Essentials for optimizing outcomes in oncoplastic breast reconstruction

Breast conservation therapy in the setting of breast cancer has been shown to be a safe method for oncologic treatment in certain patients. However, lumpectomy and radiation have historically been associated with contour deformity, asymmetry, and suboptimal aesthetic outcomes. Oncoplastic breast reconstruction is an approach to breast-conserving surgery that includes reconstruction of partial mastectomy defects in order to minimize the deformity caused by treatment. These techniques serve to optimize breast aesthetics and symmetry in the oncologic setting and have improved patient satisfaction in the setting of breast conservation. There are several key points in the planning and execution of oncoplastic surgery as well as secondary procedures to further improve outcomes. Here, the authors present an overview of patient selection, multidisciplinary planning, and surgical technique for primary and secondary reconstruction, with a focus on specific methods of improving outcomes with autologous fat transfer. This review includes an overview of the literature focusing on patient-reported outcomes (PROs), as these play an important role in a surgeon's postoperative assessment of oncoplastic breast reconstruction. Overall, patient satisfaction is high and the oncologic integrity is preserved. Clinical cases are used to illustrate conceptual framework, pertinent anatomy of various techniques, and preoperative and postoperative comparisons.