty
16.3.1 Wise Pattern Reduction
16.3.1.1 Skin Marking
16.3.1.2 The Pedicle
16.3.1.3 Surgical Procedure
16.3.2 Vertical Mammoplasty: (Fig. 16.1c)
16.3.3 Lateral Mammoplasty
16.3.4 Periareolar Pattern
16.4 Complications of Therapeutic Mammoplasty
16.5 Factors Associated with Increased Risk of Complications
16.6 Oncological Safety of Therapeutic Mammoplasty
16.7 Quality of Life After Therapeutic Mammoplasty
References
17: Batwing Mastopexy
17.1 Patient Selection
17.2 Surgical Technique
17.2.1 Preoperative Markings and Incision
17.2.2 Patient Position
17.2.3 Steps of Procedure
17.2.4 Modifications of Batwing Resection
17.3 Complications
17.4 Conclusion
References
18: Grisotti Mastopexy (B-Flap Resection)
18.1 Introduction
18.2 Patient Selection
18.3 Surgical Technique
18.3.1 Patient Position
18.3.2 Marking and Incision
18.3.3 Steps of the Procedure (Fig. 18.1)
18.4 Modifications of Grisotti Flap
18.4.1 Grisotti Flap with âE/3â Modification
18.4.2 Superior Pedicle Based Grisotti Flap
18.5 Complications
18.6 Discussion
References
19: Volume Replacement: Latissimus Dorsi Mini-Flap (LDMF) for Partial Breast Reconstruction
19.1 Introduction
19.2 Patient Selection
19.3 Contraindications
19.4 Surgical Technique
19.4.1 Patient Position
19.4.2 Incision
19.4.3 Surgical Approach
19.4.4 Mini-LD Flap Variations
19.4.5 Steps of Procedure: (Fig. 19.2)
19.5 Complications
19.6 Discussion
19.7 Conclusion
References
20: Chest Wall Perforator Flaps for Partial Breast Reconstruction
20.1 Introduction
20.2 Patient Selection and Planning
20.3 Surgical Technique
20.3.1 LateraI Intercostal Artery Perforator and Lateral Thoracic Artery Perforator Flap
20.4 Medial and Anterior Intercostal Artery Perforator Flap
20.5 Complications and Management
20.6 Conclusion
References
21: Oncoplastic Reduction Mammoplasty and Contralateral Symmetrisation
21.1 Oncoplastic Reduction Mammoplasty
21.1.1 Patient Selection and Preoperative Assessment and Planning
21.1.2 Timing of the Surgery
21.1.3 Choice of Incision and Pedicle
21.1.3.1 Choice of Incision
21.1.3.2 Choice of Pedicle
21.1.4 Steps of Surgery
21.1.4.1 Reduction Mammoplasty Using Wise Pattern Scar (Inferior Pedicle Technique)
21.1.4.2 Reduction Mammoplasty Using Lejour Vertical Scar (Superior Pedicle Technique)
21.1.5 Margin Assessment
21.1.6 Post-Operative Radiation Therapy
21.1.7 Complications
21.1.8 Oncological and Cosmetic Outcome
21.2 Contralateral Symmetrisation
21.2.1 Factors Determining the Need and Timing of Contralateral Symmetry Procedure
21.2.2 Decision Making Algorithm
21.2.3 Rationale
21.2.4 Technical Considerations
21.2.5 Conclusion
References
22: Lipomodelling in Breast Surgery
22.1 Introduction
22.2 Indications
22.2.1 Informed Consent
22.2.1.1 Preoperative Assessment
22.2.2 Technique
22.2.3 Harvesting
22.2.4 Fat Processing
22.2.5 Fat Grafting
22.2.6 Complications
22.2.7 Post-Operative Care
References
23: Extreme Oncoplasty in Breast Reconstruction
23.1 Extreme Oncoplasty
23.2 Why Extreme Oncoplasty?
23.3 Global Scenario
23.4 EO Considerations
23.5 Clinical Management in EO
23.6 Case Discussion
23.6.1 Case 1: EO for Case of MC/MF Tumours
23.6.2 Case 2: EO for Extensive DCIS
23.6.3 Case 3: EO for Clinically Large Residual Tumour After NACT
23.6.4 Case 4: EO for Post-NACT Large Residual Calcification
23.6.5 Case 5: EO for LOBC Case with Perforator Flaps
23.6.6 Case 6: EO with Dual Flap for Multicentric Disease
23.6.7 Case 7: Benign Pseudo-angiomatous Stromal Hyperplasia
References
24: Overview of Breast Reconstruction
24.1 Background
24.2 Definition
24.3 Classification
24.4 Components
24.5 Techniques
24.6 Key Points
References
25: Skin Sparing Mastectomy and Nipple Areola Sparing Mastectomy
25.1 Introduction
25.2 Oncological Concepts of Conservative Mastectomy
25.3 Conservative Mastectomy
25.4 Surgical Anatomy Pertaining to Conservative Mastectomy
25.5 Patient Selection for Conservative Mastectomy
25.6 Skin Sparing Mastectomy (SSM)
25.7 Nipple Sparing Mastectomy (NSM)
25.8 Skin Reducing Mastectomy (SRM)
25.9 Mastectomy Technique
25.10 Complications
25.11 Conclusions
References
26: Dissection Guide for Latissimus Dorsi Breast Reconstruction
26.1 Introduction
26.2 Anatomy and Function
26.3 Immediate LDMF Reconstruction
26.4 Delayed LD Reconstruction
26.4.1 Indications for LDMF
26.4.2 Contraindications for LDMF
26.4.3 LDMF in Resurfacing Surgeries and as Secondary Procedures
26.5 Advantages and Disadvantages of the LDMF
26.6 Pre-operative Assessment
26.7 Surface Marking
26.8 Technique
26.9 Postoperative Care
26.10 Postoperative Complications
26.11 Key Steps
References
27: Autologous Reconstruction of Breast
27.1 Free Flaps Used in Autologous Reconstruction of Breast
27.2 Timing
27.3 Advantages
27.4 Disadvantages
27.5 Anatomy
27.6 Planning
27.7 Harvest
27.8 Recipient Area Preparation
27.9 Flap Transfer and Anastomosis
27.10 Abdomen Closure
27.11 Post Operative Care
27.12 Complications
27.13 Secondary Procedures
27.14 Recent Advances
References
28: Silicone Gel Breast Implants
28.1 Introduction
28.2 Structure of Silicone Implants
28.3 History and Evolution of Breast Implants
28.4 Types of Implants
28.4.1 Shell Surface
28.4.2 Gel Cohesiveness
28.4.3 Shape
28.4.4 Volume
28.4.5 Style
28.4.6 Adjustability
28.4.7 Tissue Expanders
28.5 Patient Selection for Implant Based Reconstruction
28.6 Implant Selection in Breast Reconstruction
28.7 Complications Related to Silicone Implants
28.7.1 Early Complications
28.7.2 Delayed Complication
28.8 Summary
References
29: Pre-pectoral Implant Based Breast Reconstruction
29.1 Introduction
29.2 Selection Criteria
29.2.1 Good Candidates
29.2.2 Relatively Unsuitable Candidates
29.3 Surgical Technique
29.3.1 Preoperative Marking
29.3.2 Patient Positioning, Skin Preparation and Antibiotic Prophylaxis
29.3.3 Incision
29.3.4 Mastectomy
29.3.5 Implant Selection
29.3.6 ADM Wrap
29.3.7 Use of Drain
29.3.8 Skin Closure
29.3.9 Post-Operative Care
29.4 Complications and Risks
29.4.1 Immediate Complications
29.4.2 Delayed Complications
29.5 Summary
References
30: Dermal Flap Based Breast Reconstruction
30.1 Introduction
30.2 Patient Selection
30.2.1 Essential Pre-Requisite
30.2.2 Suitable Candidates
30.2.3 Poor Candidates
30.3 Surgical Technique
30.3.1 Principles
30.4 Pre-op Marking for the Procedure
30.5 Operative Procedure
30.5.1 Patient Positioning and Skin Preparation and antibiotic prophylaxis
30.5.2 Skin Incision (Fig. 30.2a)
30.5.3 Mastectomy and Creation of DF (Fig. 30.2b, c)
30.5.4 Implant Insertion (Fig. 30.2c, d)
30.5.5 Closure
30.5.6 Post-Operative Care
30.6 Complication and Risks
30.6.1 Early Post-operative Risks and Complications
30.6.2 Delayed Risk and Complication
30.7 Summary
References
31: Two-Staged and Subpectoral Implant Breast Reconstruction
31.1 Two-Staged Implant Reconstruction (Immediate or Delayed)
31.1.1 Introduction
31.1.2 Indications
31.1.3 Contraindications
31.1.4 Patient Selection
31.1.5 Preoperative Marking
31.1.6 Surgical Technique
31.1.7 Implant Selection
31.1.8 Complications
31.2 Subpectoral Implant Using Mesh (Synthetic or Biological)
31.2.1 Indications
31.2.2 Preoperative Marking
31.2.3 Surgical Technique
31.2.4 Implant Selection
31.2.5 After Care
31.2.6 Complications
31.2.7 Conclusion
References
32: Thoraco-Abdominal Flap for Large Post-Mastectomy Defects in Locally Advanced Breast Cancer
32.1 Learning Areas
32.2 Introduction
32.3 Surgical Anatomy of TA Flap
32.3.1 Patient Selection for TA Flap
32.3.2 Surgical Steps
32.3.3 Advantages of TA Flap over Other Flaps and SSG
32.3.4 Complications
32.4 Conclusion
References
33: Oncoplastic Breast Surgery-Common Complications and Management
33.1 Introduction
33.2 Complications Specific to Oncoplastic Procedures
33.2.1 Bleeding and Hematoma
33.2.2 Seroma
33.2.2.1 Management
33.2.3 Wound Infection
33.2.4 Post BCT Deformity (Fig. 33.2)
33.2.4.1 Management
33.2.5 Local Recurrence
33.2.5.1 Management
33.2.6 Post Radiotherapy Complications
33.2.7 In Expander/ Implant Reconstruction
33.2.7.1 Management
33.2.8 In Autologous Reconstruction
33.3 Complications of Individual Flaps
33.3.1 Latissimus Dorsi Flap
33.3.1.1 Lumbar Herniation
33.3.1.2 Shoulder Weakness, Stiffness and Loss of Mobility
33.3.2 Individualised Risk Assessment
33.3.3 Breast Risk Assessment Score
33.3.4 Pedicled Flaps in Oncoplastic Breast Surgery
33.3.4.1 Donor Site Morbidity
33.3.4.2 Partial or Total Flap Losses
33.3.4.3 Palpable Fat Necrosis (Figs. 33.6, 33.7, 33.8, and 33.9)
33.3.4.4 Unpleasing Scars, Flap Contracture and Volume Loss
33.3.4.5 Breast Asymmetry (Fig. 33.10)
33.3.5 Free Flaps for Partial Breast Reconstruction
33.3.5.1 Flap Failure
33.3.6 Medial Thigh Flaps
33.3.7 TRAM Flap (Transverse Rectus Abdominis Myocutaneous Flap)
33.3.7.1 Flap Failure
33.3.7.2 Flap Re-exploration
33.4 Conclusion-Salient Features
References
34: Management Approach to Recurrence Following Oncoplastic Breast Surgery
34.1 Introduction
34.2 Factors Associated with Local Recurrence
34.3 Recurrence After Mastectomy or Breast Conservation
34.4 Management of Resectable Local Recurrence After Oncoplasty
34.5 Surgery Following Oncoplastic Breast Conservation
34.6 Post-Mastectomy Recurrence
34.7 Management of the Axilla in Locoregional Recurrence
34.8 Local Management of Irresectable Local Recurrence
34.9 Re-irradiation
34.10 Systemic Recurrence
34.11 Systemic Therapy
34.12 Outcome of Treatment
34.13 Key Learning Points
References
35: Follow-Up and Cosmetic Outcomes in Breast Oncoplasty
35.1 Introduction
35.2 Goals of Follow-Up
35.2.1 Simple BCS
35.2.2 Complex Breast Oncoplasty
35.2.3 Mammography
35.2.4 Digital Breast Tomosynthesis (DBT)
35.2.5 MRI
35.2.6 MRI Indications
35.2.7 Role of Surgeon in Follow-Up
35.2.8 Screening for a New Primary Breast Cancer, in the Ipsilateral, or Contralateral Breast
35.2.9 Detection of Treatment-Related Side Effects
35.2.10 Current Guidelines on Breast Cancer Follow-Up
35.3 Cosmetic Assessment
35.3.1 Timing
35.3.2 Methods of Cosmetic Assessment
35.4 PROMs: Questionnaires
35.4.1 Breast-Q [21]
35.4.2 Breast-Q Conceptual Framework
35.4.3 The BREAST-Q BCT Module
35.5 EORTC Quality-of-Life Questionnaire [24, 25]
35.5.1 EORTC QLQ C30 & EORTCÂ â BR23
35.5.2 EORTCÂ â BR23
35.6 Objective Evaluation Methods
35.6.1 BCCT.core
35.7 Summary
References
36: Overview of Curriculum and Training for Oncoplastic Breast Surgery
36.1 Introduction
36.2 Classification of Oncoplastic Procedures for Training Purposes
36.3 Current Status of OPS Training Across the World
36.4 Conclusion
References
37: Workflow and Surgeons Check List for Oncoplastic Breast Surgery and Reconstruction