A-05: A Practical Quadrant-Based Approach to Oncoplastic Breast-Conserving Surgery

Abstract

Background: Oncoplastic breast-conserving surgery (OBCS) has expanded the role of breast conservation by allowing wider resections while preserving breast shape and symmetry. However, selection of an appropriate technique remains challenging because it depends on the anticipated volume of tissue loss, breast size and ptosis, and tumour location. Aims: To provide a practical, quadrant-based framework for selecting oncoplastic techniques according to the level of complexity and the principles of volume displacement and volume replacement. Methods: Contemporary classifications and commonly used OBCS techniques were reviewed and synthesised into a structured selection matrix. Level I procedures are suited to smaller defects, whereas Level II techniques allow management of resections of approximately 20% to 50% of breast volume through more extensive parenchymal mobilisation and, when required, therapeutic mammaplasty. Volume displacement procedures, including Benelli, Grisotti, tennis-racket, batwing, vertical, J- and V-mammaplasty, can be selected according to breast morphology and tumour quadrant. In smaller or less ptotic breasts where native tissue is insufficient, volume replacement using LICAP, LTAP, AICAP, MICAP, TDAP or selected latissimus dorsi flaps provides an alternative. Conclusion: A quadrant-specific approach facilitates systematic matching of tumour location and defect characteristics with an appropriate reconstructive strategy. OBCS can therefore widen the boundaries of breast conservation while maintaining oncological intent, breast symmetry and body image. A practical selection framework may assist surgeons in planning reproducible, patient-specific oncoplastic procedures.