Prof. Kefah Mokbel: Oncoplastic Surgery and Sentinel Lymph Node Biopsy
Oncoplastic breast surgery combines surgical oncological treatment of breast cancer with plastic breast surgery. The approach is rapidly evolving as an integral part of the surgical treatment of breast cancer and has widened the indications for breast conserving surgery (BCS). The aesthetic outcome of BCS and radiotherapy is compromised in 25% of patients and this can be avoided in the majority of such cases using the oncoplastic approach.
In women requiring or requesting mastectomy for breast cancer, skin-sparing mastectomy (SSM) can facilitate immediate breast reconstruction (IBR) and is associated with an excellent aesthetic result. In appropriately selected cases SSM is oncologically adequate. There are several patient centred advantages over conventional mastectomy, including aesthetic outcome and the avoidance of multiple staged procedures. Surgical adjustment of the contralateral breast is frequently required in order to optimise symmetry and this can be performed concurrently or as a delayed procedure. Controversies including the impact of radiotherapy (RT) on immediate breast reconstruction (IBR), preservation of the nipple-areola complex (NAC) and the role of endoscopic mastectomy are also considered.
Despite widespread uptake of oncoplastic approaches into surgical practice, validation of these techniques from randomised controlled trials is lacking.
Finally the current status of the sentinel node biopsy in the management of breast cancer including recent advances and controversies will be briefly addressed.