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International Journal of Breast Cancer
Volume 2011 (2011), Article ID 107981, 10 pages
http://dx.doi.org/10.4061/2011/107981
Review Article

Breast Conservation Surgery: State of the Art

The Breast Care Unit, Leeds General Infirmary, Leeds, West Yorkshire LS1 3EX, UK

Received 28 February 2011; Accepted 29 May 2011

Academic Editor: Mahmoud B. El-Tamer

Copyright © 2011 Jonathan White et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Linked References

  1. B. Fisher, “Laboratory and clinical research in breast cancer—a personal adventure: the David A. Karnofsky memorial lecture,” Cancer Research, vol. 40, no. 11, pp. 3863–3874, 1980. View at Google Scholar · View at Scopus
  2. D. McCready, C. Holloway, W. Shelley et al., “Surgical management of early stage invasive breast cancer: a practice guideline,” The Canadian Journal of Surgery, vol. 48, no. 3, pp. 185–194, 2005. View at Google Scholar · View at Scopus
  3. V. V. Valero, A. U. Buzdar, and G. N. Hortobagyi, “Locally advanced breast cancer,” Oncologist, vol. 1, no. 1-2, pp. 8–17, 1996. View at Google Scholar · View at Scopus
  4. A. Makris, T. J. Powles, S. E. Ashley et al., “A reduction in the requirements for mastectomy in a randomized trial of neoadjuvant chemoendocrine therapy in primary breast cancer,” Annals of Oncology, vol. 9, no. 11, pp. 1179–1184, 1998. View at Publisher · View at Google Scholar · View at Scopus
  5. A. Baildam, H. Bishop, G. Boland et al., “Oncoplastic breast surgery—a guide to good practice,” The European Journal of Surgical Oncology, vol. 33, supplement 1, pp. S1–S23, 2007. View at Publisher · View at Google Scholar · View at PubMed
  6. W. Audretsch and C. Andree, “Is mastectomy still justified—and if, in which patients?” Onkologie, vol. 29, no. 6, pp. 243–245, 2006. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  7. N. Patani and R. Carpenter, “Oncological and aesthetic considerations of conservational surgery for multifocal/multicentric breast cancer,” Breast Journal, vol. 16, no. 3, pp. 222–232, 2010. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  8. P. M. Ravdin, K. A. Cronin, N. Howlader et al., “The decrease in breast-cancer incidence in 2003 in the United States,” The New England Journal of Medicine, vol. 356, no. 16, pp. 1670–1674, 2007. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  9. W. J. Louwman, A. C. Voogd, J. A. van Dijck et al., “On the rising trends of incidence and prognosis for breast cancer patients diagnosed 1975–2004: a long-term population-based study in southeastern Netherlands,” Cancer Causes and Control, vol. 19, no. 1, pp. 97–106, 2008. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  10. C. Héry, J. Ferlay, M. Boniol, and P. Autier, “Quantification of changes in breast cancer incidence and mortality since 1990 in 35 countries with Caucasian-majority populations,” Annals of Oncology, vol. 19, no. 6, pp. 1187–1194, 2008. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  11. L. Tryggvadóttir, M. Gislum, F. Bray et al., “Trends in the survival of patients diagnosed with breast cancer in the Nordic countries 1964–2003 followed up to the end of 2006,” Acta Oncologica, vol. 49, no. 5, pp. 624–631, 2010. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  12. M. Sant, C. Allemani, M. Santaquilani, A. Knijn, F. Marchesi, and R. Capocaccia, “EUROCARE-4. Survival of cancer patients diagnosed in 1995–1999. Results and commentary,” The European Journal of Cancer, vol. 45, no. 6, pp. 931–991, 2009. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  13. S. K. Al-Ghazal, L. Fallowfield, and R. W. Blamey, “Comparison of psychological aspects and patient satisfaction following breast conserving surgery, simple mastectomy and breast reconstruction,” The European Journal of Cancer, vol. 36, no. 15, pp. 1938–1943, 2000. View at Publisher · View at Google Scholar · View at Scopus
  14. A. D. Baildam, “Breast reconstruction—state of the art,” Breast, vol. 15, supplement 2, pp. S27–S30, 2006. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  15. K. Clough, C. Nos, and A. Fitoussi, “Oncoplastic surgery for breast cancer,” Operative Techniques in Plastic and Reconstructive Surgery, vol. 6, no. 1, pp. 50–60, 1999. View at Publisher · View at Google Scholar
  16. W. Audretsch, “Reconstruction of the partial mastectomy defect: classification and method,” in Surgery of the Breast: Principles and Art, S. Spear, Ed., pp. 155–196, Lippincott Raven, Philadelphia, Pa, USA, 1998. View at Google Scholar
  17. G. Bonadonna, U. Veronesi, C. Brambilla et al., “Primary chemotherapy to avoid mastectomy in tumors with diameters of three centimeters or more,” Journal of the National Cancer Institute, vol. 82, no. 19, pp. 1539–1545, 1990. View at Google Scholar · View at Scopus
  18. J. D. Keune, D. B. Jeffe, M. Schootman, A. Hoffman, W. E. Gillanders, and R. L. Aft, “Accuracy of ultrasonography and mammography in predicting pathologic response after neoadjuvant chemotherapy for breast cancer,” The American Journal of Surgery, vol. 199, no. 4, pp. 477–484, 2010. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  19. S. V. Liu, L. Melstrom, K. Yao, C. A. Russell, and S. F. Sener, “Neoadjuvant therapy for breast cancer,” Journal of Surgical Oncology, vol. 101, no. 4, pp. 283–291, 2010. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  20. E. Yeh, P. Slanetz, D. B. Kopans et al., “Prospective comparison of mammography, sonography, and MRI in patients undergoing neoadjuvant chemotherapy for palpable breast cancer,” The American Journal of Roentgenology, vol. 184, no. 3, pp. 868–877, 2005. View at Google Scholar · View at Scopus
  21. I. E. Smith, M. Dowsett, S. R. Ebbs et al., “Neoadjuvant treatment of postmenopausal breast cancer with anastrozole, tamoxifen, or both in combination: the Immediate Preoperative Anastrozole, Tamoxifen, or Combined with Tamoxifen (IMPACT) multicenter double-blind randomized trial,” Journal of Clinical Oncology, vol. 23, no. 22, pp. 5108–5116, 2005. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  22. U. E. Krainick-Strobel, W. Lichtenegger, D. Wallwiener et al., “Neoadjuvant letrozole in postmenopausal estrogen and/or progesterone receptor positive breast cancer: a phase IIb/III trial to investigate optimal duration of preoperative endocrine therapy,” BMC Cancer, vol. 8, article 62, 2008. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  23. A. Barros, M. A. Cardoso, P. Y. Sheng, P. A. Costa, and C. Pelizon, “Radioguided localisation of non-palpable breast lesions and simultaneous sentinel lymph node mapping,” The European Journal of Nuclear Medicine and Molecular Imaging, vol. 29, no. 12, pp. 1561–1565, 2002. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  24. M. Moreno, J. E. Wiltgen, B. Bodanese, R. L. Schmitt, B. Gutfilen, and L. M. da Fonseca, “Radioguided breast surgery for occult lesion localization—correlation between two methods,” Journal of Experimental and Clinical Cancer Research, vol. 27, no. 1, article 29, 2008. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  25. J. M. Dixon, O. Ravi Sekar, J. Walsh, D. Paterson, and T. J. Anderson, “Specimen-orientated radiography helps define excision margins of malignant lesions detected by breast screening,” The British Journal of Surgery, vol. 80, no. 8, pp. 1001–1002, 1993. View at Google Scholar · View at Scopus
  26. N. J. Coombs, P. P. Vassallo, A. J. Parker, and C. Yiangou, “Radiological review of specimen radiographs after breast localisation biopsy is not always necessary,” The European Journal of Surgical Oncology, vol. 32, no. 5, pp. 516–519, 2006. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  27. U. Veronesi, N. Cascinelli, L. Mariani et al., “Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer,” The New England Journal of Medicine, vol. 347, no. 16, pp. 1227–1232, 2002. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  28. B. Fisher, S. Anderson, J. Bryant et al., “Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer,” The New England Journal of Medicine, vol. 347, no. 16, pp. 1233–1241, 2002. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  29. N. Houssami, P. Macaskill, M. L. Marinovich et al., “Meta-analysis of the impact of surgical margins on local recurrence in women with early-stage invasive breast cancer treated with breast-conserving therapy,” The European Journal of Cancer, vol. 46, no. 18, pp. 3219–3232, 2010. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  30. G. Groot, H. Rees, P. Pahwa, S. Kanagaratnam, and M. Kinloch, “Predicting local recurrence following breast-conserving therapy for early stage breast cancer: the significance of a narrow (</=2 mm) surgical resection margin,” Journal of Surgical Oncology, vol. 103, no. 3, pp. 212–216, 2011. View at Publisher · View at Google Scholar
  31. M. C. Smitt, K. Nowels, R. W. Carlson, and S. S. Jeffrey, “Predictors of reexcision findings and recurrence after breast conservation,” International Journal of Radiation Oncology Biology Physics, vol. 57, no. 4, pp. 979–985, 2003. View at Publisher · View at Google Scholar · View at Scopus
  32. M. S. Anscher, P. Jones, L. R. Prosnitz et al., “Local failure and margin status in early-stage breast carcinoma treated with conservation surgery and radiation therapy,” Annals of Surgery, vol. 218, no. 1, pp. 22–28, 1993. View at Google Scholar · View at Scopus
  33. C. Dener, A. Inan, M. Sen, and S. Demirci, “Interoperative frozen section for margin assessment in breast conserving energy,” Scandinavian Journal of Surgery, vol. 98, no. 1, pp. 34–40, 2009. View at Google Scholar
  34. K. Fukamachi, T. Ishida, S. Usami et al., “Total-circumference intraoperative frozen section analysis reduces margin-positive rate in breast-conservation surgery,” The Japanese Journal of Clinical Oncology, vol. 40, no. 6, pp. 513–520, 2010. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  35. M. Bakhshandeh, S. O. Tutuncuoglu, G. Fischer, and S. Masood, “Use of imprint cytology for assessment of surgical margins in lumpectomy specimens of breast cancer patients,” Diagnostic Cytopathology, vol. 35, no. 10, pp. 656–659, 2007. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  36. U. Veronesi, “How important is the assessment of resection margins in conservative surgery for breast cancer?” Cancer, vol. 74, no. 6, pp. 1660–1661, 1994. View at Publisher · View at Google Scholar · View at Scopus
  37. J. C. Hewes, A. Imkampe, A. Haji, and T. Bates, “Importance of routine cavity sampling in breast conservation surgery,” The British Journal of Surgery, vol. 96, no. 1, pp. 47–53, 2009. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  38. L. E. Rutqvist, C. Rose, and E. Cavallin-Ståhl, “A systematic overview of radiation therapy effects in breast cancer,” Acta Oncologica, vol. 42, no. 5-6, pp. 532–545, 2003. View at Publisher · View at Google Scholar · View at Scopus
  39. U. Veronesi, R. Saccozzi, M. Del Vecchio et al., “Comparing radical mastectomy with quadrantectomy, axillary dissection, and radiotherapy in patients with small cancers of the breast,” The New England Journal of Medicine, vol. 305, no. 1, pp. 6–11, 1981. View at Google Scholar · View at Scopus
  40. J. de Csepel, P. I. Tartter, and C. Gajdos, “When not to give radiation therapy after breast conservation surgery for breast cancer,” Journal of Surgical Oncology, vol. 74, no. 4, pp. 273–277, 2000. View at Publisher · View at Google Scholar · View at Scopus
  41. F. Perera, J. Engel, R. Holliday et al., “Local resection and brachytherapy confined to the lumpectomy site for early breast cancer: a pilot study,” Journal of Surgical Oncology, vol. 65, no. 4, pp. 263–268, 1997. View at Publisher · View at Google Scholar · View at Scopus
  42. M. Baum and J. S. Vaidya, “Targeted intra-operative radiotherapy-TARGIT for early breast cancer,” Annals of the New York Academy of Sciences, vol. 1138, pp. 132–135, 2008. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  43. J. S. Vaidya, M. Baum, J. S. Tobias et al., “Targeted intra-operative radiotherapy (Targit): an innovative method of treatment for early breast cancer,” Annals of Oncology, vol. 12, no. 8, pp. 1075–1080, 2001. View at Publisher · View at Google Scholar · View at Scopus
  44. R. R. Patel and R. K. Das, “Image-guided breast brachytherapy: an alternative to whole-breast radiotherapy,” The Lancet Oncology, vol. 7, no. 5, pp. 407–415, 2006. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  45. C. Lemanski, D. Azria, S. Gourgon-Bourgade et al., “Intraoperative radiotherapy in early-stage breast cancer: results of the montpellier phase II trial,” International Journal of Radiation Oncology Biology Physics, vol. 76, no. 3, pp. 698–703, 2010. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  46. M. Clarke, R. Collins, S. Darby et al., “Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials,” The Lancet, vol. 366, no. 9503, pp. 2087–2106, 2005. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  47. R. A. Cochrane, P. Valasiadou, A. R. Wilson, S. K. Al-Ghazal, and R. D. Macmillan, “Cosmesis and satisfaction after breast-conserving surgery correlates with the percentage of breast volume excised,” The British Journal of Surgery, vol. 90, no. 12, pp. 1505–1509, 2003. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  48. C. Boetes, J. Veltman, L. van Die, P. Bult, T. Wobbes, and J. O. Barentsz, “The role of MRI in invasive lobular carcinoma,” Breast Cancer Research and Treatment, vol. 86, no. 1, pp. 31–37, 2004. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  49. L. W. Turnbull, S. R. Brown, C. Olivier et al., “Multicentre randomised controlled trial examining the cost-effectiveness of contrast-enhanced high field magnetic resonance imaging in women with primary breast cancer scheduled for wide local excision (COMICE),” Health Technology Assessment, vol. 14, no. 1, pp. 1–152, 2010. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  50. M. C. Missana, I. Laurent, L. Barreau, and C. Balleyguier, “Autologous fat transfer in reconstructive breast surgery: indications, technique and results,” The European Journal of Surgical Oncology, vol. 33, no. 6, pp. 685–690, 2007. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  51. C. W. Chan, S. J. McCulley, and R. D. Macmillan, “Autologous fat transfer—a review of the literature with a focus on breast cancer surgery,” Journal of Plastic, Reconstructive and Aesthetic Surgery, vol. 61, no. 12, pp. 1438–1448, 2008. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  52. F. de Lorenzi, “Oncoplastic surgery: the evolution of breast cancer treatment,” Breast Journal, vol. 16, supplement 1, pp. S20–S21, 2010. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  53. K. C. Shestak, R. R. Johnson, R. J. Greco, and S. L. Williams, “Partial mastectomy and breast reduction as a valuable treatment option for patients with macromastia and carcinoma of the breast,” Surgery Gynecology and Obstetrics, vol. 177, no. 1, pp. 54–56, 1993. View at Google Scholar · View at Scopus
  54. C. Tausch, T. Hintringer, F. Kugler, C. Schmidhammer, M. Bauer, and M. Aufschnaiter, “Breast-conserving surgery with resection of the nipple-areola complex for subareolar breast carcinoma,” The British Journal of Surgery, vol. 92, no. 11, pp. 1368–1371, 2005. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  55. E. Wagner, P. Schrenk, G. M. Huemer, A. Sir, M. Schreiner, and W. Wayand, “Central quadrantectomy with resection of the nipple-areola complex compared with mastectomy in patients with retroareolar breast cancer,” Breast Journal, vol. 13, no. 6, pp. 557–563, 2007. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  56. V. Galimberti, S. Zurrida, V. Zanini et al., “Central small size breast cancer: how to overcome the problem of nipple and areola involvement,” The European Journal of Cancer Part A, vol. 29, no. 8, pp. 1093–1096, 1993. View at Google Scholar · View at Scopus
  57. L. Benelli, “A new periareolar mammaplasty: the “round block” technique,” Aesthetic Plastic Surgery, vol. 14, no. 2, pp. 93–100, 1990. View at Google Scholar · View at Scopus
  58. R. Masetti, A. Di Leone, G. Franceschini et al., “Oncoplastic techniques in the conservative surgical treatment of breast cancer: an overview,” Breast Journal, vol. 12, no. 5, supplement 2, pp. S174–S180, 2006. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  59. B. O. Anderson, R. Masetti, and M. J. Silverstein, “Oncoplastic approaches to partial mastectomy: an overview of volume-displacement techniques,” The Lancet Oncology, vol. 6, no. 3, pp. 145–157, 2005. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  60. C. Lassus, “Reduction mammaplasty with short inframammary scars,” Plastic and Reconstructive Surgery, vol. 77, no. 4, pp. 680–681, 1986. View at Google Scholar · View at Scopus
  61. C. Lassus, “Breast reduction: evolution of a technique—a single vertical scar,” Aesthetic Plastic Surgery, vol. 11, no. 2, pp. 107–112, 1987. View at Google Scholar · View at Scopus
  62. R. M. Rainsbury, “Breast-sparing reconstruction with latissimus dorsi miniflaps,” The European Journal of Surgical Oncology, vol. 28, no. 8, pp. 891–895, 2002. View at Publisher · View at Google Scholar · View at Scopus
  63. A. Yelland and D. Rainsbury, “The use of the latissimus dorsi musculocutaneous flap for immediate correction of the deformity resulting from breast conservation surgery,” The British Journal of Plastic Surgery, vol. 52, no. 5, pp. 420–421, 1999. View at Google Scholar · View at Scopus
  64. J. M. Dixon, B. Venizelos, and P. Chan, “Latissimus dorsi mini-flap: a technique for extending breast conservation,” Breast, vol. 11, no. 1, pp. 58–65, 2002. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  65. J. E. Rusby, N. Paramanathan, S. A. Laws, and R. M. Rainsbury, “Immediate latissimus dorsi miniflap volume replacement for partial mastectomy: use of intra-operative frozen sections to confirm negative margins,” The American Journal of Surgery, vol. 196, no. 4, pp. 512–518, 2008. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  66. A. M. Munhoz, E. Montag, E. Arruda et al., “Immediate conservative breast surgery reconstruction with perforator flaps: new challenges in the era of partial mastectomy reconstruction?” Breast, vol. 20, no. 3, pp. 233–240, 2011. View at Publisher · View at Google Scholar · View at PubMed
  67. H. Zaha and S. Inamine, “Laparoscopically harvested omental flap: results for 96 patients,” Surgical Endoscopy, vol. 24, no. 1, pp. 103–107, 2010. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  68. J. L. Oh, M. J. Dryden, W. A. Woodward et al., “Locoregional control of clinically diagnosed multifocal or multicentric breast cancer after neoadjuvant chemotherapy and locoregional therapy,” Journal of Clinical Oncology, vol. 24, no. 31, pp. 4971–4975, 2006. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  69. A. Resch, C. Fellner, U. Mock et al., “Locally recurrent breast cancer: pulse dose rate brachytherapy for repeat irradiation following lumpectomy—a second chance to preserve the breast,” Radiology, vol. 225, no. 3, pp. 713–718, 2002. View at Google Scholar · View at Scopus
  70. H. Liu, C. K. Huang, P. C. Yu et al., “Retromammary approach for endoscopic resection of benign breast lesions,” World Journal of Surgery, vol. 33, no. 12, pp. 2572–2578, 2009. View at Google Scholar
  71. E. K. Lee, S. H. Kook, Y. L. Park, and W. G. Bae, “Endoscopy-assisted breast-conserving surgery for early breast cancer,” World Journal of Surgery, vol. 30, no. 6, pp. 957–964, 2006. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  72. K. Yamashita and K. Shimizu, “Transaxillary retromammary route approach of video-assisted breast surgery enables the inner-side breast cancer to be resected for breast conserving surgery,” The American Journal of Surgery, vol. 196, no. 4, pp. 578–581, 2008. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  73. M. Morrow, “Minimally invasive surgery for breast cancer,” The British Medical Journal, vol. 338, p. b557, 2009. View at Publisher · View at Google Scholar · View at Scopus
  74. S. E. Singletary, “Radiofrequency ablation of breast cancer,” The American Surgeon, vol. 69, no. 1, pp. 37–40, 2003. View at Google Scholar · View at Scopus
  75. G. Manenti, F. Bolacchi, T. Perretta et al., “Small breast cancers: in vivo percutaneous US-guided radiofrequency ablation with dedicated cool-tip radiofrequency system,” Radiology, vol. 251, no. 2, pp. 339–346, 2009. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  76. S. Nakamura, M. Ishiyama, and H. Tsunoda-Shimizu, “Magnetic resonance mammography has limited ability to estimate pathological complete remission after primary chemotherapy or radiofrequency ablation therapy,” Breast Cancer, vol. 14, no. 2, pp. 123–130, 2007. View at Publisher · View at Google Scholar · View at Scopus
  77. S. Oura, T. Tamaki, I. Hirai et al., “Radiofrequency ablation therapy in patients with breast cancers two centimeters or less in size,” Breast Cancer, vol. 14, no. 1, pp. 48–54, 2007. View at Publisher · View at Google Scholar · View at Scopus
  78. C. K. Sanger and M. Reznikoff, “A comparison of the psychological effects of breast-saving procedures with the modified radical mastectomy,” Cancer, vol. 48, no. 10, pp. 2341–2346, 1981. View at Google Scholar · View at Scopus
  79. H. Bartelink, F. van Dam, and J. van Dongen, “Psychological effects of breast conserving therapy in comparison with radical mastectomy,” International Journal of Radiation Oncology Biology Physics, vol. 11, no. 2, pp. 381–385, 1985. View at Google Scholar · View at Scopus
  80. R. M. Nicholson, S. Leinster, and E. M. Sassoon, “A comparison of the cosmetic and psychological outcome of breast reconstruction, breast conserving surgery and mastectomy without reconstruction,” Breast, vol. 16, no. 4, pp. 396–410, 2007. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus