The Fellowship of the European Board of Surgery in Breast Surgery (UEMS/ESSO/EUSOMA) assesses oncological and oncoplastic breast practice. Practise with FEBS Breast questions on breast cancer surgery, axillary management, oncoplastic technique and systemic therapy decision-making, each referenced to ESMO, NCCN and EUSOMA standards.
Content reviewed 26 August 2026 against current guidelines.
Start practising freeTaken from the bank, not written for this page. Answer it in your head, then open the explanation.
A 48-year-old woman with a 28 mm, grade 2, ER-positive, HER2-negative, node-negative invasive ductal carcinoma in the lower pole of the left breast requests breast-conserving surgery. Her breast cup size is a 36E. The tumour-to-breast volume ratio is estimated at 18%. She prefers not to have a contralateral symmetrising procedure at this stage. Pre-operative MRI shows unifocal disease. The surgeon is planning an oncoplastic approach. Which of the following oncoplastic techniques is most appropriate for a large-breasted patient with a lower pole tumour, providing both oncological and cosmetic benefit without contralateral surgery?
Correct answer: E
✓ Correct answer: The Wise pattern (inverted-T) therapeutic mammoplasty is the optimal oncoplastic volume displacement technique for a large-breasted patient (macromastia, 36E) with a lower pole tumour. This technique allows resection of a large volume of breast tissue (ideal tumour-to-breast ratio 15–30%) from the lower pole while simultaneously performing a superior pedicle breast reduction, achieving oncological clearance and cosmetic improvement in a single procedure. The Wise pattern provides maximal access to lower pole tumours, allows wide margins through the skin reduction component, and is particularly suited to macromastic patients who often also benefit symptomatically from reduction. It avoids the need for contralateral symmetrising surgery immediately, as the resulting shape is usually symmetric without the contralateral procedure in the immediate setting. The Association of Breast Surgery (ABS) and EUSOMA oncoplastic consensus support this approach for lower pole lesions in women with large breasts. ✗ Why the others are wrong: A: The batwing mastopexy is designed for central or upper pole tumours involving the nipple-areola complex. It is not the optimal approach for lower pole lesions. B: The round block (donut) technique is best suited for periareolar or central tumours in smaller to medium breasts. It does not provide adequate access or volume displacement for a lower pole tumour in a large breast. D: A latissimus dorsi mini-flap is a volume replacement (not displacement) technique used when there is insufficient remaining breast tissue after excision to achieve an acceptable cosmetic result. With an 18% tumour-to-breast ratio in a large breast, volume displacement is preferred over flap reconstruction. E: Skin-reducing mastectomy with implant reconstruction is appropriate when breast conservation is not possible. With an 18% tumour-to-breast ratio and unifocal disease, BCS with an oncoplastic approach is appropriate and should be offered. Teaching point: Wise pattern therapeutic mammoplasty is the preferred oncoplastic technique for lower pole tumours in macromastic patients, combining oncological excision with breast reduction in one operation. Board pearl: Tumour location determines oncoplastic technique: lower pole → Wise pattern; upper pole → batwing; periareolar → round block; significant volume deficit → LD mini-flap (replacement). Pitfall: Using a volume replacement flap when volume displacement is sufficient — unnecessary donor-site morbidity for a tumour-to-breast ratio <25% in a large breast.
Teaching point. Wise pattern therapeutic mammoplasty is the preferred oncoplastic technique for lower pole tumours in macromastic patients, combining oncological excision with breast reduction in one operation.
Referenced to ABS/BAPRAS Oncoplastic Breast Surgery Guidelines (2012); EUSOMA Oncoplastic Consensus (Cardoso et al., EJBC 2019)
Every question is explained like this — start with 50 free ›Every question is written by Pablo Lozano Lominchar, MD, PhD, and mapped to this board’s published syllabus. Before it enters the bank it has to pass an automated check: five options, a written explanation, and a citation — a named society guideline or a named trial. Benign and functional topics cannot be published without a society guideline; oncological ones cite NCCN, ESMO or AJCC, and the classification systems that govern a topic — Bethesda, TIRADS, Atlanta, Prague, Chicago — have to appear where they apply. The author has audited the full active bank against current guideline versions: what fails is re-cited, rewritten or withdrawn. 650 questions are currently withdrawn and are served to nobody.
Scope of authorship. FEBS-Breast sits outside the author’s own subspecialty practice, which is surgical oncology — peritoneal malignancy, sarcoma, hepatopancreatobiliary and complex pelvic surgery. No diplomate of this board has signed these questions off. What they offer is traceability rather than personal authority: every answer names the current guideline or trial it rests on, so you can check it at the source before you trust it. Found an error? Tell us — it gets corrected or withdrawn.
Know the ACOSOG Z0011 and AMAROS axillary management criteria precisely, the oncoplastic level I/II classification, and where ESMO and NCCN diverge on sentinel node biopsy after neoadjuvant therapy. Practise timed questions across both the written and oral formats.
SurgBoardsQ&A offers more than 870 breast surgery practice questions mapped to the FEBS Breast syllabus, each with a full guideline-referenced explanation.
The exam covers breast cancer surgery, oncoplastic and reconstructive techniques, axillary staging and management, systemic therapy decision-making, and benign breast disease.
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