Oncoplastic breast reconstruction after IORT

Prospective randomized clinical trials have shown that breast-conserving surgery followed by radiotherapy gives equivalent survival rates compared with mastectomy. The indications for breastconserving therapy in breast cancer are expanding. The integration of oncoplastic surgery techniques with breast-conserving segmentectomy is a new approach that allows more extensive resections and results in more cosmetic favourable outcomes. During the last years we have defined five reconstruction principles in oncoplastic breast-conserving surgery. With these five principles we were able to perform more than 95% of all immediate reconstructions of partial mastectomy defects during breast-conserving surgery, resulting in optimized local and aesthetic outcomes. The oncoplastic reconstruction principles of partial mastectomy defects during breast-conserving surgery are as follows: glandular rotation, dermoglandular rotation, tumoradapted reduction mammoplasty, thoracoepigastric flap, Latissimus dorsi flap. Usually the whole breast is percutaneously irradiated after breast-conserving surgery. Depending on different risk factors, a local boost dose is applied to the tumor bed, which leads to a further reduction of local recurrences. Recently, the concept of intraoperative radiotherapy (IORT) as boost during breast-conserving surgery has been introduced internationally. From a surgical point of view intraoperative boost radiotherapy with a mobile device generating low-energy X-rays (Intrabeam^®) can be combined with all oncoplastic principles for reconstructing partial mastectomy defects. The advantage of an oncoplastic reconstruction after breastconserving surgery and IORT boost irradiation should be recommended to improve local outcome, to avoid seroma formation and to improve the cosmetic outcome after treatment.