What is Oncoplastic Breast Surgery?
Oncoplastic breast surgery is an innovative treatment approach for breast cancer that involves combining the techniques of the latest advances in plastic surgery with traditional breast surgery/breast surgical oncology to accomplish superior cosmetic outcomes in breast cancer patients. The main objective of this approach is to remove cancer while minimising the undesired effects of surgery, such as compromised cosmetic outcomes, and help in healing patients both emotionally and physically.
Indications for Oncoplastic Breast Surgery
Some of the common indications for an oncoplastic breast surgery approach include:
- Lumpectomy
- Breast reduction
- Mastopexy (breast lift)
- Breast conservation therapy
Oncoplastic Breast Surgery Techniques
The oncoplastic techniques employed depends upon the characteristics of cancer, the patient’s body and health condition, and the desired outcome of the surgery. In general, some of the most common techniques employed include:
- Skin-Sparing Mastectomy: For individuals with advanced phase breast cancer, a mastectomy may be required. Skin-sparing mastectomy involves the removal of all of the breast tissue including the nipple, yet preserving as much of the breast skin as possible. It is a breast-conserving surgery that offers an improved cosmetic outcome compared to traditional mastectomy.
- Bilateral Breast Lift (Mastopexy): Bilateral breast lift or mastopexy is a cosmetic surgical breast procedure to lift and reshape the breasts that have lost their natural shape and firmness due to lumpectomy or other factors. The procedure utilizes minimal breast tissue taken from an original excision (and comparable quantity on the other breast) rather than considerable amount of breast tissue taken from both breasts.
- Bilateral Breast Reduction: When a lumpectomy is carried out on only one breast, it can decrease its size and change its shape. Bilateral breast reduction surgery resolves this issue by changing the shape and size of the other breast as well to achieve a near-perfect symmetry.
- Local Advancement Flap: A standard lumpectomy involves removal of a tumour and a small section of the surrounding tissue and can deform the breast depending upon the size of the tumour. A local advancement flap enables your surgeon to extract the tissue that remains after a tumour has been excised and utilize it to rebuild the original look of the breast, leaving no room for defects or indentations.
Preparation for Oncoplastic Breast Surgery
In general, preparation for oncoplastic breast surgery may involve the following:
- A thorough examination by your doctor is performed to check for any medical issues that need to be addressed prior to the procedure.
- Depending on your medical history, social history, and age, you may need to undergo tests such as blood work and a mammogram to help detect any abnormalities that could threaten the safety of the procedure.
- You will be asked if you have allergies to medications, anaesthesia, or latex.
- Inform your doctor of any medications, vitamins, or supplements that you are taking.
- Refrain from taking any anti-inflammatory drugs, aspirin, or supplements, as they may increase the chance of bleeding.
- You should not consume any solids or liquids at least 8 hours prior to surgery.
- You may be instructed to shower with an antibacterial soap the night prior to surgery.
- Refrain from smoking pre- and post-procedure for a specific period of time, as this may hamper proper healing and increase your chances of areolar or nipple damage, tissue necrosis, and other complications.
- You will be given an opportunity to analyse before and after surgery pictures of patients with similar desired breast shape and size.
- A written consent will be obtained from you after the procedure has been explained in detail.
Procedure for Oncoplastic Breast Surgery
Oncoplastic breast surgery is generally done in association with lumpectomy. To start with, your surgeon removes the tumour, a little quantity of surrounding tissue, and possibly some lymph nodes if cancer has spread to the surrounding lymph nodes in the armpit or lower neck. Then, the service of a plastic surgeon is employed to carry out bilateral breast lift or breast reduction in order to accomplish two symmetrical breasts. Most often, the breast cancer surgery procedure and plastic surgery procedure are carried out one after the other. The procedures normally involve making a surgical cut around the nipple and areola, a vertical cut from the nipple to the lower breast fold, and a horizontal cut in the breast fold.
Post-Procedure Care and Recovery
Oncoplastic breast surgery is mostly an outpatient (same-day) surgery or possibly may require a night stay in the hospital.
In general, postoperative care instructions and recovery after oncoplastic breast surgery may involve the following:
- You may notice sensitivity, tenderness, swelling, and bruises over the reconstructed breast. Pain and anti-inflammatory medications are provided as needed.
- Your physician will also provide you with antibiotics to prevent the risk of infection.
- Refrain from any physical activity using your upper body for at least 2 to 4 weeks to promote healing.
- You will be able to have a shower from the first day after surgery. A waterproof dressing will protect your surgical site.
- Avoid heavy lifting or any strenuous activities as you recover.
- Your doctor will provide you with instructions on diet and wound care.
- You are recommended to wear a supportive bra for at least 2 days post procedure.
- Refrain from using anything too cold or too hot on your reconstructed breast skin as your breasts will lack normal sensation.
- You may need to take off from work for at least a week to facilitate recovery.
- You will be able to resume normal activities within a couple of weeks, but may have certain activity restrictions.
- A periodic follow-up will be scheduled to monitor your overall progress.
Benefits of Oncoplastic Breast Surgery
Some of the benefits of oncoplastic breast surgery include:
- Needs only one surgical sitting
- Easier and ideal option to construct symmetrical breasts
- Allows for a considerable quantity of tissue to be taken out, which can be beneficial for larger tumours
- The surgery is carried out prior to radiation therapy, hence prevents potential risks of radiation to surgical wounds
- Barely changes the size and shape of your breasts and provides improved breast consistency
- Gives your breasts a balanced and youthful appearance with a cosmetic quality of the highest level
Risks and Complications of Oncoplastic Breast Surgery
Oncoplastic breast surgery is a relatively safe procedure; however, as with any breast surgery, some risks and complications may occur, such as:
- Bleeding
- Poor healing of surgical cuts
- Infection at the surgery site
- Anaesthetic risks
- Blood clots
- Necrosis or tissue death
- Accumulation of fluids in breast tissue
- Loss of sensation in the breasts or nipples
