Oncoplastic Breast Surgery is a specialised approach that combines breast tumour removal with reconstructive surgery. It offers patients the chance to be cancer-free while still maintaining the breasts’ natural appearance. The procedure typically consists of 2 parts – A lumpectomy or partial mastectomy followed by reconstructive breast surgery. The procedure preserves breast symmetry to maintain balance. Sometimes this is achieved by operating on the non-affected breast as well. Oncoplastic surgery is done under general anaesthesia. Different reconstruction techniques are chosen based on the tumour’s size, location and the patient’s desired aesthetic outcome. This includes techniques like local advancement flap reconstruction, Bilateral breast reduction, Bilateral breast lift and skin-sparing mastectomy. The goal is to avoid deformities and achieve a natural appearance. Oncoplastic surgery also helps reduce the risk of cancer recurrence, by allowing larger margins of tissue to be removed. The procedure has complications like tissue necrosis, internal bleeding and perforator flap failure associated with it. Despite these risks, oncoplastic breast surgery is a viable, safe option for many breast cancer patients.
Breast cancer is one of the most common types of cancer affecting women worldwide. Surgical removal of the breast tumour is one of the most effective ways to treat breast cancer. If the cancer is not too advanced, the surgeon can choose to only remove the tumour and some tissue surrounding it, leaving the rest of the breast intact. This procedure changes the physical appearance of the breast. Oncoplastic surgery is a treatment option that leaves breast cancer patients tumour-free and with a good cosmetic outcome in one surgery. It combines a lumpectomy or partial mastectomy with reconstructive surgery. This helps retain the symmetry of the breasts and preserves a natural appearance. This may involve performing plastic surgery on the unaffected breast as well.
Oncoplastic surgery basically consists of a tumour-removal procedure and a reconstructive procedure combined into one. Before your surgery, your doctor will discuss your reconstruction options with you. The surgeon will explain their surgical plan and what the final physical appearance of the breasts will be. The oncoplastic surgery is performed under general anaesthesia. To begin with, the surgeon will make a strategic incision and remove the breast tumour and some of the surrounding tissue. The amount of tissue removed depends on the size of the tumour. The surgeon may also have to remove tissue from nearby lymph nodes. After this, the reconstruction begins. The surgeon usually performs a bilateral breast reduction or lift. The aim of this procedure is to make the two breasts symmetrical, without any indentations or deformities. These techniques are more effective and produce better outcomes when performed on women with larger breasts. This is because in such cases surgeons have more tissue to work with.
There are various breast reconstruction techniques that plastic surgeons can use to reconstruct the breast after tumour removal. The technique chosen will depend on the health of the patients, the location and size of the tumour, as well as the desired aesthetic outcome. Some of the commonly used reconstruction techniques used in Oncoplastic surgery are:
Local Advancement Flap – After the tumour and surrounding breast tissue are removed, a depression is formed in the breast. Using the local advancement flap technique, the surgeon can take the remaining breast and skin tissue and stretch it over the depression, using it to reconstruct the breast. This gives it a natural shape, while filling in the indentation.
Bilateral Breast Reduction – This procedure restores a symmetrical appearance to the breasts by removing tissue from the non-affected breast as well. Basically, both breasts have significant amounts of tissue removed, re-distributing the weight evenly between both breasts. This works best for patients with large breasts, so that even after reduction they are happy with the cosmetic results. Bilateral Breast reduction is advantageous because more tissue than required is removed around the tumour. This ensures that there are no cancer cells in the margins of tissue left in the breast.
Bilateral Breast Lift – This procedure is a more minimal version of the Bilateral Breast Reduction. This option is recommended to women who do not wish to significantly reduce the size of their breasts after surgery. In this procedure, minimal amounts of tissue are removed from the affected breast, just enough for the cancer to be completely removed from the body. An equally small amount of tissue is removed from the other breast for balance. Then, both breasts are given a lift to achieve an aesthetic appearance.
Skin-sparing Mastectomy – For patients with advanced breast cancer, all the breast tissue may have to be removed. In such instances, the surgeon may recommend a skin-sparing mastectomy. During this procedure, the skin of the breast (including the areola and nipple) are kept intact. This retained skin is then used in the reconstruction to maintain the natural shape, size and appearance of the original breast.
Most breast cancer patients who are undergoing a lumpectomy or a partial mastectomy are eligible for Oncoplastic Breast Surgery. The oncologist and reconstructive surgeon will be able to recommend the right reconstructive technique to be used on a case-by-case basis. However, the priority of the procedure is still tumour removal and making sure the patient is 100% cancer-free, so in certain cases it would be required to split up the surgeries or perform another sound of reconstruction as a separate surgery. Women with small breasts may have limited options during reconstruction.
Before the surgery, the patient will undergo a panel of blood tests, a chest X-ray and an electrocardiogram. The doctor will also perform a physical exam and check your baseline health. This is a good time to bring up and doubts and questions you may have about what to expect during the procedure and recovery. Inform your oncologist and reconstructive surgeons of any regular medication you consume. You may be advised to stop taking certain medications for a few days before the surgery. You will also have a consultation with the plastic surgeon who will perform the reconstruction. You can discuss your aesthetic preferences and the surgeon will give you realistic advice on the possibilities. After the surgery, you will be required to stay at the hospital for a few days so plan accordingly. This is so the doctors and nurses can monitor your recovery and make sure the incisions are healing well. Some pain and inflammation after surgery are expected. The doctor will also guide you about how to take care of your incision wounds, your diet and your exercise regimen.
Combining the procedures for cancer treatment with breast reconstruction offers significant benefits for patients:
Single procedure – Combining both into a single procedure means that the overall recovery time is lower. The patient suffers less of an interruption to their normal life.
Better Surgical Outcome – During oncoplastic surgery, the surgeon removes larger margins around the tumour. This reduces the chances of the breast tumour growing back.
Avoiding cosmetic deformities – Since reconstruction is immediate, the patients do not need to suffer the stigma of living with a breast deformity for any period of time. In traditional breast cancer surgery, the patient is offered reconstructive surgery only after the completion of radiation therapy and a full recovery. This means they may spend extended periods of time with a deformed breast. This can take a toll on the patient’s emotional health, confidence and self-worth.
Surgical procedure always carry a certain degree of risk. Let’s take a look at some of the disadvantages or shortcomings of Oncoplastic Breast Surgery:
Operating on the non-affected breast – In oncoplastic surgery, the non-affected breast is also operated on to achieve symmetry between both breasts. This results in more incisions with increased chances of scarring and longer recovery time. However, medical experts agree that it is a short-term inconvenience that is beneficial in the long-term.
Radiation Therapy After Reconstruction – Since tumour removal and reconstruction are performed simultaneously, radiation therapy to eliminate any remaining cancer cells must be done after the patient has healed fully. There are chances of slight shrinkage in the breasts at this time. This could be an issue for women with smaller breasts. They may have to go with reconstructive surgery after radiation therapy to achieve the correct breast size they would like.
Medical Complications – The patient may also suffer other complications like tissue necrosis, infections, hematoma, deep vein thrombosis, perforator flap failure (issues with blood supply) or internal bleeding. The patient will be monitored carefully during their hospital stay so these complications can be addressed immediately, should they arise.
For comprehensive care and expert guidance on breast cancer treatment and oncoplastic surgery, turn to Kauvery Hospital. With branches in Chennai, Hosur, Salem, Tirunelveli, and Trichy, our dedicated team of oncologists and reconstructive surgeons is committed to delivering the best outcomes for patients. Trust Kauvery Hospital for compassionate care and advanced surgical solutions, ensuring both cancer treatment and aesthetic restoration are prioritized for your well-being.
Kauvery Hospital is globally known for its multidisciplinary services at all its Centers of Excellence, and for its comprehensive, Avant-Grade technology, especially in diagnostics and remedial care in heart diseases, transplantation, vascular and neurosciences medicine. Located in the heart of Trichy (Tennur, Royal Road and Alexandria Road (Cantonment), Chennai (Alwarpet & Vadapalani), Hosur, Salem, Tirunelveli and Bengaluru, the hospital also renders adult and pediatric trauma care.
Chennai Alwarpet – 044 4000 6000 • Chennai Vadapalani – 044 4000 6000 • Trichy – Cantonment – 0431 4077777 • Trichy – Heartcity – 0431 4003500 • Trichy – Tennur – 0431 4022555 • Hosur – 04344 272727 • Salem – 0427 2677777 • Tirunelveli – 0462 4006000 • Bengaluru – 080 6801 6801
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