Oncoplasty versus Mastectomy: Decisions and Outcomes

Introduction

As reconstructive techniques have improved, patient expectations have evolved. From the simplest to the most complex resection, patients expect to be satisfied with their final esthetic result. Trying to decide on the operation that is best for patients now involves not only understanding the tumor biology but also patient preference and how to achieve the best esthetic results. Patients can choose breast conservation with or without oncoplastic reconstruction, and mastectomy with nipple sparing or without and with or without reconstruction. The challenge is helping the patient choose the optimal oncologic and cosmetic solution for them.

Understanding expectation is critical before operative intervention. For some women, it is important to preserve as much of their natural breast as possible; whereas for others, achieving the lowest local recurrence risk is the driving force even when the statistical benefit is minimal. Some women hope to end up with a smaller or larger breast. In all cases, the role of the breast surgeon is to help patients understand their choices.