From Radical Mastectomy to Breast-Conserving Therapy and Oncoplastic Breast Surgery: A Narrative Review Comparing Oncological Result, Cosmetic Outcome, Quality of Life, and Health Economy
Surgical management of breast cancer has evolved considerably over the last two decades. There has been a major shift toward less-invasive local treatments, from radical mastectomy to breast-conserving therapy (BCT) and oncoplastic breast surgery (OBS). In order to investigate the efficacy of each of the three abovementioned methods, a literature review was conducted for measurable outcomes including local recurrence, survival, cosmetic outcome, quality of life (QOL), and health economy. From the point of view of oncological result, there is no difference between mastectomy and BCT in local recurrence rate and survival. Long-term results for OBS are not available. The items assessed in the QOL sound a better score for OBS in comparison with mastectomy or BCT. OBS is also associated with a better cosmetic outcome. Although having low income seems to be associated with lower BCT and OBS utilization, prognosis of breast cancer is worse in these women as well. Thus, health economy is the matter that should be studied seriously. OBS is an innovative, progressive, and complicated subspeciality that lacks published randomized clinical trials comparing surgical techniques and objective measures of outcome, especially from oncologic and health economy points of view. 1. Introduction Until recently, surgical management of Breast Cancer (BC) has focused on two main choices: tumor resection using breast conserving therapy (BCT) and mastectomy with optional tissue displacement by breast reconstruction. From 2003, the techniques that combine the skill of resection and reconstruction in one procedure were introduced that can be named as the third approach, oncoplastic breast surgery (OBS). This approach involves reconstruction of the resection defects by volume displacement using adjacent breast tissue. Both techniques are adopted from the conventional methods of breast reduction and reconstruction [1]. Mastectomy includes excision of the breast tissue and is divided into subtypes according to the resection of lymph nodes and muscles. Traditionally, it is employed when the risk of local recurrence is increased by tumor size of greater than 5？cm, presence of lymphovascular invasion, presence of more than 4 suspected nodes, and involved or closed margins [2]. BCT is composed of lumpectomy or wide local excision and axillary dissection with or without radiotherapy. It was accepted as a surgical option after thorough evaluation in six international prospective randomized trials for early stages of BC (Stages I and II) [3, 4]. Traditional contraindication to perform BCT
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