Oncoplastic breast surgery: Benefits and limitations
Treatments for breast cancer are constantly being refined and developed through extensive research; one advanced treatment is oncoplastic breast surgery. Oncoplastic surgery is a highly effective procedure for cancer removal, and it often has more favourable cosmetic outcomes than a mastectomy or lumpectomy, for example. The oncoplastic technique is a form of breast conservation surgery and combines the traditional methods of breast cancer surgery with the aesthetic advantages of plastic surgery.
Patients often prefer the surgery as less recovery time is needed. The surgery consists of two stages; first, the breast surgeon will remove the tumour and some surrounding breast tissue and then carry out a partial breast reconstruction. Vascularised fat tissue is taken from the upper back and armpit area to fill the space left from tumour removal. Therapeutic mammoplasty is a type of oncoplastic breast surgery that utilises existing breast volume instead of the armpit/back area, resulting in a slight breast reduction.
The overall goal of oncoplastic surgery is to remove the tumour whilst minimising the unwanted cosmetic effects of the surgery; this can help the patient heal physically and emotionally in the long run.
Click on one of the links below to jump to that section:
- What are the benefits of Oncoplastic Breast Surgery?
- What are the limitations of Oncoplastic Breast Surgery?
- How does Oncoplastic Breast Surgery compare to other types of cancer surgery?
- Comparing Oncoplastic breast Surgery procedures
- Why choose Oncoplastic Breast Surgery?
What are the benefits of Oncoplastic Breast Surgery?
The fusion of traditional methods of breast cancer surgery with plastic surgery means that the cosmetic outcomes for the patient are favourable compared to other options; traditional cancer removal methods can often leave the patient with a deformed breast. Although tumour removal is the main priority of cancer surgery, cosmetic deformities can harm a patient’s self-esteem and confidence.
Another benefit of oncoplastic surgery is the recovery time. Many breast cancer patients can leave the hospital on the same day. A traditional breast cancer surgery with breast reconstruction will make you come back after your recovery and radiation therapy before cosmetic surgery. This can prolong recovery, leaving the patient with deformed breasts for an extended period of time.
With oncoplastic breast surgery, removing large breast tumours without poor cosmetic outcomes from surgery is also possible. After the tumour is removed, immediate breast reconstruction is carried out. Thanks to breast conservation surgery, sensations are preserved within the breast, which may not be possible with a mastectomy.
Finally, since recovery tends to be better for oncoplastic surgeries, adjuvant chemotherapy and radiation therapy can be carried out much sooner than traditional surgeries. This may give the patient more peace of mind over cancer remission.
What are the limitations of Oncoplastic Breast Surgery?
Surgeries don’t come without their risks and limitations. One of these limitations of oncoplastic surgery is that both breasts may require surgery to achieve what’s referred to as contralateral symmetry. This is beneficial in the long term, but it may prolong recovery.
Since tumour removal and breast reconstruction are carried out in the same procedure, radiation therapy must take place after reconstruction, which can cause minor shrinkage in the breast; this may be an issue for smaller-breasted women. Oncoplastic surgeries can be done on all breast sizes; however, if a patient has very small breasts or a large breast volume needs to be removed, then oncoplastic surgery may not be preferable.
Radiation therapy is usually recommended after breast cancer removal surgeries, to ensure that any remaining cancer cells are removed. After breast conservation surgery, like oncoplastic surgery, it is especially recommended to have follow-up radiation therapy.
Occasionally, there can be medical complications associated with breast surgery. Utilising vascularised tissue for breast reconstruction helps avoid tissue necrosis, and sensation can be preserved in the breast and nipple. However, some rare surgical complications are listed below:
- Internal bleeding
- Deep vein thrombosis
- Perforator flap failure or loss (blood supply complications)
- Fat necrosis (due to blood supply complications)
Your plastic surgeon will let you know what to expect from recovery. If you are concerned about your recovery, contact your surgeon. Signs of surgery complications include severe pain for longer than a few days, discolouration, excessive swelling or the presence of pus.
How does Oncoplastic Breast Surgery compare to other types of cancer surgery?
One of the most well-known forms of cancer surgery is a mastectomy. In a full mastectomy, the breast tissue is completely removed, and generally, this includes the skin of the breast and the nipple. Alternative partial mastectomy options include a skin-sparing mastectomy, which preserves some breast volume or a nipple-sparing mastectomy, which preserves the nipple. Lumpectomies are a common alternative to a mastectomy; they remove only a small portion of breast tissue; however, these can result in breast deformities and asymmetry.
After a mastectomy, there are options to go through breast reconstruction surgery; implants are often used in breast reconstruction. These may not give the patient cosmetic satisfaction due to a lack of symmetry and unnatural-looking breasts. Traditional cancer removal and breast reconstruction surgeries will require two separate operations, and recovery times may be longer. Additionally, patients often lose sensation in the breast and nipple if either has been spared.
Contrary to common belief, oncoplastic surgery is equally effective for tumour removal as traditional surgical oncology. This can be reassuring for women deciding on a breast cancer treatment that is both effective and has desirable cosmetic outcomes.
However, a mastectomy is often the preferred approach for invasive breast cancer, if there are multiple tumours or if the cancer is likely to spread into the lymph nodes or the chest cavity. This is because too much breast volume will need to be removed to prevent cancer resurgence; this will not allow for immediate reconstruction.
Comparing Oncoplastic Breast Surgery procedures
The table below explores the benefits and limitations of the different oncoplastic breast surgery procedures relating to tumour location, cosmetic outcome, recovery time, scarring and patient suitability.
|Procedure||Tumour location||Cosmetic outcome||Recovery||Scarring||Suitability|
|Therapeutic mammoplasty||Anywhere in the breast||The nipple is sometimes relocated, and contralateral symmetry is required—the surgery results in breast reduction.||Single surgery but on both breasts – good recovery||Scarring around the areola and underneath the breast||For larger or ptotic-breasted women|
|LICAP flap||On the (lateral) side of the breast||Breast conservation surgery, nipple sparing – a good outcome||Single surgery, usually a single breast – good recovery||Scarring is hidden underneath the bra||For any breast size, better suited for early breast cancer|
|LTAP flap||Lateral to central tumours||Breast conservation surgery, nipple sparing – a good outcome||Single surgery, usually a single breast – good recovery||Scarring is hidden underneath the bra||Suitable for smaller tumours. Not suitable for ptotic breasts when the tumour occupies more than 10% of the breast.|
|TDAP flap||Any part of the breast||Cosmetic outcomes are less reliable||It may require two surgeries if the tumour is upper-medial – longer recovery||Scarring is hidden underneath the bra||For small-medium breasts|
|LD flap||Lateral breast tumours||Breast conservation surgery, nipple sparing – a good outcome||Slow recovery and impacted movement because latissimus dorsi muscle has been used for breast reconstruction||Scarring is hidden underneath the bra||For small-medium breasts or where there is little body fat.|
Why choose Oncoplastic Breast Surgery?
Oncoplastic surgery is best suited for a patient with early breast cancer or where the tumours are located laterally or in the centre of the breast. Oncoplastic surgery is suitable for women of any breast size, although, those with lower body fat or smaller ptotic breasts may not be suitable for certain procedures.
Oncoplastic breast surgery offers effective cancer removal, while providing a desirable cosmetic outcome. Many patients also benefit from shorter recovery times. Certain procedures may require surgery on both breasts to maintain symmetry, and there may be some shrinkage due to adjuvant radiation therapy. However, oncoplastic breast surgery is generally the preferred option for most women due to superior cosmetic outcomes.