Cirurgia oncoplástica da mama: segurança oncológica e resultados estéticos no tratamento conservador da mama

Juarez Antônio  de Sousa; Waldemar  Naves Amaral; André  Maroccolo de Sousa; Laura  Sousa e Sousa; Luiza  Sousa e Sousa; Cayan  Xavier de Paula; Jéssica  Assis Bispo

doi:10.63162/v67n70e26723

Authors

Juarez Antônio de Sousa Doutor, Professor do Departamento de Ginecologia e Obstetrícia da Faculdade de Medicina da Universidade Federal de Goiás (UFG), Goiânia/GO, Brasil. Autor https://orcid.org/0000-0001-5986-7926
Waldemar Naves Amaral Doutor, Professor do Departamento de Ginecologia e Obstetrícia da Faculdade de Medicina da Universidade Federal de Goiás (UFG), Goiânia/GO, Brasil. Autor https://orcid.org/0000-0002-0824-1138
André Maroccolo de Sousa Médico Residente de Cirurgia Geral, Universidade de São Paulo (USP), São Paulo/SP, Brasil. Autor https://orcid.org/0009-0004-5613-1410
Laura Sousa e Sousa Acadêmica de Medicina, Universidade UniEvangélica, Anápolis/GO, Brasil. Autor https://orcid.org/0009-0004-9019-8846
Luiza Sousa e Sousa Acadêmica de Medicina, Universidade UniEvangélica, Anápolis/GO, Brasil. Autor https://orcid.org/0009-0007-3855-8682
Cayan Xavier de Paula Acadêmico de Medicina da Universidade Federal de Goiás (UFG) Goiânia/GO, Brasil. Autor https://orcid.org/0009-0003-2399-9427
Jéssica Assis Bispo Acadêmica de Medicina da Universidade Federal de Goiás (UFG) Goiânia/GO, Brasil. Autor https://orcid.org/0009-0002-0371-209X

DOI:

https://doi.org/10.63162/v67n70e26723

Keywords:

Breast cancer, Breast-conserving surgery, Oncoplastic surgery, Quality of life, Breast reconstruction

Abstract

Breast-conserving surgery has become the standard treatment for most patients with early-stage breast
cancer after studies demonstrated outcomes equivalent to mastectomy regarding overall survival and
local disease control. Despite its oncological effectiveness and psychosocial benefits, tumor excision may
lead to significant breast deformities, particularly when lesions are located in critical breast regions. In this
context, oncoplastic breast surgery emerged as an approach that combines oncologic surgical principles
with reconstructive plastic surgery techniques, allowing wider resections while preserving breast aesthetics.
Oncoplastic procedures are classified into volume displacement and volume replacement techniques,
with the choice depending on tumor characteristics and patient anatomy. Current evidence supports the
oncological safety of these procedures, showing recurrence rates comparable to conventional breastconserving
surgery, as well as lower rates of positive margins and reoperations. Improved cosmetic outcomes
positively influence self-esteem, body image, sexuality, and overall quality of life. Furthermore, advances in
neoadjuvant therapies have expanded the indications for breast-conserving approaches associated with
oncoplastic techniques. Today, oncoplastic surgery is recognized as an essential component of modern
breast cancer management, combining oncological safety with superior aesthetic outcomes and greater
patient satisfaction.

References

Fisher B, Anderson S, Bryant J, et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation. New England Journal of Medicine. 2002;347(16):1233-1241.

Veronesi U, Cascinelli N, Mariani L, et al. Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. New England Journal of Medicine. 2002;347(16):1227-Urban C, Lima RS, Schunemann E, et al. Oncoplastic principles in breast conserving surgery. Breast. 2011;20(Suppl 3):S92-S95.

Silverstein MJ, Savalia N, Khan S, Ryan J. Extreme oncoplasty: breast conservation for patients who need mastectomy. Breast Journal. 2015;21(1):52-59.

Clough KB, Kaufman GJ, Nos C, Buccimazza I, Sarfati IM. Improving breast cancer surgery: a classification and quadrant per quadrant atlas for oncoplastic surgery. Annals of Surgical Oncology. 2010;17(5):1375-1391.

Crown A, et al. Patient-reported outcomes after oncoplastic breast surgery. Breast Journal. 2019;25(1):85-90.

De Lorenzi F, Hubner G, Rotmensz N, et al. Oncological results of oncoplastic breast-conserving surgery: long term follow-up of a large series at a single institution. Breast Cancer Res Treat. 2016;160(3):485-491.

Losken A, Dugal CS, Styblo TM, Carlson GW. A meta-analysis comparing breast conservation therapy alone to the oncoplastic technique. Annals of Plastic Surgery. 2014;72(2):145-149.

Fitoussi AD, Berry MG, Fama F, et al. Oncoplastic breast surgery for cancer: analysis of 540 consecutive cases. Plastic and Reconstructive Surgery. 2010;125(2):454-462.

Weber WP, Soysal SD, El-Tamer M, et al. First international consensus conference on standardization of oncoplastic breast conserving surgery. Breast Cancer Res Treat. 2017;165(1):139-149.

Moran MS, Schnitt SJ, Giuliano AE, et al. Society of Surgical Oncology–American Society for Radiation Oncology consensus guideline on margins for breast-conserving surgery. Ann Surg Oncol. 2014;21(3):704-716.

Early Breast Cancer Trialists’ Collaborative Group (EBCTCG). Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death. Lancet. 2011;378(9804):1707-1716.

Mansfield L, Agrawal A, Cutress RI. Oncoplastic breast conserving surgery. Gland Surg. 2013;2(3):158-162.

Heeg E, et al. Rates of re-excision and conversion to mastectomy after breast-conserving surgery with or without oncoplastic surgery. Br J Surg. 2020.

Association of Breast Surgery. Oncoplastic Breast Surgery Guidelines. 2021.

Associação Brasileira de Mastologia. Consenso Brasileiro de Cirurgia Oncoplástica. São Paulo: SBM; última edição.

Al-Ghazal SK, Fallowfield L, Blamey RW. Comparison of psychological aspects and patient satisfaction following breast conserving surgery, simple mastectomy and breast reconstruction. European Journal of Cancer. 2000;36(15):1938-1943.