Breast Oncoplastic Surgery: Empowering Women with Confidence and Effective Cancer Removal
Breast cancer affects millions of women worldwide. Confronting this disease typically requires a comprehensive treatment plan that includes surgery, systemic therapy, and radiation. Despite the necessity of these treatments to eradicate cancer, they can leave lasting physical and emotional scars. Oncoplastic surgery, an innovative approach that merges oncologic and plastic surgery techniques, offers both therapeutic and cosmetic benefits.
The Evolution of Oncoplastic Surgery
In the past, breast cancer surgery mainly concentrated on tumor removal and achieving the best oncologic outcomes. However, this often led to significant alterations in the breast’s appearance, causing psychological distress and reducing the quality of life for many patients. The emergence of oncoplastic surgery represents a major shift in this approach, aiming not only to eliminate cancer but also to preserve or even improve the breast’s aesthetic appearance.
Oncoplastic procedures facilitate the use of advanced surgical techniques to achieve superior cosmetic results while still prioritizing cancer control. This procedure is especially advantageous for women with early-stage breast cancer, providing them the opportunity to avoid mastectomy and instead opt for breast-conserving surgery with improved aesthetic outcomes. Even for some women with larger tumors or locally advanced cancers, oncoplastic techniques can be used with breast-conserving surgery after neoadjuvant chemotherapy (chemo given before surgery) if that’s their preference.
The Technique
Clough et al categorized oncoplastic surgery into two levels based on the percentage of breast tissue resected.
- Level I involves the resection of up to 20% of the breast and includes corrective strategies such as parenchymal mobilization, tissue approximation, and repositioning of the nipple-areolar complex.
- Level II procedures entail the resection of more than 20% of the breast volume and are potential candidates for volume displacement or replacement techniques.
- For women with large tumors and large breasts, volume displacement techniques can yield excellent outcomes
- If you have smaller breasts,little to no sagging, or prefer to keep your current volume, volume replacement techniques can help rebuild the breast after surgery.
The principles of oncoplastic breast-conserving surgery, as outlined by RD Macmillan, include the following guidelines:
- Prioritize safety over achieving perfect cosmetic results.
- Ensure a wide local excision of the tumor without compromise.
- Utilize techniques within your own expertise and skill set.
- Opt for the simplest procedure that yields an acceptable outcome.
- Preserve the breast’s form and shape, handling tissues gently to prevent fat necrosis caused by trauma.
- Consider the effects of radiotherapy-induced fibrosis and scar contracture, which can draw the nipple toward the scar and cause nipple beaking.
- Aim to complete all necessary surgery, including any procedures for symmetry, in a single operation.
Common Examples include:
- Therapeutic mammoplasty (includes parenchymal mobilisation, approximation and repositioning of nipple-areolar complex)
- Reduction mammoplasty (for large and sagging breasts,the opposite healthy breast may also be reduced to match the size of the remaining breast after cancer removal surgery).
- Local Perforator flaps: LICAP, MICAP and AICAP (lateral, medial and anterior intercostal artery perforators) flaps
- Skin or nipple sparing mastectomy and whole breast reconstruction with:
- LD (latissimus dorsi) flap
- VRAM or TRAM (vertical or transverse rectus abdominis muscle) flaps
- DIEP (deep inferior epigastric perforator) flap
- Implant based reconstruction: In one-stage reconstruction, a permanent implant is placed immediately after the mastectomy. In two-stage reconstruction, a tissue expander is initially inserted after the mastectomy and incrementally filled to reach the desired volume. Later, the tissue expander is replaced with a permanent implant.
Benefits of Oncoplastic Surgery
Oncoplastic surgery offers several important benefits beyond just physical outcomes:
- Better Appearance: By merging cancer surgery with cosmetic techniques, patients often achieve better symmetry and a more natural breast shape, boosting self-esteem and body image.
- Emotional Well-being: The emotional toll of breast cancer and its treatment can be significant. Oncoplastic surgery helps address both cancer and cosmetic concerns, improving overall mental health.
- Cancer Safety: Research shows that oncoplastic techniques do not compromise cancer control. They often allow for wider tumor removal with clear margins, potentially reducing the risk of cancer recurrence.
- Fewer Surgeries: Combining cancer and reconstructive surgery into one procedure can reduce the need for multiple surgeries, lowering the risk of complications and speeding up recovery.
Challenges and Considerations
Despite its many benefits, oncoplastic surgery comes with specific challenges. It demands a high level of expertise. Many surgical centres lack the required resources or trained personnel to perform these complex procedures. ‘Additionally, careful patient selection is vital since not all women are ideal candidates for oncoplastic surgery.’
Insurance coverage can also pose a significant barrier. The classification of these procedures as either oncologic or cosmetic can impact reimbursement, making it difficult for some patients to afford the surgery. Advocacy for broader insurance coverage is crucial to ensure that more patients can access these advanced techniques.
The Future of Oncoplastic Surgery
Oncoplastic surgery is an ever-evolving field, with ongoing research and innovations aimed at refining techniques and improving outcomes. Advances in imaging technology, surgical methods, and a deeper understanding of breast cancer biology are expected to further enhance the effectiveness and aesthetic results of oncoplastic procedures.
In summary, oncoplastic surgery marks a major advancement in breast cancer treatment, offering a comprehensive approach that addresses both the physical and emotional impacts of the disease. For women suitable for breast conservation surgery, oncoplastic techniques should be explored to offer a wider range of options for a positive cosmetic result without impacting cancer treatment effectiveness.
By balancing oncologic safety with cosmetic outcomes, oncoplastic procedures provide hope and a better quality of life for many women facing breast cancer. As the field continues to progress, it holds the promise of setting new standards of care, ensuring that surviving breast cancer does not compromise one’s femininity and self-esteem.
Important Disclaimer: This blog is for informational purposes only and should not be considered medical advice. Always consult with your doctor to discuss the best course of treatment for your individual case.