Breast cancer treatment

Oncoplastic Surgery, a Cosmetic and Restorative Procedure in Breast Cancer Treatment

Oncoplastic surgery is considered a new definition of breast cancer surgery, in which, in addition to removing the breast tumor, its cosmetic surgery is also performed, ultimately greatly reducing the patient’s pain and psychological problems. In fact, this innovative method is an integration of both therapeutic and cosmetic surgeries, which were previously performed in two separate stages and phases, causing more problems.

What is Oncoplastic Surgery?

As you know, in some breast cancer surgeries, the surgeon is forced to completely remove the breast tissue, or by removing part of it, the breast becomes incomplete and deformed. In oncoplastic surgery, while performing the surgical method for cancer treatment, breast reconstruction is also performed so that after recovery, the patient feels complete both psychologically and physically.

In the past years, after breast surgery and complete removal of it or at least more than 20% of the breast tissue, deformity or complete organ defect occurred, which caused a lot of psychological damage to the patient. Complete loss of the breast or its defect, which made the body shape of women who underwent breast surgery incomplete, left negative psychological effects. Sometimes, the gap between reconstructive and cosmetic surgeries and the tissue discharge time was long, causing more psychological and physical problems for the patient. With the emergence and popularity of oncoplastic surgery by breast surgeons and specialists, this problem has been largely resolved, and the best surgical method will be recommended considering the patient’s condition.

Oncoplastic surgery emerged in 1976 after studies conducted by Dr. Fisher and Veronesi in the medical world. These studies showed that the results of breast cosmetic surgeries in the form of mastectomy could not be satisfactory. In fact, something was needed that, while treating breast cancer and removing its cancerous tissues, reconstruction was done and breast beauty was preserved.

Oncoplastic is a combination of the words “onco” and “plast,” meaning cancer and cosmetic, respectively. In fact, this surgical system is used to integrate therapeutic and cosmetic breast surgeries.

With the emergence of oncoplastic surgery, it is now possible to perform a more appropriate reconstruction and restoration method for the breast, considering the tumor size, the original size of the breast, as well as the involvement of lymph nodes. In some cases, some treatment methods should also be accompanied by this surgical procedure.

It should be noted that the result of oncoplastic surgery is directly related to the patient’s age, the location of the tumor, the stage of tumor progression, etc.

Benefits of Using Oncoplastic Surgery

Although the fight against breast cancer and the return to health should be a priority, the patient’s appearance after breast cancer treatment can also have a significant impact on their physical and mental health. Oncoplastic surgery affects physical, emotional, and psychological aspects. These benefits include:

Complete Removal of Cancerous Mass Along with Achieving Desired Cosmetic Outcome

During oncoplastic surgery, in addition to completely removing cancer cells from breast tissue, the appearance and beauty of the breast are also preserved as much as possible. With advancements in breast cancer surgical techniques, even individuals with large breast tumors can preserve part of their breast tissue during mastectomy, making oncoplastic surgery a suitable choice for these individuals. Additionally, for individuals who require both surgery and radiation therapy, oncoplastic surgery can be a suitable option for breast reconstruction and restoration of the breast’s appearance before undergoing radiation therapy.

Shorter Recovery Period

Since oncoplastic surgery combines cancer treatment with breast cosmetic surgery, there is no need for two separate procedures, allowing both cancer treatment and breast appearance to be preserved during a single operation. This will help shorten the patient’s recovery period and reduce the potential side effects of multiple surgeries.

More Natural Feel in the Breasts

In many cases, oncoplastic surgery leaves an inconspicuous scar or wound that does not affect the nipples and does not cause any damage to the breasts. As a result, this procedure preserves the natural appearance of the breast without significantly affecting the natural feel of the breasts. Additionally, during this procedure, breast symmetry can be well preserved. Instead of waiting a long time between breast cancer surgery and breast reconstruction surgery, as a result of oncoplastic surgery, the patient can immediately have the sensation of their natural breasts.

Creating Symmetry in the Breasts

During breast cancer surgery, a portion of one or both breasts is removed, resulting in the breasts’ shape and size becoming asymmetrical. However, in oncoplastic breast surgery, it is possible to simultaneously reduce breast size and perform breast lift surgery. This helps maintain more symmetry in the breasts after breast cancer treatment.

Who Is Suitable for Oncoplastic Surgery?

Oncoplastic surgery is considered a suitable cosmetic and therapeutic procedure for many women. This surgery is usually effective for individuals who undergo lumpectomy or partial mastectomy (removal of part of the breast tissue in mastectomy). Individuals who have had their entire breast tissue removed during mastectomy may consider other breast reconstruction options.

Although oncoplastic surgery can be performed for various breast shapes and forms, women with larger breasts and relatively small breast masses are more suitable candidates for this surgery. Sometimes, oncoplastic surgery can also be performed for individuals with small breasts, provided that a significant portion of their breast tissue has not been removed as a result of lumpectomy. The location of the tumor is also a determining factor for the suitability of oncoplastic surgery in women. Before deciding on this surgery, it is advisable to consult with a breast cosmetic surgery specialist and thoroughly review the breast reconstruction options based on your own conditions.

Preparation Before Oncoplastic Surgery

Before performing oncoplastic surgery, various information about the patient should be reviewed, including all specifications of the breast tumor, the timing of the last imaging, comparison of both breasts, the patient’s age, etc.

Ultimately, we should consider oncoplastic surgery as a combined surgical method that, in one procedure, combines cancer treatment and removal of cancerous tissue with innovative cosmetic surgery to make it more beautiful and attractive. Over the past decade, the increasing use of this method, along with the increasing number of scientific articles published on oncoplastic surgery, has resulted in many successes in breast surgery and aesthetics.

Studies indicate that by performing this therapeutic and reconstructive surgical procedure, patient satisfaction in terms of beauty and quality of life will be significantly increased. Also, no specific side effects of this surgical method have been proven.

It is worth mentioning that the success of performing oncoplastic surgery depends largely on the skill of the breast surgeon, and the surgeon’s level of experience and competence will have a significant impact on the outcome. It is very important that the breast surgeon has skills in both breast cancer surgery, oncology, and breast aesthetics. This way, the surgical outcome will be more successful. Therefore, pay close attention when selecting the best breast cancer specialist.

Types of Oncoplastic Surgery

We previously mentioned that oncoplastic surgery involves performing two therapeutic and cosmetic breast surgeries simultaneously. First, the tumor and infected breast tissues are removed. Then, using an appropriate method, the removed tissues are replaced. Oncoplastic surgery can preserve breast symmetry and help maintain the patient’s self-confidence. This way, during the continuation of the breast cancer treatment process, less psychological pressure will be exerted on the patient undergoing treatment.

There are multiple methods and techniques of oncoplastic surgery. The type of incision and the method of filling the empty space with the removed tissues vary in these techniques. For example, the location of the tumor in the upper or lower breast will affect the location of the incision and the oncoplastic surgery technique.

The choice of oncoplastic surgery method is based on various factors. The size of the tumor, the location of the tumor, and the amount of breast tissue removed are effective in selecting an effective reconstruction method. However, there are general methods for performing oncoplastic surgery, which we will discuss below.

Bilateral Breast Reduction

In cases where lumpectomy surgery is performed only on one breast, its size decreases. Also, lumpectomy surgery changes the shape of the breast. In such cases, it is better to make both breasts harmonious in terms of size and shape.

Bilateral breast reduction surgery has several advantages. First, during lumpectomy surgery, more breast tissue is removed. This is very useful in cases where the breast tumor is large. Another advantage is that by performing corrective surgery on both breasts, the appearance of the breasts will become symmetrical.

Bilateral Breast Lift (Mastopexy)

Mastopexy breast surgery or breast lift on both sides is considered an oncoplastic surgery method. This surgery is simpler than bilateral breast reduction surgery, which we introduced earlier. For women who do not intend to change the shape of their breasts, this surgery will be beneficial. In fact, during this surgery, instead of removing a large amount of tissue from both breasts, only enough breast tissue under treatment is removed. Usually, in bilateral breast lift surgery or mastopexy, the nipple is repositioned so that the breasts will be symmetrical in the future.

Skin-Sparing Mastectomy

Usually, in patients who are diagnosed with advanced breast cancer, performing a mastectomy (complete removal of the breast) is inevitable. In such cases, performing surgery using the skin-sparing mastectomy method helps preserve the appearance of the breast.

During skin-sparing mastectomy surgery, the breast skin is incised, and the nipple and areola are lifted from their place. Then the surgeon completely evacuates the breast tissue. Finally, the surgeon returns the removed skin to its place and reconstructs the nipple and areola. This way, the original shape and appearance of the breast are preserved.

Volume Displacement Techniques in Oncoplastic Surgery

For individuals who lose more than 10 to 20 percent of their breast volume in breast cancer surgery, various aesthetic problems arise. Therefore, it is usually necessary to use a type of filling method to address breast aesthetic problems. Volume displacement is the simplest option for breast reconstruction in oncoplastic surgery. However, volume displacement techniques also include different methods and complexities. Depending on the aggressiveness of the tumor surgery, one of these methods can be chosen.

In the volume displacement technique, the remaining breast tissue is used to fill the empty spaces. In fact, areas that remain empty after the tumor is removed are filled by reshaping the remaining breast tissue. It is interesting to note that even in cases where deep breast tissues are removed, volume displacement or local rearrangement methods can still be used.

Volume displacement is mainly used for individuals with moderate breasts. Also, the use of local tissue rearrangement methods will be more suitable for filling small tumor sites.

What are the types of surgical methods in volume displacement?

There are many methods for volume displacement of breast tissue in oncoplastic surgery. These methods are selected based on the location of the tumor. Below, we introduce the type of incision and volume displacement methods in oncoplastic surgery.

Oncoplastic Surgery for the Upper Pole of the Breast

Whether the cancerous lesion is in the upper or lower hemisphere of the breast affects the surgical method. The main techniques used for oncoplastic surgery with volume displacement in the upper pole of the breast include:

  • Crescent mastopexy
  • Batwing incision
  • Hemi-batwing incision

When cancerous lesions are present in the upper hemisphere of the breast, all three mentioned methods are used. The upper hemisphere of the breast is considered from 10 o’clock to 2 o’clock.

These methods are also very effective in cases where the patient has large breasts. With these methods, it is even possible to preserve the nipple and areolar area while removing infected tissues.

Oncoplastic Surgery for the Lower Pole of the Breast

The lower pole of the breast will be from 3 o’clock to 9 o’clock. In cases where the tumor is in the lower pole of the breast, one of the following methods is used for oncoplastic surgery:

  • Triangular incision
  • Reduction mastopexy
  • Infra-mammary (where the patient’s breast skin is preserved)

In each of these methods, a large amount of breast tissue (from subcutaneous to overlying the chest wall muscle) can be extracted and replaced. The result of oncoplastic surgery in the lower pole of the breast will usually be excellent.

Oncoplastic Surgery for Any Part of the Breast

In general, any part of the breast that is affected by a tumor and cancerous lesion is treated with one of the following oncoplastic techniques:

  • Radial-ellipse excision
  • Circumareolar technique, which helps preserve breast skin
  • Donut or round mastopexy
  • Wise pattern reduction, which is usually accompanied by nipple removal

For oncoplastic surgery in any part of the breast tissue, permanent prostheses or components called Expanders are used. This helps create enough space for placing a breast prosthesis in the future.

Do Both Breasts Need Cosmetic Surgery in Oncoplastic Surgery?

One of the most important questions that may arise about oncoplastic surgery is whether both breasts need cosmetic surgery. The answer to this question depends on the patient’s condition and the physician’s decision-making.

In general, breast tissue varies among individuals. Additionally, the growth of the tumor and its location will affect the aggressiveness and extent of the surgery. The larger the tumor and the more advanced the breast cancer, the more aggressive the surgery will be.

In cases where it is necessary for the physician to remove a large portion of the breast tissue, symmetry between the two breasts will be altered. Therefore, to create symmetry between the breasts, the other breast also needs to undergo surgery. Otherwise, even with the oncoplastic surgery performed on the affected breast, the aesthetic beauty of both breasts will be lost.

However, it is worth noting that breast symmetry can be achieved in a delayed surgery.

Complications of Breast Symmetry during Oncoplastic Surgery

Simultaneously symmetrizing the breasts during oncoplastic surgery for the affected breast will reduce the cost of the surgery. However, the resulting complications should also be considered.

Generally, during the surgery, determining the margins of the breast that need correction will be somewhat challenging. On the other hand, in the postoperative stages following breast cancer surgery, the patient’s breast appearance may change. Therefore, it seems that performing breast symmetrization surgery with a delayed approach is a more suitable solution.

Also, in many cases, patients undergo radiotherapy after breast cancer surgery. Radiotherapy can affect the appearance of the breast. For example, in many individuals, radiotherapy greatly reduces the volume of breast tissue. However, in some others, radiotherapy can cause swelling or edema in the breast.

In both cases mentioned above, the appearance of the breast will change, and symmetry between the two breasts will be lost. For this reason, most experienced physicians recommend that patients undergo breast symmetrization surgery after completing radiotherapy. The duration of radiotherapy for breast cancer treatment will typically vary from 6 to 12 months for different individuals.

Post-Oncoplastic Care

After oncoplastic surgery, the following care measures will be necessary:

After surgery, the individual should be transferred to the recovery ward.
The use of tobacco and alcoholic beverages will be prohibited for up to two weeks.
A liquid-based diet should be followed.
Wear completely cotton and loose clothing.
The patient should use a medical bra.
Avoid heavy activities for at least one month.
Showering should be done 2 to 5 days after the procedure.
It is best to avoid driving for a while.

Final Word

Dr. Farhad Moussazadeh, the best breast surgeon in Tehran, specializes in breast surgery and related diseases, breast cosmetic surgery, oncology, etc. To schedule an appointment with Dr. Moosazadeh, you can visit his appointment scheduling page on his website.

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