[What's new in oncologic plastic surgery in 2025?]

Oncological plastic surgery plays a central role in the management of cancers requiring complex reconstruction. Recent years have seen significant advances in oncology, both therapeutic and technological. The aim of this article is to provide an overview of major recent developments in oncological plastic surgery, through a selection of impactful recent studies chosen by national experts in three of the main fields of this specialty.

Between October and November 2024, national experts and/or representatives of French scientific societies were invited to participate in this analysis. The covered domains included senology, soft tissue sarcoma surgery, and oncological dermatologic surgery. Each expert selected two recent articles (≤5years) deemed relevant within their field of expertise. Selected studies had to have a direct impact on clinical practice in oncological plastic surgery. Each article was validated, analyzed, and synthesized with a focus on its practical implications for reconstructive plastic surgery.

Recent developments in oncological plastic surgery show profound changes in treatment strategies, largely influenced by the emergence of neoadjuvant immunotherapy and an increasingly personalized approach to reconstruction. In senology, there is a reduction in surgical indications, particularly with the decreasing use of sentinel lymph node biopsy in early breast cancer and reconsideration of axillary dissection in the presence of positive sentinel nodes (but normal axillary ultrasound). In soft tissue sarcomas, the role of the plastic surgeon is reinforced to ensure clear resection margins, and a risk-based reconstruction algorithm now guides the use of flaps in high-risk patients. In oncological dermatology, neoadjuvant immunotherapy is gaining a growing role in the treatment of advanced stages of melanoma and squamous cell carcinoma, reshaping the timing and indications for surgical intervention.

Oncological plastic surgery is moving towards more targeted, less invasive approaches, integrated within multidisciplinary therapeutic strategies. In this context, understanding recent oncological advances - particularly in immunotherapy, neoadjuvant protocols, and patient selection criteria - is essential for plastic surgeons to ensure optimal and up-to-date patient care.