Oncoplastia extrema, ¿alternativa a la mastectomía? Revisión de la literatura

Introduction

Conservative treatment is considered the standard of care for early stages of breast cancer with no difference in oncological safety compared to mastectomy. However, there are still certain scenarios in which mastectomy is advocated. The concept of oncoplastic surgery has emerged to improve the defects resulting from conservative surgery, in which plastic surgery techniques are used and which could also have added value in reducing the indications for mastectomy. In this context, the aim of this review is to analyse the current scientific evidence on extreme oncoplastic surgery in locally advanced breast cancers.

Materials and methods

We undertook a search of the literature published in the Medline database using the terms "extreme oncoplasty" OR "extreme oncoplastic", and found a total of 17 publications. Finally, 6 articles were analysed, after applying the inclusion and exclusion criteria.

Results

The re-excision rate after extreme oncoplasty ranged from 0%-37.8% with a conversion rate to mastectomy of 0%–13.5%. The highest rate of minor complications was 24% and of major complications was 10%, with no delay in the initiation of adjuvant treatment. Satisfaction scores of more than 75% were obtained. These results compare favourably with conventional oncoplastic surgery and mastectomy.

Conclusions

Extreme oncoplasty may be a conservative alternative to mastectomy with reconstruction in a selected group of patients with local recurrence of less than 10% at 10 years, with a low complication rate and good patient satisfaction. However, prospective randomised trials are needed to improve the quality of the evidence.