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Oncoplastic Breast Surgery — breast cancer oncology and cosmesis

Sandra Krishnan • Nov 14, 2022

Oncoplastic Breast Surgery

Combining the principles of oncologic and advanced plastic surgery techniques, to obtain an oncologically sound and aesthetically pleasing outcome.

What is oncoplastic breast conserving surgery?

The oncoplastic technique for breast cancer surgery is oncologic surgery (breast cancer removal) combined with advanced plastic surgery methods for reconstruction. Traditional breast cancer surgery procedures along with aesthetic advantages of plastic surgery techniques improves cosmetic outcomes by 2 methods — replacing the defect or reduce and/or lift breast tissue during the surgery, so the patient does not need to have two separate procedures. It is breast reconstruction done immediately, which improves on the cosmetic outcome of the procedure while managing local control of the breast cancer. The goal is to remove cancer in the most delicate way and achieving the natural and symmetric result, helping patients heal both physically and emotionally.

What do oncoplastic breast surgical procedures involve?

The complete range of procedures covered by oncoplastic breast reconstructive surgery include:

• Complete and oncologic surgery (wide excision) to remove the cancer

• Reconstruction to correct the resultant defect (partial)

• Total reconstruction (immediate and delayed) with a plethora of techniques, depending on various factors

• Final correction of asymmetry of the affected and the other (contralateral) breast.

What is the benefit of oncoplastic breast surgical procedures?

Oncoplastic reconstructive breast surgery maintains the breast shape and natural appearance, and provides a lovely outcome for patients who might have needed mastectomies previously based on site of the cancer. Nipples are carefully protected and preserved, mainly, without significant loss of sensation. There is an opportunity to achieve symmetry by using a reduction or mastopexy technique, the surgeon will operate on both breasts and restore a sense of balance.

One surgical session (unless further margin removal is required)
Larger amount of tissue can be removed, always helpful for larger cancers
The other breast can be made symmetrical
Usually done before radiation therapy

How will I feel after oncoplastic breast conserving surgical procedures?

Following are the excellent benefits of these techniques

Emotional well being
Faster recovery
Better quality of life
Higher rates of satisfaction

Who is eligible for oncoplastic breast conserving surgery?

Oncoplastic breast conserving surgery is an option for breast cancer patients who can be treated through breast conserving procedures. The breast tissue remaining after the cancer is removed should be adequate to reshape the breast. Some patients are more suited than others to this procedure. The aim is to restore the natural shape of the breast and symmetrise the other side.

Different breast types can be operated on using a wide range of oncoplastic techniques. As there are various breast shapes; particular methods are used to either reshape the breast or add extra volume to reconstruct the defect.

How safe is oncoplastic breast surgery?

One of the ways we measure cancer surgery outcome is by overall survival.

This technique has an excellent high rate of overall survival when the cancer is 3cm or below, but we can also get a good result with a many different cancer sizes and types of cancer.

What is the wound and scar like after oncoplastic breast surgery?

The oncoplastic principles are based on plastic surgery techniques, hence the aim is to provide oncologically sound surgery (clear the cancer) with an outstanding cosmetic result. We place the scars away from the visible areas of the breast and follow the normal lines of the body. This insures that the scar blends in and is as inconspicuous as possible to allow for an excellent body image after the surgery.

How long is the patient’s stay in hospital after the oncoplastic breast surgery?

Some patients may be discharged on the same day and this depends on the extent of the surgery and whether the other breast has been operated on. Sometimes an axillary (armpit) procedure is required like sentinel node biopsy or targeted axillary lymph node dissection. Also if patients have other illnesses, they may have to stay in hospital overnight but patients generally stay no longer than a day.

What are various Oncoplastic Techniques?

This depends on the cancer, patient’s body and breast shape and size, and overall health, and their desired outcome.

Local Advancement Flap

With a traditional wide excision, the cancer and a small part of the surrounding breast tissue is removed. Depending on the location and size of the tumour, this can cause a deformity in the breast.

A local advancement flap is taking take the breast tissue that remains after the cancer has been removed and using it to recreate the original appearance of the breast. Ideally, this will leave no defect or indentation.

Bilateral Breast Reduction (Therapeutic mammoplasty)

Sometimes a lumpectomy can change the shape and reduce the size of the affected breast. Bilateral breast reduction is a fantastic solution, as both breasts can be operated on, restoring immediate symmetry.

This technique allows a larger amount of tissue is removed which is useful when the cancer is larger and more breast issue needs to be excised. There will be temporary swelling and bruising that should settle down within four weeks, the surgery usually needs to be followed with radiotherapy.

Bilateral Breast Lift (Mastopexy)

Bilateral breast lift, or mastopexy, is a smaller form of bilateral breast reduction for women who don’t want to significantly reduce the size of their breasts.

In this procedure only the breast cancer and a small amount of breast issue around it is removed (and a comparable amount on the other breast). This can be accompanied by other aesthetic techniques, like nipple relocation, to help the breasts become symmetrical.

Lipofilling for breast remodelling

This a technique where fat is extracted from one area of the body and inserted into a different area, where there is mass, volume, or remodelling needed. It is used to help with the breast shape and size both on the affected rest and on the other side to achieve symmetry.

How to summarise oncoplastic breast conservation surgery?

The cancer can removed with a wide margin of surrounding breast tissue, reducing the potential of undetected cancer cells remaining and multiple lesions can be removed from the same breast with a good cosmetic outcome. The cancer removal and reconstructive surgery can be done together in the same sitting. Psychological stress of losing a breast through a mastectomy is avoided, and the aesthetic appearance is maintained for emotional recovery. The surgery is safe and low-risk. Breasts can be rebalanced by displacing or replacing volume as needed. The other side symmetry operation may be required to achieve a final balanced result. As for almost all breast conservation surgery, the patient will need to have breast radiation on the affected breast.

First study the science, and then practice the art which is born of that science — Leonardo da Vinci

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