Oncoplastic breast surgery uses an aesthetic approach to breast cancer treatment by removing the cancer while preserving and rebuilding the breast to maintain its natural look and feel.
Benefits of Oncoplastic Surgery
Combining treatment and reconstruction in the same operation means you only need one surgery. You’ll have a single recovery period, which means less interruption of your life. Operating with already planned reconstruction can enable doctors to remove more tissue surrounding the cancer site, which may help obtain complete tumor removal.
Oncoplastic and Reconstructive Surgery
Many women can now undergo breast cancer and reconstructive breast surgery simultaneously, which may involve either a breast reduction or mastopexy (breast lift).
When a partial or total mastectomy is required, it can leave the breast distorted. Due to this, during the procedure, your surgeon will remove the tumor and lymph nodes from the affected breast and then perform a breast reduction or lift to restore a natural appearance. The other breast is also modified to ensure symmetry.
To access the breast, your surgeon must make an incision around the nipple and areola, then horizontally from the nipple towards the breast fold, and finally along this fold to create an anchor-shaped incision. The amount of tissue removed depends on the cancerous tissue and its position in the breast. All breast tissue is removed if you have opted to undergo a mastectomy.
Oncoplastic Techniques
Many different oncoplastic techniques depend on the cancer’s characteristics, the patient’s health and body, and their desired outcome. Some of the most common include:
Local Advancement Flap
A traditional lumpectomy removes a tumor and a small portion of the surrounding tissue. However, depending on the size and location of the cancer, this can deform the breast.
Instead, a local advancement flap allows surgeons to take the tissue that remains after a tumor has been removed and use it to reconstruct the original appearance of the breast. This leaves no additional indentations or defects.
Bilateral Breast Reduction
When a lumpectomy is performed on only one breast, it can reduce its size and alter its shape. A bilateral breast reduction solves this problem by altering the size and shape of the other breast as well.
This technique has several benefits. Operating on the other breast removes a more significant amount of tissue. This can be helpful if the tumor is large and additional tissue is required. Modifying the other breast will also help make both breasts more symmetrical.
Bilateral Breast Lift (Mastopexy)
A bilateral breast lift, or mastopexy, is a more minimal form of bilateral breast reduction. This is a good option for women who don’t want to reduce their breasts’ original shape significantly.
Rather than removing a large amount of tissue from both breasts, the only tissue removed is from the original excision (as well as a comparable amount on the other breast). This can be accompanied by additional aesthetic procedures, such as a nipple relocation, to help the breasts become more symmetrical.
Skin-Sparing Mastectomy
For patients with advanced-stage breast cancer, a mastectomy may be necessary. If this is the case, a skin-sparing mastectomy can help the patient conserve the look of the breast.
In this procedure, the skin of the breast, including the nipple and areola, is removed. Then the breast tissue is taken out through the same incision. Afterward, the surgeon will reconstruct the breast using the removed skin, nipple, and areola. Doing so allows them to preserve the original shape and appearance of the breast.
What is an Oncoplastic Lumpectomy?
Oncoplastic breast reduction combines a traditional lumpectomy with a standard breast reduction. Lumpectomy is the surgical part of breast conservation therapy offered to women who wish to save their breasts and avoid mastectomy to treat breast cancer.
If your surgeon focuses only on removing the cancer without considering the longer-term appearance of the breast, you might not be happy with the result. Many women report looking misshapen, disfigured, or imbalanced after radiation therapy. They find it challenging to have a visible reminder of cancer when they look in the mirror or to see their clothes don’t fit correctly. Some choose to have reconstruction after lumpectomy to address these concerns. However, it’s more difficult for surgeons to work with skin affected by radiation therapy.
The goal of oncoplastic lumpectomy is to avoid any issues up front, as long as it is a safe alternative to mastectomy. You and your surgeon can start by asking a fundamental question: Can the tumor (or tumors) be removed with clean margins while giving you a cosmetic result and breast size that you’re happy with?
Consider the following five factors:
Site: Where is the cancer located? Is there cancer in multiple places?
Size: What is your breast size relative to the cancer? Will enough tissue be left to rearrange and fill the space left by lumpectomy? Are you interested in breast reduction?
Skin: Do you have excess skin or sagging that could be addressed by a breast lift during oncoplastic surgery?
Shape: Is it necessary or possible to relocate the nipple and areola to give you the desired shape?
Symmetry: Is surgery needed on the other breast to bring them into balance? Are your breasts already asymmetrical — an issue that could be addressed with oncoplastic surgery?
SUMMARY
The type of oncoplastic surgery you choose will depend on the amount of cancer present in your breast, the size of your breasts, and your personal preferences. Your doctor can answer your questions about which surgery is best for you.
REFERENCES
BreastCancer.Org
MedStar Health
NewYork-Presbyterian
WebMD
