Oncoplastic Breast Cancer Surgery

What is Oncoplastic Breast Cancer Surgery?

Oncoplastic breast cancer surgery is an advanced approach to breast cancer treatment that combines the principles of oncology and plastic surgery to achieve optimal cancer control and aesthetic outcomes. This technique involves the surgical removal of cancerous tissue followed immediately by reconstructive procedures to reshape the breast and maintain its appearance. The goal is not only to effectively treat breast cancer but also to improve or preserve the breast's shape and symmetry, which can significantly enhance the patient's quality of life and psychological well-being.

Who is Suitable for Oncoplastic Breast Cancer Surgery?

Stage and Size of the Tumour: Oncoplastic surgery is most suitable for patients with smaller tumours relative to the size of their breasts, where removing the tumour alone might lead to a significant deformity. It’s also appropriate for tumours located in parts of the breast where traditional surgery might lead to poor cosmetic outcomes.
Breast Size and Shape: Women with larger breasts might have more options for oncoplastic surgery because there is more tissue available for reshaping and achieving symmetry post-operation.
Cancer Type and Characteristics: The type of breast cancer and its specific characteristics (such as hormone receptor status and HER2 status) can influence surgical decisions. Oncoplastic surgery is generally reserved for tumours that can be safely removed with clear margins while preserving enough breast tissue for reconstruction.
Patient’s Health and Medical History: Overall health, including any underlying conditions that might affect surgery or recovery, is an important consideration. A thorough medical evaluation is necessary to assess fitness for surgery.
Patient’s Preferences and Expectations: A patient's decision to undergo oncoplastic surgery is also influenced by their personal preferences regarding breast appearance, willingness to undergo potentially longer and more complex procedures, and feelings toward potential risks and benefits.
Availability of Expertise: Oncoplastic surgery requires skilled surgeons trained in oncological and reconstructive breast surgery. The availability of such expertise is crucial in determining whether a patient can undergo this type of surgery.

Benefits of Oncoplastic Breast Cancer Surgery

Oncoplastic breast cancer surgery offers several significant benefits, focusing on both oncological safety and aesthetic outcomes:

Improved Cosmetic Results: By combining cancer surgery with plastic surgery techniques, oncoplastic surgery helps preserve or enhance the breast's appearance. This is particularly important for emotional and psychological recovery, as it can improve body image and self-esteem.
Greater Range of Breast Conservation: For some patients, traditional breast-conserving surgery might not be an option due to the size or location of the tumour. Oncoplastic techniques allow surgeons to remove larger areas of tissue while still maintaining the shape and appearance of the breast, potentially allowing more women to undergo breast conservation therapy rather than full mastectomy.
Enhanced Symmetry: In traditional breast surgery, tissue removal can leave the breasts asymmetrical. Oncoplastic surgery addresses this by reshaping the remaining breast tissue and modifying the contralateral breast if necessary, promoting symmetry.
Reduced Need for Additional Surgeries: By addressing both tumour removal and reconstruction in one procedure, oncoplastic surgery can reduce the number of surgeries a patient needs, which may decrease overall recovery time and associated risks.
Potential for Immediate Reconstruction: Oncoplastic surgery often allows for immediate reconstruction, which means patients wake up from surgery with a breast mound already in place, reducing the psychological impact of losing a breast to cancer.

Types of Oncoplastic Breast Cancer Surgery

The types of oncoplastic breast cancer surgery vary based on the technique and the extent of reconstruction required.

Mammoplasty and Reduction Mammoplasty

Mammoplasty involves reshaping the breast after tumour removal. It can be part of a breast-conserving surgery where the focus is on optimising the cosmetic outcome after removing the cancerous tissue.

Reduction Mammoplasty is used in larger-breasted women. In this procedure, both cancerous tissue and the breast size are removed. This technique is beneficial for achieving symmetry, especially if the opposite breast also undergoes reduction to match.

Volume Replacement Surgery

Techniques like autologous tissue transfer are used when a significant amount of breast tissue is removed. Fat grafting or local flaps can fill the defect left by tumour excision.

Perforator Flaps (AICAP, LICAP)

AICAP (Anterior Intercostal Artery Perforator Flap) and LICAP (Lateral Intercostal Artery Perforator Flap) involve using skin and fat from the chest wall (beneath the breast) while preserving the muscle. These flaps are rotated into the defect created by tumour removal to reconstruct the breast with natural tissue.

Crescent Flap

This is a smaller flap technique used primarily for small defects. A crescent-shaped piece of skin and tissue is moved to fill a nearby defect, often used in upper pole breast defects.

Preparation Before Oncoplastic Breast Cancer Surgery

Medical Evaluations: Undergo all necessary preoperative evaluations, including blood tests, imaging studies (like mammograms and MRI), and consultations with your surgical team. These assessments help clarify your health status and the details of the tumour.
Consultation with Surgeons: Discuss the surgical plan with the oncologic and plastic surgeons. Understand the extent of surgery, the reconstruction options, and the expected outcomes.
Medication Review: Inform your doctors about all your medications and supplements. Some might need to be adjusted or stopped before surgery, especially blood thinners or medications that affect immune response.
Preoperative Instructions: Follow any specific instructions regarding fasting, adjusting current medications, and what to bring on the day of surgery.
Arrange for Help: Plan for recovery at home. Arrange for someone to drive you home after surgery and help around the house as you recover.
Mental Preparation: Consider speaking with a counsellor or support group to mentally prepare for the changes in your body and the recovery process.

Oncoplastic Breast Cancer Surgery Procedure

Anaesthesia: You will be placed under general anaesthesia, meaning you will be asleep and pain-free during the surgery.
Tumour Removal: The oncologic surgeon removes the breast tumour and a margin of healthy tissue to ensure all cancerous cells are excised. The amount and location of tissue removed depend on the tumour's characteristics.
Reconstruction: Immediately following tumour removal, the plastic surgeon begins reconstructive efforts. This might involve reshaping the remaining breast tissue, using tissue from other parts of your body, or implanting synthetic materials to achieve a natural appearance.
Symmetry Adjustments: If only one breast is affected, the surgeon may also modify the opposite breast to create symmetry.
Closure: Incisions are closed with sutures, and drains may be placed to remove excess fluids. Bandages are applied to support the breasts during healing.
Immediate Aftercare: You’ll likely spend time in a recovery room where medical staff monitor your vital signs as the anaesthesia wears off. You may experience pain, numbness, or discomfort, which medications can manage.

Oncoplastic Breast Cancer Surgery Recovery Plan

A well-planned recovery is crucial for healing and returning to normal activities:

Physical Restrictions: Avoid strenuous activities and heavy lifting for several weeks. Gradually reintroduce activities as recommended by your surgeon.
Pain Management: Follow your doctor’s instructions for taking pain medication. Over-the-counter pain relievers may also be recommended.
Wound Care: Keep surgical sites clean and dry. Follow instructions for showering and changing dressings.
Monitoring: Regularly inspect the surgical area for signs of infection or complications and attend all scheduled follow-up appointments.
Support Garments: Wear any prescribed supportive garments to reduce swelling and support the new breast contour.
Emotional Support: Consider joining a support group or talking to a therapist, as emotional recovery is as important as physical healing in cancer care.

Oncoplastic Breast Cancer Surgery Prognosis

The prognosis following oncoplastic breast cancer surgery is generally favourable, especially when the cancer is detected and treated early. This surgery aims to effectively remove the cancer while preserving or improving the breast's appearance, contributing to both physical and psychological recovery.

Oncoplastic Breast Cancer Surgery Risks

Like all surgical procedures, oncoplastic breast cancer surgery comes with risks, which include:

Complications Related to Anesthesia
Infection
Bleeding and Hematoma
Poor Cosmetic Outcome
Asymmetry
Changes in Breast Sensation
Seroma Formation
Necrosis of Flaps

What if Oncoplastic Breast Cancer Surgery is Delayed?

The most significant risk is that the cancer could progress, potentially moving from an early, more treatable stage to a more advanced stage, which can complicate treatment and worsen the prognosis. As cancer progresses, the possibility of preserving the breast or achieving desirable cosmetic outcomes through oncoplastic techniques may decrease.

Delaying treatment can also lead to increased anxiety, stress, and uncertainty for patients, which can affect their overall quality of life. Generally, earlier treatment is associated with better survival rates. Delays can reduce these rates depending on how much the cancer progresses during the delay.