Partial breast reconstruction: current perspectives

The popularity of breast conservation therapy for the management of women with breast cancer continues to rise. To preserve cosmesis or broaden the indications for breast conservation therapy in some situations, plastic surgeons are now being challenged with the reconstruction of partial mastectomy defects. Numerous techniques exist, either at the time of resection or following radiation, and the decision of which to use depends on breast size, tumor size, and tumor location. Women with unfavorable defects in smaller breasts will often benefit from volume replacement techniques, such as local fasciocutaneous or myocutaneous flaps, without the need for a symmetry procedure. Women with moderate or larger breasts (with or without ptosis) and the potential for an unfavorable result also have the option for volume displacement procedures using local tissue rearrangement techniques to reshape the breast mound. As these are volume reduction procedures, they often require a contralateral procedure for symmetry. The extent of resection (lumpectomy versus quandantectomy) will also influence the type of reconstruction. Patient selection, surgical technique, margin status, and appropriate follow-up are crucial to maximize both oncological safety and cosmesis. The reconstruction of partial mastectomy defects will likely gain popularity as we continue to demonstrate safe and effective treatment algorithms with larger series and longer follow-up in an attempt to minimize locoregional disease and maximize cosmetic outcome.