Oncoplastic breast surgery: managing post-surgery pain and scars

Breast cancer is the most common type of cancer in the UK, despite predominantly affecting women. Over the years, breast cancer surgery operations – lumpectomy and mastectomy, have been successful in removing tumours, but they leave behind often big breast deformities. Women may have to undergo two different operations, one to remove the cancerous tissue and another plastic surgery, for breast reconstruction. This can greatly impact the patients’ lives when it comes to recovery, scarring and post-surgery breast cancer treatment.

Oncoplastic breast cancer surgery is an alternative approach that combines both cancer removal with breast reconstruction into one surgery, which can result in a better cosmetic outcome and superior recovery. In this article, You will learn the benefits of Oncoplastic breast surgery for managing post-surgery pain and scarring. You will also learn what you can do to reduce the impact of breast surgery on your life.

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The benefits of oncoplastic breast surgery

This procedure involves volume-replacement or volume displacement techniques, depending on the tumour size, location and the patient’s breast size. The surgery is an innovative approach with several recovery-related benefits in comparison to traditional surgeries.

Pain

with the majority of oncoplastic breast surgeries needing only a single operation, this minimises the recovery time, since the patient will not need to come back for a breast reconstruction, causing further damage to the breast tissue and disturbance of nerves. Regarding pain following breast surgery, you may have moderate to severe pain lasting only a few days and much of the pain should subside after several weeks.

Recovery

Oncoplastic surgery differs to alternative breast cancer surgeries. They usually minimise the surgical impact on the breasts and utilise less involved tissue for breast reconstruction. Oncoplastic breast surgeries including LICAP, LTAP and TDAP flap procedures use vascularised tissue from under the armpit/upper back, rather than muscle from the latissimus dorsi muscle. This means that muscle strength is not affected and recovery may be faster.

Another benefit is that patients can often be discharged from hospital after oncoplastic surgery on the day of, or one day after the procedure. Contrarily, for a mastectomy, with breast reconstruction, the hospital stay can be up to three days or longer. It is normal to experience swelling and bruising in the breasts for weeks to months after the surgery. It will be several months until you can see the full results of the surgery.

Managing post-surgery pain

Your plastic surgeon will help you manage the initial pain after your operation with local anaesthetic into the affected area. The patient may also be prescribed with muscle relaxers and anti-inflammatory drugs, as well as narcotic pain medication for a short period of time. After two to three days, it’s likely you’ll be able to scale down your pain medication to over-the-counter painkillers.

In addition to initial soreness from the surgery there are different types of pain that can last between six and twelve months after your surgery. As a result of nerves in the breast having been disturbed during the surgery, you may feel shooting pain, burning, itching or tingling sensations in the breast and/or nipples.

If any severe pain lasts longer than a few days, or if you experience excessive tenderness, swelling or fever, this could be a sign of infection and you should get in touch with your plastic surgeon immediately. Some patients may experience nerve pain for over a year after breast surgery, as a result of the nerves in the breasts taking longer to settle down.

Post-surgery scarring

Scarring is an inevitable consequence of surgery. Some breast surgery scars can be larger and more visible than others. Mastectomy with a reconstructive surgery will result in lots of scarring as the two procedures will generate different sets of scars and there may be a higher risk of a keloid scar (right) developing. The most common type of scars after oncoplastic breast surgery are thin, pale and flat to the skin (left).

Oncoplastic breast surgery scars are strategically placed so that they have a better cosmetic outcome. LICAP, LTAP and TDAP flap procedures result in scars along the side of the chest and back, this is hidden under the arm and by a bra strap.

Therapeutic mammoplasty procedures, that result in a breast reduction, will leave scars around the areola and in some cases on the underside of the breast. Round block mammoplasty (left) leaves just the scar around the areola, while vertical scar mammoplasty (middle) will also leave a lollipop scar down to the crease of the breast. Finally, wise pattern mammoplasty (right) will leave a lollipop scar with an additional scar running along the crease of the breast.

Managing post-surgery scarring

The scars will initially feel tight but will continue to relax after a few weeks post-surgery. Patients will require a soft but supportive, non-wired bra in the following 3-4 weeks after surgery. In this time, we also recommend:

Drinking lots of water
Eating plenty of protein (for collagen synthesis)
Keeping the wound clean and dry. DO NOT PICK YOUR SCABS
Avoiding hot showers
Avoiding exposure of the scar to direct sunlight (recommended for 9-12 months)
Avoiding vigorous exercise
Massaging your scars

Managing scarring with massage

Scars after oncoplastic breast surgery may develop differently in each individual but most of them fade to white or become very pale in 9-12 months. Massage is one way of reducing scarring, as it increases blood flow, distributes collagen and improves sensitivity.

How to massage the scar

To massage your scars, use two fingertips to apply pressure and move the fingers in either circular, up and down or side to side motions. Use a cream or lotion while massaging; this moistens the scar and keeps it flexible; avoid perfumed lotions. We recommend the following lotions for scar massage:

unscented creams containing vitamin E
Castor oil
Aloe vera
Silicone gel

Frequently asked questions

What is post-mastectomy pain syndrome?

It is a surgical complication of breast surgery that involves chronic neuropathic pain. Patients may experience pain in the armpit, arm or chest wall. If you feel severe or chronic pain which is not normal, contact your surgeon.

How safe is oncoplastic breast conservation surgery?

Oncoplastic breast surgery is a safer choice with regards to recovery, as less breast tissue is disturbed compared to mastectomy. However, radiotherapy is required to the remaining breast for the treatment to be equitable to mastectomy.

What to expect in recovery

What do breast surgery scars look like?

How to massage scar tissue after breast surgery

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