title: A systematic review of oncoplastic breast-conserving surgery: current weaknesses and future prospects.
abstract: OBJECTIVE
  The primary objectives of this systematic review on oncoplastic breast surgery (OPBS) were to evaluate the oncological and cosmetic outcomes of OPBS. The secondary objectives were to assess morbidity, quality of life, and applied algorithms.
  
  
  BACKGROUND
  Breast-conserving therapy (BCT) has become the standard of care, and survival is now excellent. Consequently, the focus of BCT has increasingly shifted to cosmetic outcome, quality of life, and patient satisfaction. Nonetheless, excision of certain tumors still presents a considerable challenge. Specialized approaches combining oncological surgery and plastic surgery techniques are collectively referred to as OPBS. A summary of OPBS outcomes would facilitate decision-making and best treatment selection by both clinicians and patients.
  
  
  METHODS
  Using specific inclusion and exclusion criteria to analyze 2090 abstracts on the topic of OPBS published between 2000 and 2011, the authors evaluated each study with respect to design and outcomes.
  
  
  RESULTS
  A total of 88 articles were identified for potential inclusion and reviewed in detail by the lead authors. No randomized controlled trials were identified. Eleven prospective observational or comparative studies fulfilled inclusion criteria and were selected. In these studies, 80% to 93% of the tumors were invasive. Tumor-free resection margins were observed in 78% to 93%, resulting in a 3% to 16% mastectomy rate. Local recurrence was observed in 0% to 7% of the patients. Good cosmetic outcome was obtained in 84% to 89% of patients. However, most studies showed significant weaknesses including lack of robust design and important methodological shortcomings, negatively influencing generalizability.
  
  
  CONCLUSIONS
  This systematic review reveals that current evidence supporting the efficacy of OPBS is based on poorly designed and underpowered studies. Given the increasing importance and application of OPBS, there is a pressing need for robust comparative studies, including both randomized controlled trials and well-designed, multicenter prospective longitudinal studies.
authors.affiliation: Department of Surgical Oncology, VU University Medical Center, De Boelelaan, Amsterdam, The Netherlands.
authors.forename: Max H
authors.initials: MH
authors.lastname: Haloua
authors.forename: Nicole M A
authors.initials: NM
authors.lastname: Krekel
authors.forename: Henri A H
authors.initials: HA
authors.lastname: Winters
authors.forename: Derek H F
authors.initials: DH
authors.lastname: Rietveld
authors.forename: Sybren
authors.initials: S
authors.lastname: Meijer
authors.forename: Frank W
authors.initials: FW
authors.lastname: Bloemers
authors.forename: Monique P
authors.initials: MP
authors.lastname: van den Tol
mesh_terms: D001943:Breast Neoplasms / Q000601:surgery*; D004954:Esthetics; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000009:adverse effects / Q000379:methods*; D015412:Mastectomy, Segmental / Q000009:adverse effects / Q000379:methods*; D009364:Neoplasm Recurrence, Local; D017060:Patient Satisfaction; D011788:Quality of Life