This document discusses level 1 oncoplastic surgery techniques, which are simple breast reshaping principles that can be performed without plastic surgery training. These techniques aim to allow for wider excisions for breast conservation while minimizing cosmetic deformities. They include undermining skin and the nipple-areolar complex, recentralizing the nipple, and using glandular flaps or sutures for immediate reshaping. Level 1 techniques can potentially solve 90% of cases and reduce positive margin and reexcision rates.

1. ONCOPLASTIC SURGERY Level 1 techniques : Simple principles Krishna B. CLOUGH, Claude NOS, Isabelle SARFATI

2. ONCOPLASTIC SURGERY Immediate breast reshaping Wider excisions Better cosmesis Increase breast conservation Plastic surgery techniques at the time of tumor excision Audretsch, Clough, Petit, Rainsbury ,...

3. ONCOPLASTIC SURGERY CLASSIFICATION Ann Surg Oncol 2010

4. ONCOPLASTIC SURGERY : A CLASSIFICATION Level 1 techniques : Less than 20 % of breast volume excised Simple reshaping techniques No skin excision No plastic surgery training Avoids deformities

5. ONCOPLASTIC SURGERY : A CLASSIFICATION Level 2 techniques : 20 to 50% of breast volume excised Major volume loss Skin excision required Mammoplasty techniques for reshaping Increase breast conservation rates

6. " LEVEL 1 " ONCOPLASTIC TECHNIQUES Simple techniques No need for plastic surgeon Part of standard breast surgery « Learn on Tuesday, Try on Thursday Keep forever »

7. BREAST CONSERVATION: DILEMMNA Free margins Reduce reexcision rate Wider excisions No cosmetic compromise

8. CONSERVATIVE SURGERY : A CLASH OF INTERESTS

10. INVOLVED MARGINS Involved margins : 10 to 40% Reexcision : 20 to 60% Delay adjuvant treatment Increased costs, complications, anxiety

11. “ RED ZONES "

12. LEVEL 1 OPS GENERAL PRINCIPLES Wide excision from skin to muscle No cavity: immediate breast reshaping Undermine skin from gland Undermine NAC completely NAC re-centralization

13. SKIN UNDERMNING

14. SKIN UNDERMINING

15. BREAST DENSITY : BIRADS CLASSIFICATION 1 2 3 4

16. NAC UNDERMINING

17. NAC UNDERMINING

18. NAC UNDERMINING

19. WIDE EXCISION FROM SKIN TO MUSCLE

20. POSITIVE MARGINS FOR BCT Standard excision : 10 to 30% Oncoplastic surgery : 5 to 18 % Clough 2003, Kaur 2005, Rietjens 2007, Fitoussi 2010 The Paris Breast Center : 8 % 2010, 1215 cases BCT, unpublished data

21. WIDE EXCISION

22. BREAST RESHAPING ?

23. BREAST RESHAPING : GLANDULAR FLAPS

24. GLANDULAR FLAPS

25. GLANDULAR FLAPS

26. GLANDULAR SUTURE

27. ROTATIONAL GLANDULAR FLAPS

28. ROTATIONAL GLANDULAR FLAP

29. ROTATIONAL GLANDULAR FLAP

30. PREVENT NAC DEVIATION ? RE-CENTRALIZATION

31. NAC RE-CENTRALIZATION Opposite to the lumpectomy bed +++

34. Upper inner Q Upper outer Q

35. BCT FOR SUBAREOLAR CANCERS

36. WIDE CENTRAL EXCISION : RESHAPING

37. WIDE CENTRAL EXCISION : RESHAPING

44. PARIS BREAST CENTER 600 new cases +ve margins : 8% Excision from skin to pectoralis Extensive skin undermining NAC undermining NAC re-centralization 90% Oncoplastic surgery level 1

45. ONCOPLASTIC SURGERY From CHILDHOOD TO ADOLESCENCE ? Effort for classification Level 1 techniques : Solve 90% of the cases Simple, no specific training Good cosmetic results Reexcision rate < 10% Level 2 techniques : mammoplasty techniques