Oncoplastic Surgery of the Breast
Edited by Maurice Y. Nahabedian. Pp 178. Saunders/Elsevier, St. Louis, Mo. 2009. Price: $180.
Oncoplastic surgery of the breast has assumed an increasingly important role in the management of breast cancer patients seeking breast-conserving therapy. Although Veronesi demonstrated conclusively that breast-conserving therapy is as safe and efficacious as mastectomy alone, little attention has been paid to the deteriorating aesthetic outcomes of breast-conserving therapy over time. Oncoplastic techniques were born of a desire to prevent deformities arising from the combined effects of therapeutic lumpectomy followed by radiation therapy. While oncoplastic techniques have been slow to achieve widespread acceptance in this country, this regrettable trend is gradually reversing, and Nahabedian's text will undoubtedly make a significant contribution to the field.
Dr. Nahabedian brings to this text a clearly thought out approach to the evolving field of oncoplastic breast surgery with an impressive line-up of contributing authors. The chapter titles reflect an appropriate cross-section of the current elements integral to an understanding of this challenging field. None of the topics are redundant, and the development of the clinical pathway in patient management is logical and well thought out.
The history of oncoplastic surgery is clearly outlined and provides a fascinating insight into the development of breast-conserving therapy, although Audretsch's enormous contribution as a key pioneer in the field is not mentioned. The chapter on safety brings the reader up to date on current data confirming the safety and efficacy of the procedures covered. The ensuing section on management algorithms attempts to delineate clinical pathways for patients presenting at differing stages following diagnosis. It is difficult to achieve a comprehensive algorithm, but Kronowitz tackles the subject with alacrity. It would have been helpful to include his seven-zone classification as a graphic within the body of the text, as it provides a very useful tool in decision making when reduction pedicles are planned. Beahm's chapter provides a concise, well-planned approach to managing the patient based on tumor location and breast size, and will be helpful to surgeons assessing the array of options available. The chapter interfaces well with Silverstein's approach to the oncologic aspects of breast-conserving therapy. The section on reduction mammaplasty is pivotal to oncoplastic surgery and could have been longer. The images clearly demonstrate the cosmetic benefits of oncoplastic reduction in the prevention of postradiation deformity, but an expanded outline with diagrams indicating pedicle transpositions for different tumor locations would be worth including in the next edition, particularly for younger surgeons facing the early cases of their careers. The sections on lateral thoracic and latissimus flaps provide alternatives for segmental reconstruction, although their popularity, like that of free flaps, has decreased as reduction techniques have matured and displaced them to some extent. It is refreshing to have radiation oncologists critically assessing the results of their treatment, and Singh does a fine job of highlighting the problems induced by radiation.
The book flows well and the print size is good, making for easy readability. Referencing is excellent. The text suffers from the common problem of inconsistent color correction of images so frequently seen in modern texts. A future edition would benefit from operative DVDs to supplement the procedures outlined within the text.
This book provides an excellent overview of oncoplastic management of breast cancer and will be a valuable addition to the library of any breast surgeon. Dr. Nahabedian is a thoughtful, honest, incisive thinker as well as a consummate surgeon. He and his coauthors are to be congratulated on a fine effort.
Glyn Jones, M.D.
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