[Oncoplasty and immediate breast reconstruction]

Oncoplasty techniques have been progressively and widely carried out in clinical practice after the description of the different procedures adapted to breast volumes and tumor locations. Surgery with oncoplasty makes it possible to reduce the rate of reoperation, for large tumors, with a local recurrence rate and overall survival rate at least equivalent to standard conservative surgeries. When surgery with oncoplasty is offered as an alternative to a mastectomy, the therapeutic implications must be the subject of informed and precise information so that the patient can make a choice between these two possibilities. Surgical expertise is necessary with the completion of initial and/or secondary, theoretical and practical training. If a total mastectomy is indicated for therapeutic or prophylactic purposes, it is more and more often possible to offer the patient immediate breast reconstruction if she wishes. Radiotherapy to the reconstructed breast and the need for adjuvant chemotherapy are no longer obstacles to this treatment proposal to the extent that the patient is requesting it and the risks of complications have been assessed and accepted. Reconstruction by breast implant remains the most used but autologous techniques and in particular lipomodeling make it possible to postpone the placement of foreign bodies.