ADVANCES IN BREAST CANCER DIAGNOSIS AND TREATMENT: ESSENTIALS

Advances in breast cancer diagnosis and treatment Essentials_kapak

ONCOPLASTIC BREAST SURGERY CLASSIFICATION

Atakan Sezer

Trakya University, Faculty of Medicine, Department of General Surgery, Edirne, Türkiye

Sezer A. Oncoplastic Breast Surgery Classification. In: Citgez B editor. Advances in Breast Cancer Diagnosis and Treatment Essentials. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.181-190.

ABSTRACT

Oncoplastic breast surgery (OBS) represents a transformative approach in breast cancer management that integrates oncologic safety with aesthetic preservation. Evolving from the limitations of traditional breast-conserving surgery (BCS), OBS addresses challenges such as poor cosmetic outcomes in patients with large tumors or unfavorable tumor-to-breast size ratios. This chapter reviews the development, classification, indications, and technical considerations of OBS, highlighting its tiered framework: Level I procedures for small-volume resections with minimal reshaping, Level II for moderate resections using volume displacement techniques, and Level III for large-volume excisions requiring complex autologous or implant-based reconstruction.

Careful patient selection considers tumor characteristics, breast morphology, and comorbidities to optimize outcomes. OBS reduces rates of positive margins and reoperations while improving patient satisfaction and quality of life. In addition to oncologic and aesthetic benefits, OBS contributes to improved radiotherapy planning by providing a better-defined tumor bed and reducing complications related to irradiation of irregularly shaped cavities. Moreover, functional preservation is enhanced through techniques that minimize distortion of the nipple-areola complex and maintain breast symmetry, further supporting patient well-being. Despite its advantages, OBS demands advanced surgical expertise and carries risks such as altered anatomy complicating re-excision and postoperative complications that may delay adjuvant therapy. Surgeons must therefore balance the benefits with the technical demands and potential risks, emphasizing the importance of experience, multidisciplinary collaboration, and appropriate training in surgical planning. Long-term follow-up studies have confirmed that OBS does not compromise oncologic outcomes, reinforcing its value as a safe alternative to mastectomy in selected patients.

OBS embodies a holistic, patient-centered philosophy in breast cancer surgery by extending breast conservation to cases that traditionally required mastectomy, ensuring oncologic effectiveness alongside psychological and aesthetic restoration. Looking ahead, the integration of innovations such as three-dimensional surgical planning, intraoperative imaging, and bioengineered tissue substitutes promises to further expand the scope and precision of OBS. Together, these advances highlight OBS as a cornerstone of modern breast cancer surgery, combining oncological rigor with reconstructive artistry to optimize both survival and survivorship.

Keywords: Breast cancer; Breast conserving surgery; Cosmetic; Flap; Mammoplasty; Reconstructive surgery

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