Oncoplastic surgery in the treatment of breast cancer: a review of evolution and surgical training.

Abstract

Oncoplastic breast surgery (OBS) has undergone significant advancement in recent decades, transforming breast cancer (BC) treatment by facilitating increased rates of breast-conserving surgery (BCS) through volume displacement techniques and enabling immediate reconstruction via volume replacement following mastectomy. This approach has demonstrably improved cosmetic outcomes and health-related quality of life metrics for patients undergoing oncological intervention. The progression of surgical methodology from Halsted's radical mastectomy to contemporary oncoplastic techniques constitutes a fundamental paradigm shift in surgical approach. Meta-analyses and prospective cohort studies have established that oncoplastic techniques maintain oncological safety when compared with conventional BCS and mastectomy, demonstrating comparable local recurrence (LR) rates and disease-free survival (DFS) outcomes. Multiple classification systems for oncoplastic procedures have been established based on quantifiable metrics including percentage of breast volume resected, surgical complexity indices, and technical approach parameters, providing evidence-based frameworks for clinical decision-making. The breast surgeon currently functions as the critical nexus in multidisciplinary treatment of BC, integrating optimized surgical techniques with multimodal treatment protocols, particularly systemic therapeutic agents. The implementation of neoadjuvant chemotherapy (NCT) regimens has expanded the indications for breast conservation in cases previously requiring mastectomy, leading to the development of the "extreme oncoplasty" concept for selected patients. Nevertheless, significant implementation barriers persist globally, predominantly related to educational infrastructure limitations and the absence of standardized oncoplastic surgical training curricula for breast surgeons. Diverse training methodologies have emerged internationally, including simulation-based learning, subspecialty fellowships, and curricular integration in surgical residency programs, though outcome-based standardization remains elusive. This non-systematic review analyzes the developmental trajectory of breast cancer surgery, examining the evolution and validation of oncoplastic techniques, standardized classification systems, applications in challenging clinical scenarios, and the current status of surgical education, emphasizing the pivotal role of professional societies in developing evidence-based educational initiatives to broaden access to these advanced surgical techniques.