Alexander Nguyen, MD, FACS, CLT, Plastic Surgeon at Reconstructive Microsurgery and Lymphedema Associates practicing at Medical City Healthcare, a part of Sarah Cannon, The Cancer Institute of HCA Healthcare, addresses some of the most commonly asked questions that patients may have about oncoplastic surgery.
Why is oncoplastic surgery important?
For certain stage breast cancers, breast conservation surgery - either a lumpectomy or partial mastectomy - can result in a deformity of the breast. Deformities may be worsened by necessary radiation therapy and are oftentimes difficult to correct after radiation therapy. Oncoplastic surgery aims to adequately address the cancer and immediately correct any deformity prior to radiation therapy.
What are the benefits of oncoplastic surgery?
- Allows the breast surgeon to remove more tissue to ensure all margins are clear of cancer.
- Can include a symmetry procedure to ensure breasts are symmetrical.
- Usually requires one surgery.
- Can address symptoms of large breasts.
- Prevents the distortion of a lumpectomy.
Who is a candidate for oncoplastic surgery?
It is important to discuss whether you are a candidate for oncoplastic surgery with your breast surgeon or plastic surgeon. Generally, patients with smaller, single tumors and patients with larger breasts who don’t mind size reduction are good candidates for oncoplastic surgery.
How is oncoplastic surgery performed?
Using a multidisciplinary approach, your lumpectomy incisions will be coordinated by your breast team, your breast surgeon and often your plastic surgeon. After the lumpectomy is completed, plastic surgery techniques are used to minimize the lumpectomy deformity. Surgery on the other breast, the one that may not have cancer, may also be performed help make the breasts symmetrical.
Who performs oncoplastic surgery?
Oncoplastic surgery may be offered by your breast surgeon or plastic surgeon, and depends on many factors. Having a team who is experienced with oncoplastic surgery techniques is essential. Often, a breast surgeon will work closely with a plastic surgeon. Plastic surgeons are trained to perform breast reshaping techniques usually used in breast lifts or breast reductions, and these techniques have been applied to oncoplastic surgery. There are also breast surgeons trained in oncoplastic surgery who perform these procedures without a plastic surgeon. If a patient requires a larger amount of tissue replacement from another location - known as a flap - a plastic surgeon with specialty training in flap surgery may be required.
Are there different types of oncoplastic surgery procedures?
The type of oncoplastic procedure performed generally depends on the defect size relative to size of the breast:
- For small defects, local rearrangement of the breast tissue will be performed to minimize the deformity.
- For medium defects, breast reduction or breast lift procedures are performed to remodel the breast to improve aesthetics.
- For larger defects, tissue replacement from another location - a flap - may be required to achieve adequate breast shape. This flap tissue usually comes from the flank, back or upper abdomen. Rarely, tissue will be transplanted from other parts of the body.