Breast cancers are the most common cancers in the world [1]. They represent 55% of gynecologic and breast cancers and 21% of all cancers in Burkina Faso [2]. Their frequency is constantly increasing and they keep the particularity of occurring in young patients in Africa [3-5]. Surgery remains the essential curative treatment. This surgery has undergone an important evolution since the first modern description by Halsted in 1889 [6]. Radical mastectomy is mutilating and a consequence of refusal of treatment, even depression [7]. This has prompted surgeons to develop less mutilating techniques [8, 9].

Surgical oncology has therefore become less and less extensive without compromising oncological safety [8, 9]. Indeed, with the advent of radiotherapy, breast cancer surgery has become more and more conservative [8, 9]. This results in a permanent concern to leave aesthetically acceptable breasts in place [10]. This gave birth to a subspecialty of oncology borrowing plastic surgery techniques, it is oncoplastic breast surgery. Commonly practiced in Europe, in the treatment of breast cancer, oncoplasty is still in its onset in West Africa, more particularly in Burkina Faso. Indeed, diagnostic delays and the inaccessibility of radiotherapy further reduce the scope for conservative surgery [7]. However, demand is growing, pushing surgeons to perform conservative surgery with the use of oncoplastic technique upon radiotherapy outside Burkina Faso [7]. Burkina Faso has just completed the construction of its first radiotherapy centre and oncoplasty should take off as soon as this centre begins to operate. This work aims to describe the first steps of oncoplastic breast surgery in Burkina Faso through its indications, techniques, difficulties and results.

We report 64 cases of oncoplastic surgery, that is 6.9% of the 918 surgeries performed for breast cancer over the past 9 years. The mean age of the patients was 44 +/- 15.2 years with extremes of 21 and 62 years (Table 1). The size of tumor was less than or equal to 2 cm in 63.3%. Infiltrating ductal carcinomas represented 84.4% of cases (Table 1).

Breast cancer is the most common female cancer [11]. In the West, conservative surgery and breast reconstruction have gained momentum and 74% of women in France benefit from them without the oncological prognosis being degraded [12]. In India, between 38.8 and 46.6% of patients benefit from this innovative surgery [13]. Although this is still timid in Burkina Faso, requests for conservative surgery are increasingly made by patients. This is why conservative surgery is gradually taking its place [7]. The patients eligible for conservative surgery were only those requesting, carrying a single mass, less than 3 cm, distant from the areola-nipple plaque when radiotherapy was available [14]. Currently, size of tumor is no longer the main eligible criteria for conservation [7, 14]. The conservative surgery with or without an oncoplastic technique is possible as soon as the ratio of tumor size to breast size is less than 20% [7, 14]. The only formal contraindications to conservative surgery are inflammatory tumors regardless of their response to neoadjuvant chemotherapy and also the patient’s refusal [7]. In our setting, the absence of radiotherapy between 2013 and 2020 reduced the potential number of oncoplastic breasts surgeries. This is why only 6.9% of women operated on for breast cancer have benefited from it. In fact, few women could afford radiotherapy outside the country after surgery. We used 6 oncoplastic techniques. The techniques most used in our series were the upper pedicle technique and the Round block technique respectively. The techniques used depend on the topography of the tumor [14]. Oncoplasty can be performed immediately or after neoadjuvant chemotherapy when the size of the mass is large [14, 15]. In all cases of invasive carcinoma, we have associated an axillary dissection removing the first two stages of Berg. This is consistent with the surgical management of invasive breast cancer [16].

Complications were rare in our series and mainly consisted of aesthetic sequelae associated with grade 1 and 2 conservative treatment (ASCT) treated with lipoffiling. In the literature, many sequelae have been described and their treatment is done through lipoffilling, autologous or heterologous flaps [14, 17]. Recurrences were noted in 4.7% of cases. This recurrence rate in our group of patients who all had radiotherapy after surgery was not greater than the rate observed after radical surgery [18]. The 5-year survival was 90.5% in our series. It is better than that of the general population of patients followed for breast cancer [15]. This should be viewed with caution as these better results are largely due to the small size of the tumors in this series rather than to the oncoplastic technique used [9].

In addition to the better oncological results noted, oncoplasty provides aesthetic satisfaction and psychological well-being to the patient [19-21]. In our series, all patients remained satisfied with their breasts even after radiation therapy. In Africa, although satisfaction is objectively seeing it can be overestimated [7]. The patients religiously refrain from criticizing their doctor. Rather, they prefer to thank him for the little obtained [7].

In conclusion, oncoplastic breast surgery is possible in Ouagadougou. The techniques are diversified. The results are good both oncological and aesthetical. It provides physical and psychosocial satisfaction which should be better appreciated by a larger study. With the growing number of specialists, the efforts of associations fighting against cancer which educate women to consult early, and especially the recent advent of radiotherapy, conservative surgery and oncoplasty have a bright future in Burkina Faso.

Many thanks to Doctor Diane NDZANA for translating this article in English.

No funding was received to assist with the preparation of this manuscript.

The authors have no relevant financial or non-financial interests to disclose

The study was authorized by hospital management and department heads. The data collection was done anonymously and confidentiality was respected for all the patients.

The pictures of breast cancers attached (Figs. 1, 2, and 3) were used with the agreement of the patient or their family for those who are deceased.