Oncoplastic Surgery
Breast surgery after lumpectomy
What is oncoplastic surgery?
New breast cancer treatments have helped the evolution of new plastic surgery techniques, targeted for this special group of patients. A large lumpectomy may distort the shape of the breast. This surgery was designed to restore more normal appearance and symmetry, contouring both breasts at the same time for the best possible cosmetic result.
Planning begins well before your lumpectomy, with consultation with you, your cancer surgeon and your plastic surgeon.
Who is a good candidate for oncoplastic surgery?
The best candidates are women who can be treated with breast conservation (lumpectomy) and breast reduction or breast lift (mastopexy) procedures. These women have enough breast tissue to allow proper recontouring. Your surgical team will explain all of the risks and benefits and will help you decide which is the best option for you.
Will I need two separate procedures?
One of the main advantages of oncoplastic surgery is that it’s performed during the surgery in which the cancer and its surrounding tissue are removed. Following the lumpectomy, the plastic surgeon immediately steps in to complete the procedure. Since you and the surgical team have made most decisions prior to the surgery, the plastic surgeon knows exactly what will be done and is ready to proceed.
Why is it better to do everything at once?
Besides the obvious reduction in stress and worry before a second surgical procedure, the risks of anesthesia are avoided. The breasts will be symmetrical immediately after the surgery, and the problems of large or drooping breasts can also be eliminated.
Wound healing is a special issue in breast cancer patients. Your treatment will probably include a course of radiation therapy, which can slow down good wound healing. Oncoplastic surgery patients will do all surgical healing at one time, following the single surgical procedure. The wounds have the opportunity to completely heal, and radiation therapy can be started with reduced risk of wound problems.
How is the surgery performed?
There are many new and innovative treatments for breast cancer. Modified radical mastectomy was the treatment of choice before lumpectomy was found to be as effective.
In modified radical mastectomy - which is still required in a few cases - all of the breast tissue and the lymph nodes in the armpit are removed. Reconstruction has traditionally been done in a second procedure, and may involve transfer of tissues from other parts of the body, or tissue expanders to slowly stretch the skin, followed by implant placement.
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New oncoplastic procedures allow case-specific treatments. In all "lumpectomies", the cancer and surrounding tissue are removed, and immediate plastic surgery is performed. Depending upon the location of the tumor and the patient’s anatomy and preferences, there are a number of choices.
A small-breasted woman might desire larger breasts. Breast implants would be inserted to increase breast size.
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A woman with larger or ptotic ("droopy") breasts may open for breast reduction procedures, with or without implants. As always, every patient is different and is treated with a plan designed for her and with her.
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What should I expect after the surgery?
You will probably not require any drains, and the procedure may be performed on an outpatient basis, or with a one-night hospital stay. Your breasts will be sore for a few days, but the discomfort will improve quickly. You will be given a prescription for pain medication, if needed. The sutures will be removed after several days.
Recovery time is usually around six weeks, but many patients are able to return to work in half that time.
What are the potential complications?
There are the usual risks with any surgery, including bleeding, infection and anesthesia complications, but complications occur rarely with these procedures.
Occasionally the nipple and areola are found to have insufficient blood supply during the surgery, usually as a result of the location of the tumor and lumpectomy. In this situation, a free nipple graft may be performed, with removal and reimplantation of the nipple in its new location. This will result in nipple numbness and inability to nurse an infant. Your surgical team will discuss this with you prior to surgery so that you can make an informed decision about how to proceed, should this complication occur.