Comparing oncoplastic breast surgeries and lumpectomies
After being diagnosed with breast cancer, patients need to weigh up the options available to them when it comes to surgical treatment. The main priority is to get the best possible outcome in terms of long-term quality of life, but other factors such as aesthetic satisfaction should also be considered.
The lumpectomy is a common surgical procedure for removing breast cancer lumps, but it can, in some cases, lead to distortion of the breast and therefore an undesirable aesthetic outcome. Oncoplastic breast-conserving surgery involves lump removal and reconstruction of the breast at the same time for an optimal aesthetic outcome.
In this article, we’ll outline the differences between these two procedures, the benefits and drawbacks of each, and patient suitability to help you understand which one might be more appropriate for you.
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A lumpectomy is a process of removing a lump from the breast without performing any restoration at the same time. Usually, a margin of healthy tissue surrounding the lump is also removed in order to ensure that the cancerous tissue is completely removed. Depending on the size of the lump and its location in the breast, lumpectomies can sometimes result in a distortion of the breast shape or asymmetry between the breasts.
Oncoplastic techniques can allow larger lumpectomy so extending the potential role of breast conserving surgery. This can avoid the need for a full mastectomy in groups who have historically seen poor cosmetic outcomes with lumpectomies in early breast cancer cases. They combine tumour removal with immediate reconstruction of the breast, utilising plastic surgery methods to retain a satisfactory shape, size and breast volume. Oncoplastic techniques are also often referred to as oncoplastic breast conservation surgery because the goal is to conserve as much of the natural breast tissue as possible.
With the LTAP flap, TDAP flap and LICAP flap, for example, this involves transplanting natural tissue from the side of the torso beneath the armpit into the gap left by the excised tumour. This tissue remains connected to the blood flow from the relevant artery. The therapeutic mammaplasty, on the other hand, doesn’t use skin and tissue from elsewhere on the body and instead removes additional breast tissue as well as the tumour to achieve a smaller and uplifted shape so eliminating the defect left by cancer excision.
Depending on the size and location of the tumour, a simple lumpectomy may be a less invasive option than oncoplastic surgery. This is suitable for many patients but if a deformity is created repair of that at a later date will be more involved and complicated. However, since oncoplastic surgery involves breast reconstruction at the same time as cancer removal, patients only have to undergo a single surgery and recovery period. This tends to be favourable over a lumpectomy followed by another surgery for reconstruction at a later date.
Standard lumpectomies are often recommended to patients with relatively small tumours in the outer and lower portions of the breast, where there is enough tissue that removal of the lump is unlikely to lead to distortion or dimpling of the breast.
When a lump is located on the medial or central portion of the breast, or the lump is large relative to the size of the breast, the risk of distortion with a standard lumpectomy is quite likely. In these cases, your surgeon might recommend oncoplastic breast surgery such as the TDAP flap, LTAP flap and LICAP flap. In patients with very large breasts or breast sagging (ptosis), a therapeutic mammoplasty can give an opportunity to reduce the size and improve the appearance of the breasts at the same time as tumour removal.
Patients with multiple tumours, very large tumours, or more aggressive types of cancer may not be suited to a lumpectomy or oncoplastic breast surgery. Instead, a mastectomy may be required to ensure the cancer is completely removed. In these instances, reconstruction with breast implants or surgeries such as the DIEP flap may be possible to restore breast shape and volume.
Both lumpectomy and oncoplastic surgery will leave patients feeling tired, uncomfortable, swollen and tender for a few days to a few weeks post-operation. The recovery period for oncoplastic surgery is quite similar to that of a lumpectomy, given it is a single surgery.
Additionally, oncoplastic methods like the LTAP flap and therapeutic mammoplasty do not use any muscle to rebuild the breast (as is the case with the LD flap, for example). This significantly reduces the recovery period and means strength in the side of the body the tissue is taken from is not impacted long-term (though there may be some stiffness immediately following the operation).
For both types of breast cancer surgery patients must avoid strenuous activity for several weeks afterwards. A comfortable and supportive sports bra should be worn for eight to 12 weeks, and patients should avoid sleeping on their front or side over this period as well.
Patient satisfaction and quality of life are generally higher with oncoplastic techniques compared to mastectomies. In addition to improved cosmetic outcomes, the reasons for this include the use of natural tissue and the higher likelihood that sensation will return to the breast and nipple. Many patients with large and sagging breasts appreciate the opportunity to undergo an oncoplastic breast reduction or lift following tumour excision.
It’s common for patients to require radiation therapy following lumpectomy or oncoplastic surgery to ensure thorough treatment of cancer cells. Sometimes this can cause the breast tissue to shrink, which can negatively affect chest symmetry. If extensive radiation therapy is necessary, this should be discussed prior to surgery.
Furthermore, there is usually no need for additional restorative surgeries after an oncoplastic reconstruction, though the patient may request another procedure if the shape or size of their breast(s) change following recommended radiation therapy. With standard lumpectomies, about a third of patients often find that they’re unhappy with the appearance of their breasts after fully healing and opt to undergo reconstructive surgery at a later date. In these modern times these are cases being offered oncoplastic surgery.
Frequently asked questions
Will my breast retain feeling after oncoplastic surgery?
It’s not uncommon to experience some loss of sensation following oncoplastic breast surgery. Most patients find that sensation eventually returns once the tissues heal, but in some cases, full sensation may not completely return.
Will your choice of surgery affect the chances of cancer coming back?
Some breast cancer research has identified evidence to suggest that oncoplastic surgery might reduce the risk of cancer coming back. A 2006 study of 99 patients found that those who underwent oncoplastic surgery had a reduced need for further excisional surgeries than those who underwent a lumpectomy. There were also fewer secondary mastectomies required for the oncoplastic group compared to the lumpectomy group.
For more information about lumpectomies or oncoplastic surgery, or to discuss which option would be right for you, contact a member of the Stephen McCulley team today.