Targeted oncoplastic breast surgery (TOBS) – classification of breast-conserving techniques

Background: Most patients presenting with breast cancer are treated by breast-conserving therapy (BCT). Some of these patients present with poor cosmetic results after surgery. To avoid partial defects after BCT a wide spectrum of reconstructive techniques have been published.

Material and Methods: We prospectively defined five major principles in targeted oncoplastic breast surgery based on the localization, size of the segmental resection defect, size of the breast and the necessity for skin resection during breast-conserving therapy: BCT-glandular rotation, BCT-dermoglandular rotation, BCT-tumoradapted reduction mammoplasty, BCT-thoracoepigastric flap, BCT-latissimus dorsi flap. We analyzed the clinical practicability and the cosmetic results. All patients received adjuvant therapy according to international guidelines. 35% of the treated patients received neoadjuvant chemotherapy.

Results: Between November 2010 and November 2013 we performed 652 breast-conserving operations in 627 patients. For reconstruction of the partial resection defect during segmental resection the defined five oncoplastic principles were used as follows: glandular rotation (n = 378; 58%), dermoglandular rotation (n = 104; 16%), tumoradapted reduction mammoplasty (n = 91; 14%), thoracoepigastric flap (n = 20; 3%) and latissimus dorsi flap (n = 59; 9%). Partial mastectomy defects could be reconstructed during BCT with these five oncoplastic principles in 97%. The cosmetic results were good or excellent in 95%.

Conclusion: The use of targeted oncoplastic breast surgery allows the reconstruction of segmental resection defects during breast-conserving therapy with highest clinical applicability and results in favourable aesthetic outcomes.