Should Oncoplastic Surgical Procedures Be Tailored to Each Patient Individually?
Absolutely yes. Oncoplastic surgery requires an individualized approach.
Today, oncoplastic surgery is not merely a method aimed at aesthetic improvement, but a complex approach that combines radical tumor excision with aesthetic integrity. However, this surgical approach cannot be applied using a single protocol, as each patient has different anatomical, oncological, and psychosocial characteristics.
Why is Individualization Necessary?
1. Tumor Characteristics Vary
- Tumor location (e.g., upper-outer vs. lower-inner quadrant)
- Size, multifocality, or multicentricity
- Proximity to the skin, nipple, or pectoral fascia
These characteristics directly determine which oncoplastic procedure can be applied.
2. Breast Anatomy and Breast-Tumor Ratio
- Breast volume, ptosis, glandular structure
- Tumor-to-breast ratio: If this ratio is above 20%, Level 2 techniques (e.g., reduction mammoplasty) are generally required.
3. Patient Preference and Psychosocial Factors
- Aesthetic expectations
- Desire for symmetry
- Expectations regarding the return to social life and quality of life after surgery
4. Treatment Plan: Neoadjuvant Chemotherapy, Radiotherapy, etc.
- For example, more conservative oncoplastic options may be considered for tumors that have shrunk after neoadjuvant chemotherapy.
- In patients scheduled for radiotherapy, flap selection and incision site planning should be performed with greater care.
What Does the Literature Say?
- The ESSO–EUSOMA 2021 oncoplastic surgery guidelines recommend individualization of oncoplastic procedures and emphasize that “one procedure does not fit all patients.”
- The oncoplastic techniques defined by Silverstein and Clough are based on patient-specific surgical algorithms.
- The Cochrane database and NICE guidelines recommend that patient expectations and tumor characteristics be integrated into surgical planning.
Clinical Application Example:
Even with the same tumor localization:
- In a young patient with small breasts, glandular rotation may be sufficient;
- In a ptotic, voluminous breast patient, therapeutic reduction can achieve both tumor resection and symmetry.
- In other words, “one surgery does not fit all patients.” Individual adaptation enhances both oncological safety and patient satisfaction.
“Oncoplastic surgery is principle-based, not protocol-based. The success of surgery depends on a multidisciplinary plan tailored to the tumor’s biology, the breast’s anatomy, and the patient’s expectations.”
