title: Oncoplastic surgery for breast cancer based on tumour location and a quadrant-per-quadrant atlas.
abstract: BACKGROUND
  The majority of published techniques for oncoplastic surgery rely on an inverted-T mammoplasty, independent of tumour location. These techniques, although useful, cannot be adapted to all situations. A quadrant-per-quadrant atlas of mammoplasty techniques for large breast cancers was developed in order to offer breast surgeons a technique dependent on tumour location, which reduces the risk of postoperative complications and delay to adjuvant therapy.
  
  
  METHODS
  From 2005 to 2010, a series of eligible women with breast cancer were treated by quadrant-specific oncoplastic techniques. All complications and any delay to adjuvant treatment were recorded prospectively, along with local and distant cancer recurrences. Cosmetic outcome was evaluated using a five-point scale.
  
  
  RESULTS
  A total of 175 patients were analysed. The median tumour size, after histological examination, was 25 (range 4-90) mm. Twenty-three patients (13.1 per cent) had involved margins. Seventeen of these patients were treated by mastectomy and three had a re-excision. Complications occurred in 13 patients (7.4 per cent), which led to a delay to adjuvant treatment in three (1.7 per cent). After a median follow-up of 49 (range 23-96) months, three patients had developed a local recurrence. The mean score after cosmetic evaluation was 4.6 of 5.
  
  
  CONCLUSIONS
  A quadrant-per-quadrant approach to oncoplastic techniques for breast cancer was developed that tailors the mammoplasty for each tumour location. This panel of techniques should be a useful guide for breast surgeons, and extends the possibilities for breast conservation for large or poorly limited cancers, with a low complication rate and good cosmetic results.
authors.affiliation: The Paris Breast Centre--L'Institut du Sein, Paris, France. krishna.clough@orange.fr
authors.forename: K B
authors.initials: KB
authors.lastname: Clough
authors.forename: T
authors.initials: T
authors.lastname: Ihrai
authors.forename: S
authors.initials: S
authors.lastname: Oden
authors.forename: G
authors.initials: G
authors.lastname: Kaufman
authors.forename: E
authors.initials: E
authors.lastname: Massey
authors.forename: C
authors.initials: C
authors.lastname: Nos
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000601:surgery*; D018270:Carcinoma, Ductal, Breast / Q000601:surgery*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000601:surgery*; D018275:Carcinoma, Lobular / Q000601:surgery*; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome