This document discusses oncoplastic surgery level 2 techniques. Level 2 techniques involve the resection of 20-50% of breast volume and require skin excision and mammoplasty techniques for reshaping. It presents a classification system for level 2 oncoplastic surgery techniques based on the quadrant of the breast involved, and provides examples of specific techniques for each quadrant, such as the batwing technique for the upper inner quadrant and the racquet technique for the upper outer quadrant. The goal of these techniques is to increase breast conservation rates by redistributing volume loss through therapeutic mammoplasty procedures.

1. ONCOPLASTIC SURGERY LEVEL 2 TECHNIQUES Krishna B. CLOUGH, Claude NOS, Isabelle SARFATI Therapeutic mammoplasties

2. ONCOPLASTIC SURGERY : A CLASSIFICATION Level 1 techniques : Less than 20 % of breast volume resected Simple reshaping techniques No plastic surgery training Avoid deformities Reduce reexcisions

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

4. INCREASING BREAST CONSERVATION RATES Development of new surgical techniques: Redistribution of volume loss by mammoplasty

5. 1. Oncologic criteria WHO NEEDS OP SURGERY ?

6. WHO NEEDS OP SURGERY ? 2. Anatomic criteria

8. LOWER POLE

9. " SUPERIOR PEDICLE " TECHNIQUE Clough K.B. et al, AnnChirPlastEsth 1990

10. LOWER POLE

11. LOWER POLE

13. " LEVEL 2 " MAMMOPLASTY TECHNIQUES Other quadrants ? Same technique ? ?

20. DANGEROUS ! AVOID LONG GLANDULAR FLAPS

21. DIVERSIFICATION OF OPS TECHNIQUES Berry JPRAS 2009

22. " LEVEL 2 " MAMMOPLASTY TECHNIQUES Difficult for non plastic surgeon Lack of guidelines Simplification / Standardization : Quadrant per quadrant classification

23. ONCOPLASTIC SURGERY ATLAS Ann Surg Oncol 2010

24. QUADRANT PER QUADRANT LEVEL 2 TECHNIQUES

25. LOWER INNER QUADRANT

26. LOWER INNER QUADRANT

27. LOWER INNER QUADRANT

28. LOWER INNER QUADRANT

29. LOWER INNER QUADRANT

31. UPPER INNER QUADRANT

32. " BATWING " TECHNIQUE Silverstein et al, LancetOncol. 2005

33. UPPER POLE TUMORS

34. " ROUND BLOCK " TECHNIQUE

40. UPPER POLE

41. INFERIOR PEDICLE MAMMOPLASTY

43. UPPER OUTER QUADRANT

44. UPPER OUTER QUADRANT

45. " RACQUET " TECHNIQUE

52. LOWER OUTER QUADRANT

53. "J" TECHNIQUE LOWER OUTER QUADRANT

58. Resection 220 g

59. RETROAREOLAR CANCERS

63. CURRENT SERIES 240 CASES Level 2 OPS Mean excision weight: 145 g Mean T size: 25 mm (max 90) All quadrants

65. BREAST CANCER SURGERY Small tumors : wide excision Large tumors : mastectomy Breast surgery : two bullet rifle 1.Lumpectomy 2.Mastectomy

66. Therapeutic mammoplasties Wider excisions Extension of breast conservation « The third path » ONCOPLASTIC SURGERY 2.OPS 1.Lumpectomy 3.Mastectomy

67. ONCOPLASTIC SURGERY LEVEL 2 TECHNIQUES Wide excision ? Mastectomy ? Level 2 oncoplastic surgery : the " Third path ” Redistribution of volume loss by Mammoplasty Quadrant per Quadrant classification : guide for technique selection

68. ONCOPLASTIC MASTERCLASS PARIS B.CENTER 30 surgeons . Hands-on course 3 full days : Day 1 Surgical techniques Day 2 Cadaver dissection Day 3 Live surgery [email_address]

69. www.idsein.fr

70. 3-5 May 2011 29-31 0ctober 2011 [email_address]