Invisible Surgery Concept and Scenario Strategy: How to Get the Best Aesthetic Results in Oncoplastic Breast-Conserving Surgery.

The authors believe that oncoplastic breast surgery has to achieve the best possible aesthetic results. In this article, they propose the concept of "invisible surgery." This is a combination of certain oncoplastic techniques that allows for restoration of the original appearance of the breast without obvious scars on the breast. Further, the authors classify the techniques as follows: the "level 1 technique," with contour approach; the "from inside" technique; the lateral parenchymal flap; the axillary subcutaneous adipofascial flap; the rotational lateral thoracic flap; regional island perforator flaps (lateral intercostal artery perforator, lateral thoracic artery perforator, anterior intercostal artery perforator, and medial intercostal artery perforator flaps); and the nipple-sparing mastectomy with immediate expander reconstruction. These techniques were combined by internal logic-one can move from one to another according to the preoperative planning and margins status during the operation. They call their approach the "scenario strategy." The authors have performed 138 operations in 137 patients using this approach. Most of them involved the "from inside" technique and perforator flaps. The average tumor size was 2.4 cm, and the average specimen weight was 43.2 g. The total rate of complications was 14.6 percent. According to this concept, the surgery should be performed in such way that breast appearance will not change. It should be planned as one would plan a staged procedure, taking into account possible changes in the scenario during the operation to achieve the best possible aesthetic result.