Oncoplastic to Onco-Aesthetic Surgery: A Movement toward Overtreatment?

85 Lters Dear Editor: I read with considerable concern the communication from Dr Carmichael and Dr Mokbel in this journal on the subject ‘Evolving Trends in Breast Surgery: Oncoplastic to Onco-Aesthetic Surgery’ [1]. The authors laud the use of oncoplastic breast surgery (OBS) and characterise its further development as deserving of the designation ‘onco-aesthetics’. This suggests a sense of justification for giving a pre-eminent role to aesthetic procedures in the surgical treatment of breast cancer. Such a prioritisation calls for serious reconsideration in light of treatment objectives, as current evidence indicates that the use of OBS may have a negative impact on patient outcomes in terms of survival and morbidity. Current data demonstrate that breast conservation treatment (BCT) is associated with higher breast cancer-specific survival and improved local control compared with mastectomy [2,3]. This fact legitimises the goal of expanding the eligibility for BCT and extending its utility. The quality of cosmetic outcomes is also a factor to be considered, and there is little objection to using reasonable methods to achieve acceptable breast forms. However, the incremental and progressive use of OBS for the express purpose of achieving aesthetic excellence is controversial. There are data to suggest that patients who have undergone OBS score significantly worse than those who have undergone standard BCT in terms of cosmetic outcomes, when assessed objectively by the software programme BCCT.core [4]. This indicates that significant mobilisation during mammoplasty has implications for both cosmesis and effective boost delivery during raLETTERS