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Types of oncoplastic breast-conserving surgery: therapeutic mammoplasty

Types of oncoplastic breast-conserving surgery: therapeutic mammoplasty

Oncoplastic breast-conserving surgery
 is the process of removing cancer with a lumpectomy and delivering an immediate breast reconstruction using plastic surgery techniques. By using the patient’s natural tissue instead of implants, this technique provides an excellent alternative to the full mastectomypreserves sensation in the breast and achieves a superior cosmetic outcome.

Therapeutic mammoplasty is just one type of oncoplastic breast surgery. It’s a good choice of early breast cancer treatment for women with large breasts who are happy to undergo a breast reduction at the same time as lump excision. This guide will explain this procedure in more detail, including its benefits and some risks to bear in mind.

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What is a therapeutic mammoplasty?

A therapeutic mammoplasty combines a lumpectomy (a wide local excision of a tumour) with the oncoplastic reconstruction of the breast. In addition to the lump, tissue and skin are removed from the breast to create a smaller, uplifted shape.

When a lump is removed from the breast using a traditional excision method, it can cause a deformity in the breast’s shape and size, resulting in an asymmetrical appearance. A therapeutic mammoplasty prevents this deformity by modifying the shape of the breast immediately after the lump removal.

This method of oncoplastic surgery is favourable to a full mastectomy because it preserves as much breast tissue and sensation as possible. Compared to other breast conservation surgeries, such as the LICAP flap, TDAP flap and LTAP flap procedures, there is no transplant of tissue from other areas of the body like the back or under arm area and relies on reshaping existing breast tissue.

There are several techniques for delivering a therapeutic mammoplasty. One of the most common methods is a round block mammoplasty, which involves a doughnut-shaped piece of tissue being removed from around the nipple. It results in a scar only around the edge of the areola.

Vertical scar mammoplasty involves an incision around the nipple in addition to a vertical incision from the nipple to the crease beneath the breast. This creates a lollipop-shaped scar. It’s a technique suitable for tumours located in different parts of the breast and common in smaller breasts with some droop.

Finally, wise pattern mammoplasty uses an incision around the areola, vertically from the areola down to the crease of the breast and horizontally in the crease of the breast. An anchor-shaped scar is therefore created. This method allows for tumours to be removed from anywhere inside the breast.

What are the benefits of therapeutic mammoplasty surgery?

The main benefit of therapeutic mammoplasty surgery is that the cancer is removed and the breast reconstructed in a single surgery. Additionally, the patient does not have to lose the entire breast and the nipple is usually preserved.

Many patients appreciate the improved shape and lift of the breast following this type of surgery. The procedure can be performed bilaterally (on both breasts) to achieve symmetry. When oncoplastic breast reconstruction procedures are followed by radiotherapy, there is a risk that the skin can become sore and break down. With a therapeutic mammoplasty, this risk is reduced because transplanted tissues are not used to reconstruct the breast.

What are the limitations of therapeutic mammoplasty surgery?

Like any other type of breast cancer surgery, patients must undergo a general anaesthetic to have a therapeutic mammoplasty and may experience discomfort and pain during recovery.

Complications are rare, but those to be aware of include seroma (a build-up of fluid in the surgical site which might require draining) and haematoma (a pooling of blood under the skin). There is also a low risk of infection in the wound, delayed wound healing and bruising. Loss of nipple sensation can occur but this will typically return to normal in time.

Compared to alternative oncoplastic breast cancer treatments, therapeutic mammoplasties tend to cause more scarring because larger areas of skin and tissue are removed. The extent and location of scarring vary depending on the size and location of the lump as well as the breast size and shape. Your breast surgeon will strive to make minimal incisions to keep scarring at a minimum, but the primary goal is to achieve the best possible shape and size.

Who is a good candidate for a therapeutic mammoplasty?

Therapeutic mammoplasties are best suited to patients with large breasts who are willing to undergo a reduction in breast volume following cancer treatment. Those with breast ptosis (drooping of the breast tissue) or very large and heavy breasts may welcome the opportunity for breast reduction surgery at the same time as tumour removal. However, it can also be helpful in smaller breasted patients with some droop.

If you’d like to know if you’re a good candidate for therapeutic mammoplasty, contact us today to arrange a consultation with Stephen McCulley.

Frequently asked questions

What is the recovery process like after a therapeutic mammoplasty?

You can expect to remain in hospital for one night following this surgery, particularly if you are having a bilateral therapeutic mammoplasty. You might require wound drains to help reduce swelling but these are usually removed before discharge. You will not be able to drive for at least two weeks after the surgery and you need to avoid strenuous activity for a few weeks.

How should you look after your wounds following therapeutic mammoplasty surgery?

Waterproof glue dressings are used to protect wounds following surgery. You can shower but avoid taking a bath for several weeks following the surgery as your incision sites shouldn’t be soaked but you can shower.

How safe is oncoplastic breast conservation surgery?

Oncoplastic breast conservation surgery is generally safe. As with any surgery, it is not without risk of complications, but these should be discussed with you prior to the procedure.

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Types of oncoplastic breast-conserving surgery: LTAP flap

Types of oncoplastic breast-conserving surgery: LICAP flap