Integration of Plastic Surgery in the Course of Breast-Conserving Surgery for Cancer to Improve Cosmetic Results and Radicality of Tumor Excision

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Abstract
Reducing the psychological distress, which may result from the treatment of breast cancer is an important plastic surgical goal. Such distress occurs with both conservative surgery (CS) and total breast reconstruction (BR), as in the case of mastectomy. Immediate or delayed breast reconstructions are becoming increasingly common as their absolute contraindications are becoming less and less. For example, absolute contraindications to immediate breast reconstruction might only be limited to cases of locally advanced disease or inflammatory cancers. Today’s plastic surgeons are called upon to improve the cosmetic results of aggressive conservative treatment. Indications for breast-preserving surgery, restricted initially to very small tumors, unifocal tumors, are now being proposed for tumors up to 4 or 5 cm in diameter, bifocal tumors located in the same quadrant, and even for large tumors which have been reduced in size by several courses of neoadjuvant chemotherapy. In some cancer protocols, the size reestriction on tumors suitable for CS relates only to tumor size as it compares to total breast volume, the main criterion being the final expected cosmetic result. In all cases, the cosmetic outcome correlates to the size of the specimen removed — more precisely, to the size of the specimen compared to the size of the breast and the size of the tumor including the width of the free margins.