Therapeutic Mammaplasty
R.D. Macmillan, MBChB, MD, FRCS,* R. James, MBChB, BA, MEd, FRCS,
K.L. Gale, MBChB, FRACS, and S.J. McCulley, MBChB, FCS(SA), FRCS
Nottingham Breast Institute, Nottingham City Hospital,
Nottingham, United Kingdom
Therapeutic mammaplasty is a term for the oncoplastic application of breast reduction and mastopexy techniques to treat selected breast tumours by breast conserving surgery (BCS). It has the potential to increase the indications for BCS as well as achieve more acceptable aesthetic results from it in suitable women. Now an established technique in the range of oncoplastic options for women with breast cancer, it finds common application and is associated with good oncological and quality of life outcomes.
Therapeutic mammaplasty is a term for the oncoplastic application of breast reduction and mastopexy techniques to treat selected breast tumours by breast conserving surgery (BCS) [1]. Its principle aim is to offer many of the women who would experience a poor cosmetic outcome from standard techniques of BCS an alternative option, and in doing so extend the indications for BCS and improve quality of life.
Therapeutic mammaplasty techniques extend the indications for BCS in two ways:
(1) By achieving acceptable aesthetic outcomes for women with breast cancers who would have unacceptable outcomes with other BCS techniques.
(2) By enabling breast conserving surgery for larger breast cancers.
Thus many women who are treated by therapeutic mammoplasty would otherwise either have a poor outcome from standard techniques of BCS, or have been recommended mastectomy. Poor cosmetic outcome after simple wide local excision is perhaps best predicted by the percentage of breast tissue being removed and the location of the breast cancer but many factors contribute [2]. Quandrantectomy with its wide volume of parenchymal excision‐to‐breast ratio had poor aesthetic outcomes when compared to tumourectomy and early studies concerning the cosmetic outcome of BCS reported rates of excellent/ good outcomes for small breast cancers on the Harris scale between 60% and 86% [3–10].
Therapeutic mammoplasty can achieve more acceptable aesthetic outcomes compared to other BCS techniques:
• By reducing breast size.
• By minimising the significant impact of radiotherapy on women with large breasts.
• By achieving a preferred breast size and shape.
There is a substantial body of evidence confirming the benefits of breast reduction in terms of quality of life. Women with macromastia who undergo breast reduction demonstrate significantly higher levels of self‐esteem, improved quality of life across all domains, improved social and psychosexual function and reduced pain following their surgery [11–15]. As it will be difficult to offer reduction mammaplasty safely after radiotherapy, it can easily be argued that therapeutic mammoplasty should be offered to all women with breast cancer being considered for BCS that wish smaller breasts. This would include women with very small breast cancers.
Excerpt from publication as appears in Journal of Surgical Oncology 2014. Download full article here.