According to the American Society of Breast Surgeons, oncoplastic surgery involves a form of breast conservation surgery for oncologic resection, ipsilateral reconstruction using either volume displacement or replacement techniques, and contralateral symmetry surgery when indicated [1]. While the first major step for offering improved aesthetic options in breast cancer surgery was the popularization of breast-conserving surgery over mastectomy for appropriate candidates, oncoplastic breast surgery furthers this advance by allowing the excision of a larger amount of breast tissue without compromising aesthetic outcomes, thereby broadening the indication for breast-conserving surgery [2]. In addition, studies report no differences in terms of adverse postoperative outcomes in oncoplastic surgery compared to that of conventional surgery [[3], [4], [5]]. The goal of oncoplastic surgery is disease eradication while taking into consideration the quality of life of the patient with minimal compromise in cosmesis [2]. Emphasis on the positive impact on quality of life and enhanced self-esteem is a key motivation for developing new oncoplastic techniques to further improve patient outcomes [6].

Currently, there are four main categories of breast-conserving surgery techniques: simple wide excision, therapeutic breast reduction, therapeutic mastopexy and volume replacement [2]. Oncoplastic techniques and procedures have evolved in recent years and some standardization and algorithms have been proposed based on tumor size and location, the size of the diseased breast, and the presence of ptosis [7]. Despite these advances, the risk of complications caused by surgery and/or adjuvant radiation therapy, including seromas, breast infections, radiation fibrosis, lymphedema and chronic pain, is still a key consideration when selecting the most adequate technique [8,9]. Taking into account the trend to performing oncoplastic breast surgery, this type of intervention is now included in some standard training programs for breast surgeons [10]. In addition, new guidelines delineating basic oncoplastic techniques have been published in the last years [10,11]. Another relevant consideration in the selection of the most adequate oncoplastic technique is scar cosmesis. For instance, it is well known that sentinel lymph node biopsy (SLNB) along with breast-conserving surgery is the standard of care for early breast cancer and while it has been recognized to as having the same outcomes as axillary lymph node dissection, this procedure creates two scars that can affect a woman's body image and produce skin and wound complications after radiotherapy [12,13].

However most breast cancer surgery in non-metropolitan areas of the USA and in low medium income countries (LMIC) is still performed by general surgeons who may not have had advanced oncoplastic training. [Stitzenberg KB, Chang Y, Louie R, Groves JS, Durham D, Fraher EF. Improving our understanding of the surgical oncology workforce. Ann Surg. 2014 Mar; 259(3):556–62. PMID: 24169179] [Herb J, Holmes M, Stitzenberg K. Trends in rural-urban disparities among surgical specialties treating cancer, 2004–2017. J Rural Health. 2022 Sep; 38(4):838–844. Epub 2022 Mar 14. PMID: 35288990] [Francies FZ, Hull R, Khanyile R, Dlamini Z. Breast cancer in low-middle income countries: abnormality in splicing and lack of targeted treatment options. Am J Cancer Res. 2020 May 1; 10(5):1568–1591. PMID: 32509398]. Thus the importance to develop easy to implement oncoplastic techniques that could allow non-oncoplastic trained surgeons to provide good cosmetic outcomes.

To mitigate the aforementioned problems, we developed the Modified Oncoplastic Lift, Lymphatic Excision and Reconstruction (MOLLER) Technique [14]. This technique uses simplified standard oncoplastic surgical principles to compensate for the loss of volume and projection of the reconstructed breast using internal mastopexy and tissue flap advancements while minimizing axillary incisions for axillary lymph nodes. This technique does not require advanced oncoplastic training. It is easy to teach with a rapid learning curve and is a suitable surgical option for surgeons wishing to perform oncoplastic resection.