Synopsis
Choose a breast-conserving oncoplastic approach that achieves adequate cancer excision while preserving breast shape and access to effective adjuvant treatment.
- Oncoplastic conservation combines cancer excision with volume displacement or replacement; a cosmetic opportunity does not make an oncologically unsuitable conservation operation safe.
- Displacement reshapes remaining breast tissue, often through therapeutic mammoplasty in a larger ptotic breast; replacement brings tissue into a defect when the remaining breast volume is insufficient.
- Orient the specimen and mark the tumour bed with titanium clips for radiotherapy. Offer further surgery for invasive cancer or DCIS at a radial margin; consider it for invasive cancer more than 0 but less than 1 mm away, or pure DCIS more than 0 but less than 2 mm away.
Key red flags
An enlarging tense breast, worsening skin colour or unexpected severe pain after surgery needs prompt surgical assessment rather than waiting for a scheduled cosmetic review.
Investigation priorities
Define the malignant target and establish whether its extent permits the proposed conservation operation. Review mammography, ultrasound and biopsy together; add selected imaging only when it answers an unresolved extent question.
Management branches
A woman with a large ptotic breast has a unifocal lower-pole cancer. Imaging and biopsy agree, conservation is appropriate, and she would welcome a smaller breast.
- The team reviews the planned excision relative to the nipple-bearing tissue and confirms that a therapeutic mammoplasty can remove the cancer while retaining a viable reshaped breast. She chooses displacement after discussing simple excision, replacement and mastectomy alternatives.
- The surgeon performs the agreed excision, orients the specimen and places tumour-bed clips for the radiotherapy handover before completing the planned reshaping. This case uses a documented pedicle design compatible with the cancer location; the decision is not made from breast size alone.