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Oncoplastic Breast Surgery
Everything You Need To Know Oncoplastic Breast Surgery
What is oncoplastic breast surgery?
The term “Oncoplastic” is a relatively new sub-speciality of breast cancer surgery. It refers to a combination of cancer treatment and cosmetic breast reconstructive surgery. It involves the removal of breast cancer with sufficiently wide free margins followed by reconstructing the defect area. It also includes contralateral breast symmetrisation and nipple reconstruction following mastectomy.
Who is a suitable candidate for oncoplastic breast surgery?
Oncoplastic breast surgery (OBS) indications are based on patient and physician preference. It is recommended for patients who are at risk of breast deformity after standard breast contouring surgery (BCS). Patients with multifocal tumours (including large T4 tumours), macromastia, large breast/breast volumes, and low neutropenia who respond well to oestrogen replacement therapy. OBS is more commonly used in central/upper/inner quadrant tumours for aesthetic reasons. OBS relieves macromastia symptoms and provides oncoplastic reduction of breast cancer in one session.
Patients who require mastectomy because of margin positivity, have inflammatory breast cancer, or have insufficient remaining breast tissue following tumour resection are not eligible for OBS.
Preparation for oncoplastic breast surgery
A comprehensive history and physical examination will be conducted on the day of the consultation to exclude any underlying medical, physical, or social issues that must be addressed prior to the procedure.
Blood and imaging tests may also be performed to detect any abnormalities that may hinder the efficacy of the treatment. It is essential that the oncologist is aware of any potential allergies, medications or supplements the patient may be taking, and the patient is advised to fast for a period of 4 to 8 hours the day of the surgery.
Procedure for oncoplastic breast surgery
Oncoplastic breast surgery is dependent on a variety of factors, including the location and size of the tumour, the ratio of the tumour to the breast size, and the patient’s desired outcome. During this procedure, the surgeons will perform a combination of lumpectomy or partial mastectomy and plastic surgery techniques (reconstructive surgery). Listed below are some of the most common oncoplastic procedures:
Lumpectomy
A traditional lumpectomy involves removal of the tumour and a small part of the surrounding tissue. This can result in breast deformity depending on its size and location.
Local advancement flap
A local advancement flap allows the surgeon to take the tissue that is left over after a tumour is removed and reconstruct the breast’s original appearance. This leaves no extra indentations or defects in the breast.
Bilateral breast reduction
Bilateral breast reduction involves removal of a large volume of tissue from the other breast to restore symmetry of breasts following a lumpectomy in only one breast. This procedure can be beneficial in cases where the tumour is particularly large and additional tissue is required.
Bilateral Breast Lift (Mastopexy)
Bilateral breast lift involves removal of breast tissues from the initial excision. This procedure can be combined with other aesthetic treatments, such as nipple relocation, to improve the symmetry of the breasts.
Bilateral mastectomy
Bilateral mastectomy involves the removal of both breasts, including the nipples and areola to remove cancer or to improve the prognosis of a woman who is at high risk of developing breast cancer. Following this procedure, the surgeon may also perform a breast reconstruction surgery to retain the original shape of the breasts.
Post-procedure care and recovery for oncoplastic breast surgery
Patients are typically able to return home within a few days of the procedure, as long as there are no complications. Post-procedure pain and swelling may occur; however, these can be managed with medications. Generally, women can return to their usual activities within 4-6 weeks. It is important to maintain a healthy diet and avoid strenuous physical activity during the recovery period. Follow-up visits with the surgeon are recommended.
Risks and complications of oncoplastic breast surgery
Oncoplastic breast surgery improves cosmetic outcomes in breast cancer patients and is a reasonably safe procedure, there are certain risks to be aware of, including:
- Pain or tenderness
- Poor tissue healing
- Swelling
- Scars
- Blood vessel and nerve damage
- Hematoma
- Surgical site infection
- Anaesthetic reactions
- Sensation of numbness, tingling, or itching
- Nipple necrosis
FAQs
No, oncoplastic breast reduction is not performed on young adolescent girls. Oncoplastic and traditional breast reduction procedures can only be performed on women whose breasts are fully developed, which usually happens in the late teenage years. Additionally, most women who are diagnosed with breast cancer and require oncoplastic breast reduction are middle-aged or older.
It is more common to experience a reduction in the size of the breast after radiation therapy. As a result, surgeons will typically make the breast slightly larger to accommodate breast shrinkage. In rare cases, a secondary operation may be necessary to improve breast symmetry if alterations caused by radiation are extremely noticeable.
Oncoplastic breast surgery provides the same level of breast tissue removal as lumpectomy (a surgical procedure to remove cancer or abnormal tissue from the breast). Furthermore, oncoplastic breast surgery is followed by radiation therapy. Thus, there will be no compromise in cancer care.
Oncoplastic breast surgery has been shown to have a low local recurrence rate and excellent survival rates, despite having worse tumour characteristics, according to a study published in the European Journal of Cancer.
Exercises may vary depending on the type of oncoplastic breast surgery undergone. Some early exercises after oncoplastic breast surgery include:
- Rotating shoulders slowly to stimulate muscles
- Brushing or combing one’s own hair
- Gently extending the arm behind one’s back until it touches right below the shoulder blades.
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What is oncoplastic breast surgery?
The term “Oncoplastic” is a relatively new sub-speciality of breast cancer surgery. It refers to a combination of cancer treatment and cosmetic breast reconstructive surgery. It involves the removal of breast cancer with sufficiently wide free margins followed by reconstructing the defect area. It also includes contralateral breast symmetrisation and nipple reconstruction following mastectomy.
Who is a suitable candidate for oncoplastic breast surgery?
Oncoplastic breast surgery (OBS) indications are based on patient and physician preference. It is recommended for patients who are at risk of breast deformity after standard breast contouring surgery (BCS). Patients with multifocal tumours (including large T4 tumours), macromastia, large breast/breast volumes, and low neutropenia who respond well to oestrogen replacement therapy. OBS is more commonly used in central/upper/inner quadrant tumours for aesthetic reasons. OBS relieves macromastia symptoms and provides oncoplastic reduction of breast cancer in one session.
Patients who require mastectomy because of margin positivity, have inflammatory breast cancer, or have insufficient remaining breast tissue following tumour resection are not eligible for OBS.
Preparation for oncoplastic breast surgery
A comprehensive history and physical examination will be conducted on the day of the consultation to exclude any underlying medical, physical, or social issues that must be addressed prior to the procedure.
Blood and imaging tests may also be performed to detect any abnormalities that may hinder the efficacy of the treatment. It is essential that the oncologist is aware of any potential allergies, medications or supplements the patient may be taking, and the patient is advised to fast for a period of 4 to 8 hours the day of the surgery.
Procedure for oncoplastic breast surgery
Oncoplastic breast surgery is dependent on a variety of factors, including the location and size of the tumour, the ratio of the tumour to the breast size, and the patient’s desired outcome. During this procedure, the surgeons will perform a combination of lumpectomy or partial mastectomy and plastic surgery techniques (reconstructive surgery). Listed below are some of the most common oncoplastic procedures:
Lumpectomy
A traditional lumpectomy involves removal of the tumour and a small part of the surrounding tissue. This can result in breast deformity depending on its size and location.
Local advancement flap
A local advancement flap allows the surgeon to take the tissue that is left over after a tumour is removed and reconstruct the breast’s original appearance. This leaves no extra indentations or defects in the breast.
Bilateral breast reduction
Bilateral breast reduction involves removal of a large volume of tissue from the other breast to restore symmetry of breasts following a lumpectomy in only one breast. This procedure can be beneficial in cases where the tumour is particularly large and additional tissue is required.
Bilateral Breast Lift (Mastopexy)
Bilateral breast lift involves removal of breast tissues from the initial excision. This procedure can be combined with other aesthetic treatments, such as nipple relocation, to improve the symmetry of the breasts.
Bilateral mastectomy
Bilateral mastectomy involves the removal of both breasts, including the nipples and areola to remove cancer or to improve the prognosis of a woman who is at high risk of developing breast cancer. Following this procedure, the surgeon may also perform a breast reconstruction surgery to retain the original shape of the breasts.
Post-procedure care and recovery for oncoplastic breast surgery
Patients are typically able to return home within a few days of the procedure, as long as there are no complications. Post-procedure pain and swelling may occur; however, these can be managed with medications. Generally, women can return to their usual activities within 4-6 weeks. It is important to maintain a healthy diet and avoid strenuous physical activity during the recovery period. Follow-up visits with the surgeon are recommended.
Risks and complications of oncoplastic breast surgery
Oncoplastic breast surgery improves cosmetic outcomes in breast cancer patients and is a reasonably safe procedure, there are certain risks to be aware of, including:
- Pain or tenderness
- Poor tissue healing
- Swelling
- Scars
- Blood vessel and nerve damage
- Hematoma
- Surgical site infection
- Anaesthetic reactions
- Sensation of numbness, tingling, or itching
- Nipple necrosis
FAQs
1. Can young adolescent girls get an oncoplastic breast reduction done?
No, oncoplastic breast reduction is not performed on young adolescent girls. Oncoplastic and traditional breast reduction procedures can only be performed on women whose breasts are fully developed, which usually happens in the late teenage years. Additionally, most women who are diagnosed with breast cancer and require oncoplastic breast reduction are middle-aged or older.
2. Breasts may shrink during radiation therapy, so how can oncoplastic breast surgery procedure ensure symmetry if only one breast needs radiation after surgery?
It is more common to experience a reduction in the size of the breast after radiation therapy. As a result, surgeons will typically make the breast slightly larger to accommodate breast shrinkage. In rare cases, a secondary operation may be necessary to improve breast symmetry if alterations caused by radiation are extremely noticeable.
3. Is oncoplastic breast surgery an effective treatment of breast cancer?
Oncoplastic breast surgery provides the same level of breast tissue removal as lumpectomy (a surgical procedure to remove cancer or abnormal tissue from the breast). Furthermore, oncoplastic breast surgery is followed by radiation therapy. Thus, there will be no compromise in cancer care.
4. Does oncoplastic breast surgery increase the risk of cancer recurrence?
Oncoplastic breast surgery has been shown to have a low local recurrence rate and excellent survival rates, despite having worse tumour characteristics, according to a study published in the European Journal of Cancer.
5. What kind of exercises are recommended after oncoplastic breast surgery?
Exercises may vary depending on the type of oncoplastic breast surgery undergone. Some early exercises after oncoplastic breast surgery include:
- Rotating shoulders slowly to stimulate muscles
- Brushing or combing one’s own hair
- Gently extending the arm behind one’s back until it touches right below the shoulder blades.
References:
1. Oncoplastic breast surgery. National Health Library.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4115743/.
2. Oncoplastic breast surgery. National Health Library.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5351526/#:~:text=Indications%20and%20Contraindications%20to%20OBS&text=Patients%20with%20multi%2Dfocal%20tumors,17%2C58%2C59).
3. Oncoplastic breast surgery. Columbia Surgery.
https://columbiasurgery.org/conditions-and-treatments/oncoplastic-breast-surgery. .
4. After breast cancer surgery. Cancer Research UK. https://www.cancerresearchuk.org/about-cancer/breast-cancer/treatment/surgery/after-surgery.