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Oncoplastic & breast reconstructive surgery for breast cancer

What is oncoplastic breast surgery?

Many women with breast cancer are candidates for breast-conserving surgery, also called lumpectomy, partial mastectomy or quadrantectomy. In this type of operation, your surgeon selectively removes the tumor and leaves the remaining breast intact.

In some instances, there must be some reshaping of the breast to help prevent contour deformities that may develop in the future, particularly after radiation. This reshaping, done at the same time as removal of the tumor, is called oncoplastic surgery. Oncoplastic surgery not only removes the cancer, it also prevents undue scarring and deformation of the breast, helping to maintain an aesthetically pleasing breast after all of the treatment for cancer is complete.

What is breast reconstructive surgery?

Some women are not candidates for breast-conserving surgery and need to have a mastectomy. A mastectomy involves the surgical removal of all the breast tissue. Breast reconstructive surgery is the procedure of rebuilding a total breast after mastectomy. The nipple can also be reconstructed, if desired.

Usually two or three operations are required to complete breast reconstruction, and surgery is often performed on the other breast to improve shape and symmetry. Many women are able to begin the process of reconstruction at the time of mastectomy, also known as immediate reconstruction. For various reasons, reconstruction at the time of mastectomy may not be safe, and your surgeon will recommend delayed breast reconstruction.

There are several different techniques to reconstruct a breast, all of which fall into two basic categories:

  • Implant-based reconstruction - using a gel implant with or without a tissue expander
  • Autologous reconstruction - using a woman’s own tissue in the form of a flap or graft

A combination of both techniques is sometimes required.

What is oncoplastic and reconstructive surgery?

Video: Oncoplastic Surgery

Dr. Stephen Ray explains oncoplastic surgery.

Oncoplastic & breast reconstructive surgery

Implant-based reconstruction

Implant-based reconstruction is the most common form of breast reconstruction. This typically involves the placement of a tissue expander at the time of mastectomy. The tissue expander is gradually filled with fluid over several weeks to stretch the skin and create a pocket for the implant. You and your surgeon will work together to decide what volume is desired.

Once this process is complete, the expander is removed in a second operation and the permanent gel implant is placed. Breast implant technology is continually advancing and many new choices are available, including anatomically-shaped implants. Again, your surgeon will guide you through the decision making process. The final step of reconstruction involves a minor procedure to create the nipple.

In very select instances, it is possible to avoid tissue expansion and perform a single-stage reconstruction with direct placement of an implant at the time of mastectomy.

Autologous flap reconstruction

Autologous reconstruction involves using your own tissue to reconstruct the breast. The surgery is more involved, and the recovery is usually longer.  However, this type of breast reconstruction is very natural, which is important to many women. It is also the preferred technique for reconstruction for women who require radiation as part of their therapy.

The tissue itself is called a “flap” and the area it is taken from is called the “donor site.” The most common donor site is the lower abdomen, but other options include the inner thigh, upper back or even buttock.

Advanced techniques of flap reconstruction have become possible with the application of reconstructive microsurgery. Specifically, the skin and fat of the lower abdomen can be removed while keeping the muscles intact, significantly improving recovery and overall health of a woman.

Autologous fat grafting

In addition to flap reconstruction, surgeons are now performing a breast reconstruction procedure called autologous fat grafting. This procedure involves gentle liposuction of a woman’s own fat cells from anywhere in the body, and then carefully injecting them to rebuild the breast. This technique can also help to improve breast shape and symmetry after implant reconstruction, flap reconstruction or lumpectomy.

Meeting your individual needs

Early in the process, you'll meet with a plastic surgeon to devise a plan for your reconstructive surgery. Your surgeon will pay close attention to your treatment plan and personal goals for reconstruction, understanding the impact that removal and reconstruction of the breasts has on your overall health. If immediate reconstruction is not possible, your surgeon and care team will devise a strategy to help you achieve safe and effective breast reconstruction at an appropriate time.

Your care team also understands that breast cancer surgery can have psychological consequences. Changes to your physical shape and form can raise concerns about your sexuality and womanhood. Your care team includes mind-body therapists, image enhancement specialists and spiritual counselors to help address these issues and enhance your overall well-being.

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