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Understanding oncoplastic breast conserving surgery

Understanding oncoplastic breast conserving surgery

Breast conserving surgery is sometimes used as part of a breast cancer treatment plan. During this procedure, only the tumour and some of the breast tissue that surrounds it are removed. The portion of breast that is removed depends on the size of the cancerous lump, where it is located and the size of the breast being operated on.

One of the benefits of breast conserving surgery methods is that it is smaller surgery and can leave good cosmetic results and normal sensation in the breast. As the size of the tumour removal increases the shape of the breast can be affected and in large percentage excisions many patients may get poor cosmetic results. Oncoplastic surgery is an aesthetic approach to breast cancer surgery. Oncoplastic breast conserving surgery is the use of plastic surgery techniques to fill cancer defects or re-shape the breast to improve cosmetic outcomes in breast conserving surgery.

This article will explain what oncoplastic surgery is, who it is a good option for, some of the different types of oncoplastic breast conservation and the pros and cons to know about when considering this surgical technique.

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What is oncoplastic breast surgery in breast conserving cancer surgery?

The oncoplastic technique for breast cancer surgery combines tumour removal with advanced plastic surgery techniques to improve cosmetic outcomes by either replacing cancer defects or reduce and/or lift the breast as part of the cancer surgery. The removal of the cancer and the reconstructive surgery are carried out in sequence, so the patient does not need to undergo two separate procedures. It is an immediate breast reconstruction method that improves on the cosmetic outcomes of alternative surgeries, while also providing local control of the cancer.

Oncoplastic reconstructive breast surgery helps to preserve a natural breast shape and appearance, and avoids the need for full mastectomies in groups who have historically had bad aesthetic outcomes following lumpectomies. The nipples are kept intact in most cases and there is minimal or no loss of sensation. Even in cases where cancer is only present in one breast, the plastic or oncoplastic surgeon will operate on both breasts to achieve symmetry if a reduction or mastopexy technique is used.

The cosmetic benefits of the oncoplastic methods can be particularly useful for the ongoing emotional wellbeing of the patient after their cancer journey. Research indicates that oncoplastic breast conserving surgery offers faster recovery, better quality of life and higher rates of patient satisfaction with breast appearance in comparison with mastectomy and immediate breast reconstruction methods.

Who is eligible for oncoplastic breast surgery?

Oncoplastic breast surgery is only an option for cancer patients who can be treated through breast conserving methods. There would also need to be enough breast tissue remaining after the tumour is removed to be able to reshape the breast. This means that some patients are more suited than others to this type of breast re-shaping procedure.

With different oncoplastic techniques available, the approach can be used with a range of breast types. In smaller breasts then it may not be feasible to re-shape the breast and then volume replacement surgery would be used. The best advice is to speak with your doctor or contact a specialist surgeon to learn if you would be a good candidate for this procedure.

What are the different types of oncoplastic breast surgery?

As previously mentioned, there are various types of oncoplastic surgery available, and each is suited to a different breast type.

Therapeutic mammoplasty

This procedure involves breast reduction techniques for excising the cancer and reshaping the breast, ensuring there is no obvious indentation post-surgery. In most cases, both breasts will be operated on to ensure they are symmetrical. It is only suitable for patients that can be treated with breast conserving methods and that have sufficient breast tissue remaining to adequately reshape the breast. There will be some temporary swelling and bruising that should settle down within four weeks, and patients are advised to follow the surgery with radiotherapy.

Lateral intercostal artery perforator (LICAP) flap

The LICAP flap is an oncoplastic approach using the chest wall perforator flap technique for partial breast reconstruction. It uses skin and fat from the lateral chest area close to the armpit to fill the space left by cancer removal in the outer breast area. This aims to achieve the breast’s previous shape and size, so is suitable for a wider range of patients who are eligible for breast conserving surgery. This includes patients with moderate to small breasts for whom the therapeutic mammoplasty technique is not feasible.

Lateral thoracic artery perforator (LTAP) flap

The LTAP flap is another partial breast reconstruction procedure using the lateral chest wall, and can be carried by itself or in combination with the LICAP flap. Such a technique is highly recommended for breast cancer patients with small breasts and lateral or central tumours. At Stephen McCulley’s practice, the LTAP has replaced the thoracodorsal artery perforator (TDAP) flap in the majority of perforator flap cases.

What are the pros and cons of oncoplastic breast surgery?

The cancer is often removed with a wider margin of surrounding tissue, reducing the potential of undetected cancer cells remainingA contralateral symmetry operation is often required to maintain symmetry
Multiple tumours can be removed from the same breast with an optimal cosmetic outcomeAs it is breast conservation surgery, the patient will need to undergo at least whole-breast radiation on the cancer-affected breast
The tumour removal and restorative surgery happen together in a single hospital visit
The psychological stress of losing an entire breast through a mastectomy is taken away, and the cosmetic appearance is retained to help with emotional recovery
Very safe and low-risk
The breasts are rebalanced by displacing or replacing volume

Frequently asked questions

How safe is oncoplastic breast surgery?

Oncoplastic breast conserving surgery has a very high rate of overall survival in tumours up to 3cm but can still be used safely with good safety outcomes in a wide range of cancer sizes and types.

What is the scarring like after oncoplastic breast surgery?

One of the key aims of the oncoplastic approach is good cosmetic results, leaving the scars outside of the breast in case of flaps or similar to cosmetic breast lifts. Scarring is generally very well tolerated with these techniques, but will differ from case to case and should be discussed with your surgeon if you have concerns.

How long will a patient stay in hospital after oncoplastic breast surgery?

You may be discharged on the same day. In some cases, you may have to stay in hospital overnight but patients generally stay no longer than a day.