title: Oncoplastic techniques allow extensive resections for breast-conserving therapy of breast carcinomas.
abstract: OBJECTIVE
  To assess the oncologic and cosmetic outcomes in women with breast carcinoma who were treated with breast-conserving therapy using oncoplastic techniques with concomitant symmetrization of the contralateral breast.
  
  
  BACKGROUND
  Although breast-conserving therapy is the standard form of treatment for invasive breast tumors up to 4 cm, in patients with large, ill-defined, or poorly situated tumors, cosmetic results can be poor and clear resection margins difficult to obtain. The integration of oncoplastic techniques with a concomitant contralateral symmetrization procedure is a novel surgical approach that allows wide excisions and prevents breast deformities.
  
  
  METHODS
  This is a prospective study of 101 patients who were operated on for breast carcinoma between July 1985 and June 1999 at the Institut Curie. The procedure was proposed for patients in whom conservative treatment was possible on oncologic grounds but where a standard lumpectomy would have led to poor cosmesis. Standard institutional treatment protocols were followed. All patients received either pre- or postoperative radiotherapy. Seventeen patients received preoperative chemotherapy to downsize their tumors. Mean follow-up was 3.8 years. Results were analyzed statistically using Kaplan-Meier estimates.
  
  
  RESULTS
  Mean weight of excised material on the tumor side was 222 g. The actuarial 5-year local recurrence rate was 9.4%, the overall survival rate was 95.7%, and the metastasis-free survival rate was 82.8%. Cosmesis was favorable in 82% of cases. Preoperative radiotherapy resulted in worse cosmesis than when given postoperatively.
  
  
  CONCLUSIONS
  The use of oncoplastic techniques and concomitant symmetrization of the contralateral breast allows extensive resections for conservative treatment of breast carcinoma and results in favorable oncologic and esthetic outcomes. This approach might be useful in extending the indications for conservative therapy.
authors.affiliation: Department of General and Breast Surgery, Institut Curie, Paris, France. krishna.clough@curie.net
authors.forename: Krishna B
authors.initials: KB
authors.lastname: Clough
authors.forename: Jacqueline S
authors.initials: JS
authors.lastname: Lewis
authors.forename: Benoit
authors.initials: B
authors.lastname: Couturaud
authors.forename: Alfred
authors.initials: A
authors.lastname: Fitoussi
authors.forename: Claude
authors.initials: C
authors.lastname: Nos
authors.forename: Marie-Christine
authors.initials: MC
authors.lastname: Falcou
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle; D001943:Breast Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D002277:Carcinoma / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D003131:Combined Modality Therapy; D004954:Esthetics; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D015412:Mastectomy, Segmental / Q000379:methods*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology*; D009367:Neoplasm Staging; D017060:Patient Satisfaction; D011446:Prospective Studies; D013518:Surgery, Plastic / Q000379:methods*; D016019:Survival Analysis; D016896:Treatment Outcome