Advances in breast surgery have given women more choices in their breast cancer treatment. The procedure does not involve only the removal of the entire breast known as a mastectomy, or the removal of a tumor (lump) known as lumpectomy; women now have several options thanks to oncoplastic breast surgery. Since the 1990’s when the term was coined, it has grown to be a popular procedure due to the demands for procedures that not only aim to cure, but also leave an aesthetically pleasing breast in place.
What is oncoplastic surgery?
This is a plastic surgery procedure that is used to treat breast cancer. The word ‘oncoplastic’ is a Greek word that is derived from the words ‘onco’ which refers (to tumor) and ‘plastic’ which refers to (to mold). In this procedure, plastic surgical techniques are used to reshape and reconstruct the breast after wide excision of the breast cancer. The result is a more effective breast surgery that enables the removal of cancer and reconstruction of the breasts. For this procedure to be done, it needs careful planning and a delicate balance between the aesthetic aims and the oncological needs.
What is oncoplastic breast reduction?
In this procedure, there is a combination of standard breast reduction and traditional lumpectomy. The oncologic treatment is lumpectomy; it is offered to women who are candidates for breast conservation therapy, and want to avoid mastectomy to save their breasts while they undergo breast cancer treatment. Unfortunately, even patients with larger breasts may be left with defects and significant asymmetries after this procedure.
Reduction mammaplasty (breast reduction) is ordinarily performed for women who have large, heavy breasts that would like to reduce their size to have a more comfortable lifestyle. In the setting of breast cancer, its use allows the cancer surgeon the ability to remove more breast tissue associated with the cancer; the plastic surgeon then reconstructs the remaining breast tissue in such a way as to leave a breast with a smaller but more aesthetically pleasing shape. Finally, the non-cancerous breast is reduced to match.
Is breast cancer effectively treated using oncoplastic breast reduction?
Oncoplastic breast surgery has expanded the indications for breast conservation, allowing women with larger tumors relative to breast size, locally advanced cancers, and prior history of chemotherapy the ability to save their breast and avoid mastectomy. The additional benefits are that larger margins are able to be taken on the cancer side, which has been shown to reduce the chance of a metachronous (another cancer diagnosed later on in the same breast) lesion by 33%. Also, reducing the non-cancerous breast removes additional tissue that can decrease the overall chances of a synchronous (another cancer at the same time) lesion in that breast. As in a traditional lumpectomy, radiation still follows after oncoplastic reduction, which helps with local control of the cancer. Cancer care is therefore not compromised with this procedure.
Can you compare the long-term results of an oncoplastic breast reduction with other types of surgical options when looking at cancer therapy?
Studies have been done to compare the results of oncoplastic surgery with that of the standard breast conservation therapy, and there have been comparable outcomes. The main difference is a more cosmetically pleasing result. Women who undergo oncoplastic breast reduction for cancer have the same survival rate as those who undergo mastectomy.
Are there complications with an oncoplastic breast reduction?
Just like any surgical procedure, there are complications in this type of surgery that are similar to traditional breast reduction and lumpectomy operations. Some of the medical complications a patient can be exposed to include infections, bleeding, increase or decrease in sensation of the nipples, issues with wound healing, asymmetry, request for another surgery, and cosmetic dissatisfaction.
What is involved in the breast reduction procedure?
Before the operation is performed, surgeons mark the patients while in the preoperative room using pattern markings for the breast reduction procedure. Once that is complete, the patient is taken to the operating room where general anesthesia is used to induce sleep.
The tumor is first removed by the breast surgeon together with some extra margins of nearby breast tissue. The extra margins are important in oncoplastic surgery because it ensures that there is complete removal of the tumor.
Once the oncologic surgery is done, the tissue that is remaining is assessed by the plastic surgeon and reshaped to a more elevated, smaller, and naturally rounded breast. The nipple-areolar complex is then relocated to a more central location on the remaining breast.
Once the cancer side has been completed, the plastic surgeon then performs a standard reduction on the opposite side for symmetry. In general, the healthy breast is made about 20% smaller than the breast with cancer, to account for radiation changes that will occur on that side. This allows for greater chance of symmetry at the conclusion of the cancer therapy.
What are the scars that are created by breast reduction?
During a breast reduction, two main types of incisions are made; the wise or anchor pattern, or the lollipop pattern. The anchor pattern is a circle around the areola and a straight line that heads down under the breast but along the fold resembling an anchor. The lollipop scar is also a circle around the areolar and a straight line is drawn to the fold that is under the breast; this shape resembles that of a lollipop.
The breast’s baseline shape, the location of the tumor, and the size of the postoperative breast help the surgeon and the patient to determine the type of incision that will be made.
Who is the right candidate for an oncoplastic breast reduction?
An oncoplastic operation is possible for patients who have previously undergone a breast surgery. Women who have medium to large sized breasts and suffer from some of the symptoms of macromastia (large breasts) including neck and back pain, rashes, and shoulder grooving are good candidates. Smaller breast patients can also be considered if their tumors are small.
Who is not the ideal candidate for oncoplastic reduction?
Women who smoke, those with very small breasts, and those who cannot achieve negative margins with repeated lumpectomy are not good candidates.
If you are interested in oncoplastic breast reduction and believe you may be a good candidate, please contact us at Cold Spring Plastic Surgery by calling 631.201.8413 or 212.472.2022. You can also visit our offices at Cold Spring Plastic Surgery 224 Wall Street Suite 201 Huntington, New York 11743, or at 1049 5th Avenue Suite 2D New York New York 10028.
Posted in: Breasts