Oncoplastic breast surgery is a relatively new term. It is a combination of cancer (oncologic) surgery and plastic surgery. In broad terms, it refers to an operation designed to remove cancer from the breast and preserve, restore and in some cases improve the natural appearance of the breast. The goal of oncoplastic surgery is to achieve an acceptable breast appearance while maintaining uncompromising cancer principles. In my opinion the principles of oncoplastic surgery should be applied to all women who have breast cancer so they can survive cancer and maintain their quality of life.
The term oncoplastic is usually applied when a lumpectomy is performed. Compare this to the term reconstruction, which is used when the entire breast is removed (mastectomy) and a new breast is made.
We know from experience that even small lumpectomies can result in significant deformity and pain. Often the immediate cosmetic outcome after a lumpectomy and radiation is good but over time, due to ongoing radiation changes and scarring, the breast can shrink, dimple and pucker. This is somewhat dependent on the location of the cancer and experience breast surgeons can predict it. These deformities are difficult to fix without removing the rest of the breast and starting from scratch. And options are limited in this scenario because the patient has received radiation. So sometimes, in the past, patients had mastectomy and reconstruction to avoid this problem. Now if oncoplastic techniques are used, even large lumpectomies are do-able and the breasts often look better that they did before the patient had cancer.
Oncoplastic surgery is frequently done at the same time as lumpectomy. Usually patients go home the same day. Typically the breast surgeon does the lumpectomy and the plastic surgeon does the oncoplastic portion. Since the remaining breast tissue is going to be rearranged, it’s critical that the breast surgeon mark the site where the cancer was. This will be important when it comes time to deliver radiation or if there are positive margins and re-do surgery is necessary. Metallic clips or a feducial can be used.
Oncoplastic surgery also refers to surgery on the noncancerous (contralateral) breast. It is done to obtain symmetry (symmetry procedure) and can also be done at the same time as the lumpectomy.
Since whole breast radiation can result in breast shrinkage, especially as years go by, some plastic surgeons make the contralateral breast a little smaller than the cancer side in anticipation of this.