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Oncoplastic & breast reconstructive surgery for breast cancer

Oncoplastic & breast reconstructive surgery

We offer several options for oncoplastic and breast reconstructive surgery to help rebuild the shape of the breast after surgery, reduce scarring and preserve as much of the breast tissue as possible.

What is oncoplastic breast surgery?

Oncoplastic breast surgery uses an aesthetic approach to breast cancer treatment by removing the cancer while also preserving and rebuilding the breast to maintain its natural look and feel. With this multidisciplinary approach, the reconstructive plastic surgeon and surgical oncologist work as a team, collaborating on a strategy to remove the cancer in a way the preserves as much breast tissue and skin as possible. Reconstructive techniques are then used to reshape and rebuild the breast. Oncoplastic surgery not only removes the cancer, it is also designed to prevent excessive scarring and deformities, helping to produce an aesthetically pleasing breast after treatment.

In addition to helping restore a healthy physical appearance, oncoplastic breast surgery may also help women heal emotionally after cancer surgery—restoring feelings of confidence, self-esteem and femininity.

Oncoplastic reconstruction techniques include:

Corrective surgery repairs: Patients who had breast reconstruction that resulted in an abnormal breast appearance after a mastectomy may choose corrective surgery to restore the breast to a more natural look.

Skin-sparing mastectomy: This technique involves removing breast tissue while preserving the outer skin. This less-invasive approach to a mastectomy helps preserve the natural contour and shape of the breast while reducing the risk of scarring. Reconstruction options following a skin-sparing mastectomy include silicon or saline implants and autologous fat grafting or tissue transfer. While both procedures use the body’s own cells to rebuild the breast, fat grafting techniques transfer fat cells from other areas of the body, while tissue transfers transplant tissue from the abdomen, back, buttock and other regions.

Nipple-sparing mastectomy: This procedure preserves all the skin of the breast, including the nipple and areola, while removing nearly all the inner tissue of the breast. Unlike a traditional mastectomy, it preserves a thin layer of fat and blood vessels that are needed to maintain adequate blood flow and protect the skin’s viability. Since most of the nerves to the skin are removed during the mastectomy, the preserved skin and nipple often become permanently numb. A nipple-sparing mastectomy, combined with immediate breast reconstruction, may produce a reconstructed breast that looks similar to the original breast, with the skin and nipple intact.

3-D nipple tattoo: Instead of using tissue to rebuild a nipple, some women choose to have a nipple tattooed on the reconstructed breast. Many 3-D nipple tattoos provide realistic results by darkening, contouring and shading the nipple area to match the opposite breast.

What is breast reconstructive surgery?

Breast reconstruction is a surgical procedure used to recreate a breast’s shape and contour after a mastectomy or lumpectomy. The goal of breast reconstruction is to provide symmetry and a natural-appearing breast. Breast cancer patients now have many options. Surgeons may recreate a breast at the time of mastectomy or after a mastectomy. They may also correct misshapen breasts that result after breast conservation surgery. 

Many women are able to begin reconstruction at the time of their mastectomy, a process known as immediate reconstruction. But not all women are candidates for this approach. Determining if, and when to begin reconstruction is an individual decision, made by the patient and her care team, based on a number of factors.

Various breast reconstruction techniques are available, all of which fall into two basic categories:

  • Implant-based reconstruction, which uses a gel implant with or without a tissue expander
  • Autologous reconstruction, which uses the patient’s own tissue in the form of a flap or graft

A combination of oncoplastic and breast reconstructive techniques may be required.

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. You and your surgeon will work together to determine the desired volume.

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.

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 buttocks. The area and method chosen will depend on the amount and quality of tissue available.

Advanced techniques of flap reconstruction have become possible with the application of reconstructive microsurgery. With this technique, the skin and fat of the lower abdomen are removed while keeping the muscles intact, which may improve recovery and the patient’s overall health.

Cancer Treatment Centers of America® (CTCA) offers a wide array of tissue transfer procedures, including:

Deep inferior epigastric artery perforator (DIEP) flap surgery: This microsurgical procedure moves fat, skin and the blood supply from the lower belly to the breast.

Stacked DIEP flap reconstruction: A newer approach to DIEP, this procedure is used to reconstruct one breast in women who don’t have adequate extra belly tissue and are therefore ineligible for standard DIEP surgery.

Transverse rectus abdominis myocutaneous (TRAM) flap surgery: This operation also uses abdominal tissue and is typically shorter in duration than the DIEP flap surgery. It is performed less often because it affects the core abdominal muscles.

Superficial inferior epigastric artery (SIEA) flap: An alternative free-flap procedure, this technique uses the skin and fat of the lower abdomen. In an SIEA flap, incisions are made in the skin and fat only, allowing the flap to be transferred based on the superficial inferior epigastric vessels. This often results in less post-operative pain and lower risk of herniation.

Transverse upper gracilis (TUG) flap: This procedure uses the gracilis muscle, located in the upper inner thigh, starting at the pubic bone and ending along the inside of the upper leg. You use the gracilis muscle to bring your leg toward your body. Patients who undergo TUG flap surgery are no longer able to use this muscle.

Superior gluteal artery perforator flap (SGAP) and inferior gluteal artery perforator flap (IGAP) flap: For patients who do not have sufficient tissue in the abdomen or thigh, the gluteal region, or buttock, may also be used to create a flap. The SGAP flap uses the upper portion of the buttock, while the IGAP flap uses the lower portion. 

Rubens free flap: This procedure uses the fatty area in the region near the hip. This tissue may be harvested in a patient who has undergone an abdominoplasty or a TRAM flap in the past.

Latissimus dorsi flap: This procedure uses muscle, skin and fat from the back. Similar to implant reconstruction, it is performed in two stages.

Autologous fat grafting

In addition to flap reconstruction, a breast reconstruction procedure called autologous fat grafting may also be an option. This procedure involves gentle liposuction of a woman’s own fat cells from anywhere in the body. The cells are then carefully injected into the breast to rebuild its shape and contour. This technique may also help to improve breast shape and symmetry after implant reconstruction, flap reconstruction or lumpectomy. Transferring fat may help nurture the formation of new blood vessels, improve skin texture and, in some cases, restore some lost sensation.

Meeting your individual needs

Early in the process, you'll meet with a reconstructive 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 may have 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 may have psychological consequences. Changes to your physical shape and form may raise concerns about your sexuality and womanhood. Depending on your needs and preferences, your care team may include mind-body therapists, image enhancement specialists and spiritual counselors to help address these issues and enhance your overall well-being.

Learn more about breast cancer treatments.

Breast reconstructive surgery

"I saw firsthand, the restorative and even transformative powers of plastic surgery. From then on my course was set," says Reconstructive Surgeon Dr. Rola Eid. Watch the video below.