Background. Assessment of the ratio between tumour volume and breast volume in therapeutic mammoplasty is paramount. Traditionally based on clinical assessment and conventional breast imaging, the role of breast magnetic resonance imaging (MRI) in this context has not been established. Methods. Data was collected from all women undergoing therapeutic mammoplasty (TM) between 2006 and 2011. Each case was discussed at an MDT where MRI was considered to facilitate surgical planning. The contribution of MRI to disease assessment and surgical outcome was then reviewed. Results. 35 women underwent TM, 15 of whom had additional MRI. 33% of patients within the MRI subgroup had abnormalities not seen on either mammography or USS. Of those undergoing MRI, 1/15 patients required completion mastectomy versus 3 patients requiring completion mastectomy and 1 patient requiring further wide local excision (4/20) in the conventional imaging group. No statistical difference was seen between size on MRI and size on mammography versus final histological size, but a general trend for greater correlation between size on MRI and final histological size was seen. Conclusion. MRI should be considered in selected patients undergoing therapeutic mammoplasty. Careful planning can identify those who are most likely to benefit from MRI, potentially reducing the need for further surgery. 1. Introduction The primary aim of surgical oncology is complete removal of the cancer with clear margins. Within breast surgery, the realisation that adequate oncological margins could be obtained without full amputation of the breast was first put forward by Keynes in 1937 [1]. With the addition of irradiation of the breast for control of local recurrence in 1939, a fundamental change was brought about in the approach to the breast cancer. With time breast surgery has become less and less radical. The Halstead radical mastectomy and the Patey modified radical mastectomy are now largely confined to the history books and we are without question in an era when the majority of patients can have “breast conserving surgery” [2]. With the refinement of breast conserving surgical techniques, combined with the development of specialist breast surgeon training in reconstructive and aesthetic breast surgery, the place of cosmesis in the surgical management of breast cancer has gained increasing attention. There is evidence that removal of greater than 10–20% of breast volume is associated with unacceptable cosmetic appearance and poor psychological adjustment after surgery [3]. Therefore, the role of
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