Oncoplastic Surgery

Oncoplastic Surgery for Breast Cancer

Oncoplastic surgery combines breast cancer surgery with reconstructive and plastic surgery techniques to remove cancerous tissue while carefully reshaping the breast. It is commonly considered when a lumpectomy or other breast-conserving surgery could affect the breast’s shape, size or symmetry.

The approach aims to address two important aspects of treatment: achieving appropriate cancer removal and creating a natural-looking breast contour after surgery. Depending on the individual case, the procedure may involve rearranging existing breast tissue, a breast lift or reduction technique, or other reconstructive methods.

What Is Oncoplastic Breast Surgery?

Oncoplastic breast surgery brings together the principles of breast cancer surgery and reconstructive surgery. During breast-conserving surgery, the surgeon removes the tumour along with an appropriate margin of surrounding tissue. Oncoplastic techniques can then be used to reshape the remaining breast tissue and reduce visible changes caused by the removal.

For some patients, this may involve oncoplastic lumpectomy, breast tissue rearrangement, breast reduction or breast lift techniques. The specific approach depends on the location and size of the tumour, the amount of tissue that needs to be removed, breast size and shape, and the overall cancer treatment plan.

Who May Benefit From Oncoplastic Surgery?

Oncoplastic surgery may be considered for patients undergoing breast-conserving surgery when removal of the tumour could noticeably change the breast’s appearance. It can be particularly useful when a relatively large amount of breast tissue needs to be removed or when the tumour is located in an area where tissue loss could create a visible indentation or asymmetry.

Patients with larger or more ptotic breasts may also be candidates for techniques that combine cancer removal with a breast reduction or lift. However, suitability is individual and depends on the cancer characteristics, breast anatomy and planned treatment.

Common Oncoplastic Surgery Techniques

The technique selected by the surgical team depends on the patient’s anatomy and treatment requirements. Possible approaches include:

• Breast tissue rearrangement to fill the space created by tumour removal.
• Oncoplastic breast reduction when cancer removal can be incorporated into a reduction procedure.
• Oncoplastic breast lift (mastopexy) to reshape and reposition breast tissue.
• Local tissue flap techniques to replace volume when additional tissue is required.
• Fat grafting in selected situations, particularly for correcting contour irregularities or asymmetry after treatment.

More complex procedures may involve coordination between a breast cancer surgeon and a plastic surgeon.

Benefits of Oncoplastic Breast Surgery

The potential benefits depend on the individual case, but oncoplastic techniques may help:

• Remove the breast cancer while maintaining breast-conserving treatment when appropriate.
• Reduce the appearance of dents or contour changes caused by tissue removal.
• Improve breast shape and symmetry.
• Incorporate breast reduction or lifting into the cancer surgery when clinically appropriate.
• Plan incisions and tissue movement with both cancer treatment and breast appearance in mind.

Oncoplastic surgery is not simply cosmetic surgery. The priority remains appropriate cancer treatment, with reconstructive techniques used to help manage the resulting breast shape and appearance.

Oncoplastic Surgery vs Breast Reconstruction

Although the terms are sometimes used interchangeably, they can describe different situations.

Oncoplastic surgery is often performed alongside breast-conserving surgery such as a lumpectomy. The surgeon removes the cancer and uses reconstructive techniques to reshape the remaining breast tissue.

Breast reconstruction more commonly refers to rebuilding the breast after a mastectomy, although reconstruction can also be performed after breast-conserving surgery when needed. Reconstruction may be performed immediately during the original operation or later, depending on the patient’s treatment plan.

Preparing for Oncoplastic Surgery

Before surgery, your healthcare team will review your diagnosis, imaging, biopsy and treatment plan. The surgical team may also assess breast size and shape, the location of the tumour, the amount of tissue expected to be removed and whether additional cancer treatment such as radiation therapy is planned.

Patients should discuss previous surgeries, medications, smoking or nicotine use, allergies and other relevant health information with their surgical team. Your surgeon will provide specific instructions regarding eating and drinking before surgery, medications, wound care and other preparation requirements.

Recovery After Oncoplastic Surgery

Recovery varies according to the extent of surgery and whether additional procedures are performed. Some patients experience temporary swelling, bruising, discomfort or changes in breast sensation during healing.

Your surgical team will provide instructions about wound care, supportive garments, physical activity, follow-up appointments and when you can gradually return to normal activities. Recovery can also be influenced by additional breast cancer treatments, including radiation or systemic therapy.

Follow-up is important because your care team will monitor healing and coordinate any further cancer treatment that may be required.

Risks and Considerations

As with other surgical procedures, oncoplastic breast surgery has potential risks. These may include pain, bleeding, infection, fluid collection, wound-healing problems, changes in breast sensation, scarring, asymmetry and changes in breast shape.

The risks vary according to the surgical technique, the extent of tissue removal, individual health factors and other cancer treatments. Your surgeon should explain the expected benefits, alternatives and potential complications before you make a treatment decision.

Choosing an Oncoplastic Surgery Team

Oncoplastic surgery requires careful coordination between cancer treatment and reconstructive planning. Depending on the complexity of the procedure, care may involve a breast surgeon, plastic surgeon, oncologist, radiologist, pathologist and other members of a multidisciplinary breast cancer team.

When considering oncoplastic breast surgery, patients should ask about the surgeon’s experience with the specific procedure being proposed, the expected effect on breast shape, possible alternatives, recovery requirements and how the surgery fits into the overall breast cancer treatment plan.

Frequently Asked Questions About Oncoplastic Surgery

Is oncoplastic surgery only for breast cancer?

The term is most commonly associated with breast cancer surgery, particularly breast-conserving surgery combined with techniques to reshape or reconstruct the breast. The exact procedure depends on the patient's diagnosis and surgical plan.

Is oncoplastic surgery the same as a lumpectomy?

No. A lumpectomy removes the tumour and a surrounding margin of tissue while preserving most of the breast. Oncoplastic lumpectomy combines cancer removal with plastic-surgery techniques to reshape the breast when appropriate.

Can oncoplastic surgery be performed during lumpectomy?

Yes. Oncoplastic techniques are often performed during the same operation as breast-conserving surgery, although the appropriate approach depends on the individual patient's cancer and anatomy.

Does oncoplastic surgery eliminate the need for other cancer treatments?

No. Oncoplastic surgery is a surgical approach and does not replace other treatments that may be recommended for breast cancer. Depending on the diagnosis, treatment may also involve radiation therapy, chemotherapy, hormone therapy, targeted therapy or other cancer treatments.

Is oncoplastic surgery suitable for everyone?

No. Eligibility depends on factors such as tumour size and location, breast anatomy, the amount of tissue that needs to be removed, the type and stage of cancer, previous treatment and the overall treatment plan. A qualified breast cancer surgical team can determine whether an oncoplastic approach is appropriate.

Make an Informed Treatment Decision

Choosing breast cancer surgery is a personal decision that should be based on cancer control, overall health, treatment goals and the expected functional and aesthetic outcome. If you are considering oncoplastic surgery, discuss your options with a qualified breast cancer surgical team and ask how the procedure would fit into your complete treatment plan.

The most appropriate surgical technique varies from patient to patient, so an individual consultation is essential before deciding on treatment.