Introduction Introduction Approximately 14,000 women and 100 men are diagnosed with invasive breast cancer each year in the Netherlands, and approximately 1,900 patients have an in situ carcinoma. A woman’s risk of having breast cancer during the course of her life is 12%‐13%. Breast cancer is the most common form of cancer in women in the Netherlands.1,2 Ablative surgery has been the primary and single modality for the treatment of breast cancer for centuries. The Halsted radical mastectomy, which consisted of an en bloc excision of the breast, the pectoralis muscles, and the axillary lymph nodes, remained the golden standard for almost a century.3,4 For the past 40 years, breast cancer treatment has transitioned from the Halsted radical mastectomy to less extreme, breast‐conserving procedures, or to breast reconstruction in cases where breast amputation had been performed. The advances in autologous tissue techniques, the refinements in implant technology, and the development of a‐cellular dermal matrix and immediate breast reconstructive techniques have resulted in increasing superior aesthetic results while reducing patient morbidity and improving quality of life.5 Summary of breast cancer treatment: limited conserving therapy or ablative therapy with reconstruction Although breast cancer is the most common female cancer in Western populations, treatment developments such as screening to reduce the size at diagnosis, radiotherapy, chemotherapy, and hormonal therapy have improved survival.6,7 Improving survival has coincided with less radical treatment strategies and more focus on aesthetic outcome. The emotional and psychosocial benefits of breast‐conserving therapy or mastectomy with breast reconstruction compared with mastectomy have been clearly demonstrated. In breast‐conserving therapy, lumpectomy in combination with radiation has proven to be as effective as mastectomy and has potential advantages of better cosmesis and body image compared with amputation.8 Randomized trials with 2 cm9 and 4 cm10 tumors have confirmed overall survival after breast conserving treatment being similar to that after mastectomy, although the rate of local recurrence was slightly higher.11,12 Depending on the volume of resection, breast‐conserving surgery followed by radiation result in poor cosmesis and therefore not fulfill surgical and patient expectations.13,14 Therefore, breast‐conserving surgery further evolved to include breast‐reshaping and/or volume replacement techniques, which enable wider tumor excision with an aesthetic superior outcome.15 With breast‐reshaping techniques based on reductionplasty techniques, the breast parenchyma is redistributed to fill the defect in the breast.16,17 The use of breast reduction techniques enables a greater volume of tissue containing the cancer to be removed with tumor free resection margins. Good preoperative planning between the surgeon and the plastic surgeon allows adequate 11
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