About Oncoplastic Breast Surgery
What Is Oncoplastic Breast Surgery?
Oncoplastic breast surgery is a specialised approach to breast cancer surgery that combines removal of the cancer with techniques used in reconstructive and plastic surgery.
The cancer is removed using appropriate oncological surgical principles, while the remaining breast tissue may be rearranged or reshaped to help preserve the breast’s appearance.
Depending on the individual situation, this may involve:
- Rearranging breast tissue after tumour removal
- Reshaping the remaining breast
- Breast reduction techniques
- Breast lift techniques
- Repositioning the nipple
- Local tissue rearrangement
- Reconstruction using an implant in selected circumstances
- Surgery on the opposite breast to improve symmetry in selected patients
The particular technique depends on the size and location of the cancer, the amount of breast tissue that needs to be removed, breast size and shape, and your individual treatment goals.
Oncoplastic surgery is not simply cosmetic breast surgery performed at the same time as cancer surgery. The primary objective remains safe and appropriate treatment of the breast cancer.
The reconstructive technique is selected around the cancer operation rather than the other way around.
Indication
Why Is Oncoplastic Breast Surgery Performed?
Traditional breast-conserving surgery removes the cancer together with a margin of surrounding healthy tissue.
For some women, particularly when a larger area of tissue needs to be removed, this can result in a visible change in breast shape.
Oncoplastic techniques can allow the surgeon to reshape the breast at the time of cancer removal.
Potential benefits include:
- Maintaining a more natural breast shape
- Reducing the likelihood of a significant indentation after tumour removal
- Improving the position and appearance of scars in selected procedures
- Allowing removal of a larger area of tissue while preserving breast shape in appropriate patients
- Improving breast symmetry
- Addressing breast size or droop when reduction or lift techniques are appropriate
- Combining cancer treatment and breast reshaping within the same operation
However, oncoplastic surgery is not suitable for every patient.
The priority is always complete and safe treatment of the cance
Am I suitable for oncoplastic breast surgery?
Oncoplastic surgery may be considered for patients undergoing breast-conserving surgery when removal of the tumour is likely to significantly alter the shape or volume of the breast.
It may be particularly useful when:
- The tumour is relatively large compared with the breast
- The cancer is in a location where removal could create an obvious deformity
- A significant amount of breast tissue needs to be removed
- The breasts are large or have significant excess tissue
- Breast reduction or a lift could be incorporated into the cancer operation
- The patient wants to preserve the breast where this is oncologically appropriate
It can also form part of more complex reconstructive strategies when mastectomy is required.
Your suitability depends on your cancer diagnosis and your individual anatomy.
Procedure
How is Oncoplastic Breast Surgery Done?
Oncoplastic surgery is planned around the location and size of the breast cancer.
Before surgery, Dr Rizvi will review your:
- Breast imaging
- Biopsy results
- Cancer type
- Tumour size and location
- Breast size and shape
- Existing scars
- General health
- Previous breast surgery
- Planned cancer treatment
The surgical plan is then designed to achieve the required cancer excision while considering the final shape of the breast.
Depending on the operation, the surgeon may rearrange breast tissue, perform a breast reduction or lift, or use another reconstructive technique.
In some cases, the opposite breast may also be considered to improve symmetry.
The appropriate approach is individualised rather than based on a single standard technique.
Discuss Your Oncoplastic Breast Surgery Options
If you have been diagnosed with breast cancer and are considering breast-conserving surgery, Dr Ali Rizvi can assess whether an oncoplastic approach may be appropriate for you.
Types of Oncoplastic Breast Surgery
There are several approaches to oncoplastic breast surgery.
Level I Oncoplastic Surgery
Level I techniques generally involve rearranging the remaining breast tissue after the cancer has been removed.
They may be appropriate when the volume of tissue removed is relatively small and there is sufficient remaining tissue to reshape the breast.
Level II Oncoplastic Surgery
Level II techniques allow more extensive reshaping and may be useful when a larger proportion of the breast needs to be removed.
These techniques can include:
- Therapeutic mammoplasty
- Breast reduction patterns
- Mastopexy techniques
- More extensive tissue rearrangement
- Selected local tissue techniques
The specific technique is chosen according to the tumour and the patient’s breast anatomy.
Therapeutic Mammoplasty
Therapeutic mammoplasty combines breast cancer removal with breast reduction and reshaping techniques.
It can be particularly useful for women with larger breasts who require removal of a significant amount of breast tissue.
During the operation, the cancer is removed with an appropriate margin, while the remaining breast tissue is reshaped.
The nipple may also be repositioned as part of the procedure.
The opposite breast may sometimes be reduced or reshaped to improve symmetry.
Therapeutic mammoplasty can therefore combine two objectives to treat the cancer and reshape the breast.
Whether it is appropriate depends on the location and size of the tumour, breast anatomy and the overall cancer treatment plan.
Oncoplastic Breast Surgery After Lumpectomy
A lumpectomy, also called breast-conserving surgery or wide local excision, removes the breast cancer while preserving the rest of the breast.
For some patients, a standard lumpectomy may leave a noticeable change in breast shape.
Oncoplastic techniques can be incorporated into the procedure to help fill or reshape the area where tissue has been removed.
The resulting breast may therefore have a more natural contour than would be possible with a straightforward excision alone.
However, oncoplastic surgery does not change the fundamental cancer treatment requirements.
The cancer must still be removed with appropriate surgical margins, and additional treatments such as radiotherapy may still be required depending on the diagnosis.
Oncoplastic Surgery and Breast Reconstruction
Oncoplastic surgery and breast reconstruction overlap, but they are not exactly the same.
Oncoplastic breast-conserving surgery generally involves removing the cancer while reshaping the remaining breast tissue.
Breast reconstruction is more commonly associated with rebuilding breast volume or shape after a mastectomy, although reconstruction techniques may also be used in other circumstances.
Reconstruction may involve:
- Implant-based reconstruction
- Tissue rearrangement
- Local tissue techniques
- Other reconstructive procedures
The appropriate option depends on whether breast-conserving surgery or mastectomy is recommended and on your individual circumstances.
If reconstruction is being considered, your surgeon will discuss the advantages, limitations and potential complications of each approach.
Can Oncoplastic Surgery Avoid a Mastectomy?
In selected patients, oncoplastic breast-conserving surgery may allow a larger area of breast tissue to be removed while maintaining a satisfactory breast shape.
This can sometimes provide an alternative to mastectomy for patients who might otherwise have a poor cosmetic result from standard breast-conserving surgery.
However, oncoplastic surgery cannot guarantee that a mastectomy will be avoided.
The safest operation depends on the extent and characteristics of the cancer.
Factors that may influence the choice include:
- Tumour size
- Tumour location
- Number of tumours
- Breast size
- Breast shape
- Genetic or other cancer-related factors
- Previous treatment
- Patient preferences
Dr Rizvi will explain which surgical options are appropriate for your particular cancer.
Sentinel Lymph Node Biopsy and Oncoplastic Surgery
For selected patients with invasive breast cancer, sentinel lymph node biopsy may be performed during the same operation as breast-conserving surgery.
The sentinel lymph nodes are the first lymph nodes to which lymphatic fluid from the breast is likely to drain.
Removing and examining these nodes can help determine whether cancer cells have spread to the lymph nodes.
This means an oncoplastic breast cancer operation may involve several components, such as: cancer removal, sentinel lymph node biopsy and breast reshaping
The exact combination depends on the type and stage of the breast cancer.
What Is Recovery Like After Oncoplastic Breast Surgery?
Recovery varies considerably depending on the type of oncoplastic operation performed.
A relatively small tissue rearrangement may have a different recovery from a therapeutic mammoplasty or reconstruction.
You may experience:
- Pain or tenderness
- Swelling
- Bruising
- Temporary changes in breast sensation
- Tightness
- Changes in breast shape while swelling settles
- Surgical scars
- Temporary restrictions on physical activity
Dr Rizvi will provide specific instructions about wound care, physical activity, exercise, work and follow-up.
The final appearance of the breast cannot usually be judged immediately after surgery.
Swelling and changes in breast tissue can continue to settle over the following weeks and months.
If radiotherapy is required, this can also affect the appearance and feel of the breast over time.
What Will My Breast Look Like After Surgery?
Every patient heals differently, and the final appearance cannot be predicted with complete certainty.
The result depends on:
- The amount of breast tissue removed
- The location of the cancer
- Your breast size and shape
- The oncoplastic technique used
- Your healing process
- Whether radiotherapy is required
- Whether surgery is performed on the opposite breast for symmetry
The breast may look different immediately after surgery because of swelling and bruising.
The appearance generally changes as healing progresses.
It is important to discuss your expectations with your surgeon before surgery so that the proposed operation is based on both cancer safety and realistic aesthetic goals.
Risks and Possible Complications
Oncoplastic breast surgery is surgery for cancer and carries the risks associated with both breast cancer surgery and the particular reconstructive technique used.
Potential complications can include:
- Bleeding
- Infection
- Fluid collection or seroma
- Delayed wound healing
- Scarring
- Changes in breast sensation
- Breast asymmetry
- Fat necrosis
- Changes in breast shape
- Nipple or skin complications in selected procedures
- Need for further surgery
- Anaesthetic complications
- Cancer recurrence
Some complications are more likely with particular techniques.
For example, larger reductions and more extensive reshaping can have different wound-healing considerations from simpler tissue rearrangement.
Dr Rizvi will discuss the risks relevant to the operation recommended for you.
Frequently Asked Questions
Is oncoplastic breast surgery the same as cosmetic breast surgery?
No. The primary purpose of oncoplastic breast surgery is to treat breast cancer. Reconstructive techniques are incorporated to help preserve or restore breast shape following cancer removal.
Is oncoplastic breast surgery only for breast cancer?
Oncoplastic techniques are primarily associated with breast cancer surgery, particularly breast-conserving surgery. The specific use of reconstructive techniques depends on the individual diagnosis and operation.
Can oncoplastic surgery be performed with a lumpectomy?
Yes. Oncoplastic techniques can be incorporated into breast-conserving surgery to reshape the breast after the cancer has been removed.
Can oncoplastic surgery avoid a mastectomy?
In selected patients, oncoplastic breast-conserving surgery may allow a larger area of tissue to be removed while maintaining breast shape. However, it cannot replace mastectomy when mastectomy is the safest or most appropriate cancer operation.
Will I need surgery on both breasts?
Not necessarily. In some patients, surgery on the opposite breast may be considered to improve symmetry. This depends on the patient’s anatomy, preferences and proposed surgical technique.
Will I need radiotherapy after oncoplastic breast surgery?
Radiotherapy may still be recommended after breast-conserving surgery, including oncoplastic breast surgery. Whether radiotherapy is required depends on the type and stage of the breast cancer and your overall treatment plan.
Does oncoplastic breast surgery leave scars?
Yes. Any surgical procedure leaves scars, although the location and appearance depend on the technique used. Some oncoplastic techniques allow the surgeon to incorporate scars into breast reduction or lift patterns.
How long does oncoplastic breast surgery take?
Operating time varies considerably depending on the type of cancer surgery and reconstructive technique. Therapeutic mammoplasty and more extensive reconstruction generally take longer than a straightforward breast-conserving operation.
Can oncoplastic surgery be performed after a mastectomy?
Reconstructive surgery can be performed at the time of mastectomy or at a later stage. The appropriate reconstruction depends on the patient’s circumstances, cancer treatment and preferences.
