ONCOPLASTIC SURGERY HOUSTON
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.
Oncoplastic Surgery Is Usually Done Before Radiation
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.
Oncoplastic Surgery Can Be Used In Several Scenarios:
- When a relatively large amount of lumpectomy tissue has to be removed
If less than 10 – 15% of the breast volume is excised the soft tissue immediately adjacent to the lumpectomy cavity can be used to reduce the size of the cavity/defect. The breast surgeon frequently does this.When it is necessary to remove a larger amount of tissue to obtain negative margins the area may have to be replaced with a tissue flap that has its own blood supply.
An example of this is the latissimus dorsi flap.
- Patients with very large breasts (macromastia)
Lumpectomy can be performed at the time of bilateral breast reduction using the same incision.
- Patients with drooping or sagging breasts (ptosis) but not necessarily a lot of breast tissue
Lumpectomy can be performed at the time of bilateral breast lift (mastopexy) using the same incision.
- Patients who have undergone lumpectomy and radiation and are unhappy with the cosmetic outcome
A latissimus dorsi pedicle flap is often used in these cases.