What are the long-term outcomes and potential side effects of Oncoplastic Breast Surgery?
Breast cancer surgery often leaves women with deformed, asymmetrical breasts or needing implant reconstruction. As a result, traditional clinical oncology techniques such as mastectomy or lumpectomy surgery can severely negatively impact self-esteem and patient satisfaction.
Oncoplastic Breast Survey, or OBS, is a type of surgery that combines tumour removal (surgical oncology) with breast reconstruction (plastic surgery) into one single procedure. Breast-conserving methods such as OBS aim to retain as much natural breast tissue as possible while achieving a satisfactory oncological outcome.
In this article, we will first look at the oncological outcomes of Oncoplastic Surgery regarding how successful this surgery is as a breast cancer treatment option. Secondly, we look at the long-term medical implications of the procedure that are not cancer-related. Then finally, we consider the cosmetic outcomes of Oncoplastic Breast Surgery in terms of patient satisfaction and psychological well-being. We also compare the oncoplastic procedure to other breast-conserving surgery options.
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- The potential long-term effects of Oncoplastic Breast Surgery
- The oncological outcomes of Oncoplastic Breast Surgery
- The cosmetic outcomes of Oncoplastic Breast Surgery
- How do the outcomes and long-term impacts compare to other procedures?
The potential long-term effects of Oncoplastic Breast Surgery
Although rare, it is crucial to be aware of the potential long-term side effects associated with Oncoplastic Surgery. Most possible long-term side effects are not severe or dangerous and may even subside. Speak to your breast surgeon if you are concerned about any long-term side effects.
- Nerve pain – due to large amounts of breast tissue being disturbed, nerve pain is common in recovery. Unfortunately, some patients can experience itching, burning, or shooting pains in the breasts for up to but rarely exceeding 12 months. Read about pain management here
- Loss/change in sensation – in some cases, patients may experience a loss of sensation in the breast or nipple. This side effect is more likely when undergoing a reduction mammoplasty procedure, where the breast volume is reduced (oncoplastic breast reduction), and the nipple may have been relocated.
- Keloid scarring – these types of scars (discoloured, raised and tough) are more likely to occur if you fail to take proper care of your wound and scars after the procedure. Read about post-surgery scar care here.
- Fat necrosis – this rare side effect results from blood flow issues causing fat tissue to die and become lumpy. This side effect is not dangerous but undesirable should it occur.
Although cancer resurgence is rare, there is always a risk that cancer can re-emerge. As a result, it is essential to get radiation therapy after oncoplastic breast conservation surgery. It is also worth noting that adjuvant radiation therapy may cause slight shrinkage in breast tissue.
The oncological outcomes of Oncoplastic Breast Surgery
Oncoplastic Surgery is primarily a cancer treatment, so it must perform effectively as such. Here, we explore the efficacy of the oncoplastic approach in terms of the necessity of adjuvant cancer treatment, cancer relapse and re-excision rates. We also compare Oncoplastic Breast Surgery to alternative techniques.
Adjuvant chemotherapy/radiation therapy requirements
It is always recommended to seek radiation therapy after Oncoplastic Surgery for the best oncological results. Radiation therapy helps to ensure the removal of any undetected cancer cells. As for Adjuvant chemotherapy, at least one-quarter of invasive breast cancer patients require adjuvant chemotherapy after oncoplastic breast cancer surgery. Breast conservation surgery may, therefore, be preferred for early-stage breast cancer patients.
Cancer relapse rates
Fortunately, cancer resurgence is relatively rare after Oncoplastic Surgery. A study found that cancer relapsed locally and distally at a rate of 1.1-12.4%, respectively. Alternatively, other researchers found local resurgence to be 0-1.8% per year after the four-and-a-half years post-surgery. Cancer resurgence rates are generally low; however, it is important to compare breast-conserving procedures.
Cancer relapse and re-excision rates compared to other procedures
Breast cancer resurgence and re-excision rates were compared between Oncoplastic Breast Surgery and other breast-conserving surgeries. That there was a decrease in re-excision rates for OBS (2.7% versus 13.4% for standard procedures). There was also a lower overall cancer relapse rate for Oncoplastic Breast Surgery patients – 1.3-2.7% for OBS compared to 2.2-7.5% for other procedures.
The cosmetic outcomes of Oncoplastic Breast Surgery
The secondary purpose of Oncoplastic Surgery is to achieve a desirable cosmetic outcome. Here, we explore cosmetic satisfaction and the patients’ psychological well-being after breast cancer surgery.
Despite cosmetic failure occurring 1-18% of the time with Oncoplastic Breast Surgery, the procedure is still associated with high patient satisfaction. In fact, 95% of breast cancer patients were happy with the cosmetic outcome and were equally satisfied even without contralateral symmetry – meaning without surgery on the non-cancerous breast to achieve symmetry. Smaller-breasted women were also equally satisfied.
Despite asymmetry having little effect on patient satisfaction, 89% of patients did notice some asymmetry (according to another study reporting 94% overall satisfaction). However, patient satisfaction only decreased when over 20% of the breast volume was removed.
Perceived quality of life/self-esteem
The risk of detriment to a patient’s self-esteem or quality of life is also low – 95% of breast cancer patients reported good psychological well-being after recovering from Oncoplastic Surgery.
Comparisons to other procedures
Finally, Oncoplastic Breast Surgery showed higher patient satisfaction rates compared to a partial mastectomy and reconstruction using breast implants.
When assessing your cancer treatment options, it is important to consider patient suitability for the oncoplastic technique. The oncological and cosmetic benefits are more limited for invasive tumours, or tumours that occupy more than 20% of the breast volume. Aside from these two scenarios where OBS may not be suitable, it has been shown that Oncoplastic Surgery is an effective and satisfactory breast-conserving surgery.
How do the outcomes and long-term effects compare to other procedures?
Ultimately, surgery options available to breast cancer patients depend on the size and the type of tumour, the desired cosmetic results, your breast anatomy/BMI and numerous other factors. However, Oncoplastic Surgery may be preferred over a traditional lumpectomy or partial mastectomy with reconstructive surgery.
Tumour removal with immediate reconstruction is an effective cancer treatment strategy for non-invasive, early-stage breast cancer and is equally if not more effective than other breast-conserving strategies. However, it is always advised that patients follow up with radiation therapy. Breast cancer patients are also less likely to experience medical complications with OBS than with other types of surgery, including a partial mastectomy with reconstruction. Additionally, the cosmetic outcomes are better for oncoplastic procedures than a traditional implant reconstruction, leading to overall higher quality of life.
If you’d like to discuss Oncoplastic Breast Surgery in more detail, please get in touch with the Stephen McCulley team today!
- Long-term Results After Oncoplastic Surgery for Breast Cancer: A 10-year Follow-up
- Oncological and cosmetic outcomes of oncoplastic breast conserving surgery
- How safe is oncoplastic breast conservation?: Comparative analysis with standard breast conserving surgery
- Patient Satisfaction Following Level II Oncoplastic Breast Surgery: A Comparison with Mastectomy Utililizing the Breast-Q Questionnaire will be published in Surgical Oncology
- Patient satisfaction after unilateral oncoplastic volume displacement surgery for breast cancer, evaluated with the BREAST-Q™
- Cosmetic Outcome and Percentage of Breast Volume Excision in Oncoplastic Breast Conserving Surgery
- Early Postoperative Outcomes in Breast Conservation Surgery Versus Simple Mastectomy with Implant Reconstruction: A NSQIP Analysis of 11,645 Patients
- Oncoplastic breast conservation surgery is oncologically safe when compared to wide local excision and mastectomy