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Types of Oncoplastic breast-conserving surgery

Types of Oncoplastic breast-conserving surgery

Standard breast cancer procedures such as a mastectomy or lumpectomy can leave patients with deformity to the breasts. Even with implant breast reconstruction surgery, women can be left with asymmetrical or unnatural-looking breasts in some cases and the same can occur with autologous reconstruction. Oncoplastic Surgery involves breast cancer removal and immediate partial breast reconstruction using living tissue. Women can undergo one single procedure and be left with an excellent cosmetic outcome from breast reconstruction.

There are different types of Oncoplastic Breast Surgery, including the LICAP flap, the TDAP flap and the LTAP flap. These procedures use a perforator flap, meaning that vascularised tissue is used for breast volume replacement. A therapeutic mammoplasty is also possible, whereby, existing tissue is used for breast reconstruction, resulting in breast reduction.

Here, we will explore the different surgical oncology approaches and when these options might be suitable. We will also explore the cosmetic outcomes of each procedure to help you decide whether each oncoplastic technique is appropriate.

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What is a LICAP flap breast cancer surgery?

This type of breast cancer surgery stands for Lateral Intercostal Artery Perforator flap surgery. It refers to the name of the artery supplying blood to the perforator flap that is used for breast volume replacement. During the perforator flap reconstruction, the vascularised tissue, made primarily of fat, is taken from the side of the torso/armpit area and rotated into the breast, where the tumour would have previously occupied. This procedure often uses a propeller flap (whereby the flap is only connected in one location and can be rotated in any direction). This is possible because the blood supply runs horizontally across the armpit/chest area.

Lateral Intercostal Artery Perforator

This procedure is ideally suited to patients with tumours in the outer half and the underside of the breast. This is because the blood supply to the reconstructive tissue runs along the chest/armpit area. This procedure is also suitable for women of any breast size.

Illustration of a breast, indicating in red which areas of the breast are covered by the LICAP flap procedure (lateral portion).;

Cosmetic outcome

Scarring is hidden underneath the bra strap, and immediate breast reconstruction after breast cancer removal is possible using natural breast tissue. As a result, cosmetic outcomes are generally good.

Read more about LICAP flap surgeries here.

What is TDAP flap breast-conserving surgery?

This type of procedure stands for Thoracodorsal Artery Perforator flap. Again, the procedure refers to the name of the artery supplying blood to the pedicled flap. This artery can be found in the armpit/back area, slightly further back from the breast than that used in TDAP flap procedure. This procedure is less common; however, it uses a true pedicle, meaning that a section of primarily fat tissue can be relocated to replace volume anywhere in the breast after breast cancer removal.

Patient suitability

This procedure is suitable for treating breast cancer anywhere in the breast but is particularly useful for patients with central or medial tumours, where alternative procedures are not possible. This procedure is also used for secondary breast reconstruction procedures. In this case, tumour removal occurs in a separate procedure from reconstructive surgery.

An illustration of a breast indicating in blue where the TDAP procedure covers (upper central tumours) in the breast.

Cosmetic outcome

Again, scarring is hidden underneath the bra strap, and immediate reconstruction is possible. Scarring may be more severe with delayed reconstruction surgery after radiation therapy.

Read more about TDAP flap procedures here.

What is LTAP flap breast-conserving surgery?

This procedure stands for the Lateral Thoracic Artery Perforator flap, which refers to the artery running down the breast’s side in the chest/armpit area. In this procedure, natural fat tissue connected to a healthy blood supply is turned over into the breast from the armpit/chest area to replace the volume lost after breast cancer removal. This procedure has a true pedicle, meaning that volume replacement is possible in almost any part of the breast.

Patient suitability

This procedure is suitable for patients with this artery running down the side of the breast, instead of across into the breast. Fortunately, this includes 95% of patients. As mentioned, this procedure is ideal for a broad range of breast tumours located anywhere in the breast but best for lateral and centrally placed cancers.

An illustration of a breast, indicating in green where the LDAP procedure can cover (lateral, upper portion) in the breast.

Cosmetic outcomes

Again, scarring is hidden underneath the bra strap, and the breasts can be reconstructed immediately after breast cancer removal. This results in a natural breast shape with subtle scarring.

Read more about the LTAP flap procedure here

Which procedure would be suitable for me?

If your breast surgeon is performing a perforator flap procedure, they will have to identify which blood vessel can provide the best blood supply to your pedicle. This is usually determined prior to your procedure; however, it may be the case that your plastic surgeon plans one procedure and finds a better blood supply during the operation.

Overall, if you have an LTAP blood vessel running down the side of the breast, this procedure will likely be the most suitable. Otherwise, if you have a lateral tumour and a LICAP is available, this procedure may be preferable. Finally, if you have a central tumour or the reconstructive surgeon has issues locating a strong blood supply, the LTAP may be the best option.

What is a therapeutic mammoplasty?

This procedure is different to perforator flap procedures because it is an oncoplastic reduction. Larger or ptotic (sagging) breasted women can undergo a procedure whereby, the breast cancer is removed and immediately reconstructed using existing, natural breast tissue. There are three main types of reduction mammoplasty; the first is called a round block mammoplasty, leaving a scar around the areola. The second is called a vertical scar mammoplasty, leaving a lollipop shaped scar around the areola and down to the breast crease. The third is a wise pattern mammoplasty, leaving an additional horizontal scar in the breast crease.

Patient suitability

This procedure is ideal for large-breasted women or women with ptotic (sagging) breasts, since it involves breast reduction. Therapeutic Mammoplasties can be used for tumours anywhere in the breast, particularly central or medial tumours where perforator flap procedures are less feasible.

Cosmetic outcome

The scarring from this procedure is usually more visible since it is on the breast itself. The wise pattern mammoplasty would result in the most apparent scarring. However, after a full recovery, the result would be natural, lifted breasts for most patients.

Read more about a reduction mammoplasty

If you are interested in Oncoplastic Surgery as a treatment option for your breast cancer, contact Stephen McCulley today and find out which treatment options are available.

Related content

Types of Oncoplastic Breast Surgery: LICAP flap

Types of Oncoplastic Breast Surgery: TDAP flap

Types of Oncoplastic Breast Surgery: LTAP

Types of Oncoplastic Breast Surgery: Therapeutic Mammoplasty