Where excision volumes are more than 10% of total breast volume with medial lesions) and more than 20% with lateral – outer – lesions, an unsatisfactory aesthetic outcome is probable. Tumours that are located centrally in the breast that require nipple excision also often result in visible asymmetry and distortion.

Oncoplastic breast surgery may not be suitable for patients who smoke, or suffer from diabetes or who are obese or where connective tissue disorders may render them more prone to wound complications. A patient will need to be suitable for standard wide local excision procedure with ~1cm of surrounding tissue, i.e. relative to breast size the tumour removal must allow this margin.

Level 1 oncoplastic techniques are used when under 20% of breast volume is to be excised. This involves picking the best placement of the incision, excising the cancer with wide margins and mobilising breast tissue skin and nipple to give the best cosmetic result. Level 2 oncoplastic techniques are used when 20-50% of breast volume is to be excised.

Oncoplastic surgery techniques are classified into two types – volume displacement techniques and volume replacement techniques (indicated below as VDT and VRT). Volume displacement is where remaining breast tissue is used to fill the area previously occupied by the tumour. Displacement techniques reshape the breast/s and will result in smaller breast volume. Volume replacement techniques involve the patient’s own skin and tissue graft (autologous) using myoctaneous or subcutaneous flap procedures. The disadvantage of volume replacement techniques is that they involve more extensive surgery and prevent use of the flaps for any future whole breast reconstruction surgery.

Breast conservation – Volume Displacement techniques

• Crescent Mammoplasty (VDT) – Upper Pole
• Batwing Mammoplasty (VDT) – Upper Pole
• Doughnut / Benelli / Round Block Mammoplasty (VDT)
• Doughnut / Benelli / Round Block Mammoplasty (VDT)
• Lesure Vertical Mammoplasty
• J Mammoplasty
• Matrix Flap
• Shutter Flap
• Racquet Mammoplasty
• Wise Pattern Reduction Superior/Inferior Flap Mammoplasty (VDT)
• Mitre Flap
• Reduction Mammoplasty (VDT) – Lower Pole

Volume replacement Techniques

• Latissimus Dorsi Flap (VRT)
• Thoracic epigastric flap
• Lipo-filling

Techniques used with Mastectomy

• Nipple Sparing Mastectomy with Reconstruction
• Skin Sparing Mastectomy with Reconstruction
• Delayed or Immediate Reconstruction
• Two Stage reconstruction – Tissue expander + Implant
• Implant reconstruction
• Latissimus Dorsi flap reconstruction
• TRAM Flap reconstruction
• DIEP Flap Reconstruction
• Nipple Reconstruction

For detailed information on these techniques, do not hesitate to contact Dr Gault via his reception staff on 07 5539 3999