Breast Conservation surgery
Breast Conservation surgery is a type of breast cancer treatment where unlike the tradiational mastectomy that involves removal of the entire breast, in BCS ( breast conserving surgery) the tumor tissue is removed with adequate margins while the remaining breast tissue is retained. The patient is cured of cancer while at the same time the breast mound is retained giving the patient a sense of relief.
Traditional BCS: In this form of surgery, the incision is directly placed on the tumor and the cancer is removed with an adequate margin. No attempt is made to fill the resulting cavity and similarly no attempt is made to restore the shape. In this form, even though the patient is cured of cancer, she ends up with a mutilated breast.
Oncoplastic breast surgery is a specialized approach of Breast Conservation surgery that combines oncologic surgery (removal of cancerous tissue) with plastic surgery techniques to treat breast cancer while preserving or enhancing the aesthetic appearance of the breast. This approach is designed to ensure optimal cancer treatment without compromising the cosmetic outcomes, which can have a significant impact on a patient's quality of life after surgery.
Key Principles of Oncoplastic Surgery:
1. Cancer Removal:
- The primary goal of oncoplastic surgery is the safe removal of cancerous tissue while ensuring clear surgical margins (meaning no cancer cells are left behind in the edges of the removed tissue). The extent of tissue removal depends on the size, location, and stage of the tumor.
2. Breast Aesthetics:
- After the cancer is removed, reconstructive techniques are applied to reshape the breast, minimize deformities, and maintain symmetry with the other breast. This may involve rearranging the remaining breast tissue, performing a breast reduction, or using implants or autologous tissue reconstruction.
Types of Oncoplastic Breast Surgery:
1. Oncoplastic Breast-Conserving Surgery (Lumpectomy with Reconstruction):
- This is the most common type of oncoplastic surgery. It involves performing a lumpectomy, or partial mastectomy, to remove the tumor while leaving most of the breast intact.
- After tumor removal, reconstructive techniques (like tissue rearrangement or reshaping) are used to prevent deformities or indentations where the tumor was removed. The adjacent tissues around the tumor excision cavity are mobilised to fill the defect and restore shape.
- This approach allows for breast conservation, where the overall shape and size of the breast are maintained, even though a portion of the breast tissue is removed.
2. Therapeutic Mammoplasty:
- For women with larger breasts, oncoplastic surgery can involve a therapeutic mammoplasty, which is a combination of breast cancer surgery and a breast reduction. This is particularly useful for women who need a significant amount of tissue removed.
- The surgeon removes the tumor and additional surrounding tissue, and the breast is reshaped and reduced in size. Often, a symmetry procedure on the opposite breast is performed to achieve a balanced, even appearance.
3. Partial Breast Reconstruction:
- In cases where a large portion of the breast tissue is removed, partial breast reconstruction using a variety of techniques may be necessary. Options include:
- Flap techniques: Tissue from another part of the body, such as the back (latissimus dorsi flap), is used to replace the missing breast tissue.
- A modern method is to use tissues adjacent to breast and are based on small blood vessels called perforators. There are several types of such flaps ( AICAP, MICAP, LICAP and LTAP)
Benefits of Oncoplastic Surgery:
1. Improved Cosmetic Outcomes:
- By combining cancer removal with plastic surgery techniques, oncoplastic surgery minimizes disfigurement and leads to better cosmetic outcomes compared to standard lumpectomy or mastectomy. The goal is to maintain the shape, size, and symmetry of the breasts.
2. Reduced Psychological Impact:
- Oncoplastic surgery helps address the emotional and psychological effects of breast cancer surgery by preserving or enhancing the patient’s appearance. This can contribute to better self-esteem, body image, and quality of life after surgery.
3. Larger Tumors Can Be Treated with Breast-Conserving Surgery:
- Oncoplastic techniques enable surgeons to safely remove larger tumors without compromising the breast’s appearance. In many cases, women who would have previously required a mastectomy can instead undergo breast-conserving surgery.
4. Single-Stage Surgery:
- Oncoplastic surgery can often be done in a single operation, where cancer removal and breast reconstruction are performed simultaneously, minimizing the need for additional surgeries.
5. Symmetry Procedures:
- In cases where one breast has been reshaped or reduced in size due to cancer removal, oncoplastic surgery allows for symmetry procedures on the unaffected breast, such as a lift or reduction, to ensure a balanced appearance.
Who is a Candidate for Oncoplastic Surgery?
Oncoplastic surgery is generally suitable for:
- Women with early-stage breast cancer.
- Women who are eligible for breast-conserving surgery (lumpectomy).
- Women with large breasts who may benefit from a therapeutic mammoplasty or breast reduction.
- Women concerned about the cosmetic outcomes of breast cancer surgery, particularly if the tumor is in a visible location (e.g., near the cleavage or nipple).
- Women with larger tumors who want to avoid mastectomy but still wish for a good aesthetic result are often given chemotherapy prior surgery to reduce the size of tumor.
Recovery and Considerations:
1. Recovery Time:
- Recovery from oncoplastic surgery may take longer than standard lumpectomy or mastectomy due to the additional reconstructive procedures. Recovery times can vary based on the extent of the surgery and individual healing rates.
- Patients may experience some bruising, swelling, and discomfort, which typically improves within a few weeks.
2. Radiation Therapy:
- After oncoplastic breast-conserving surgery, patients will mandatorily require radiation therapy to reduce the risk of cancer recurrence. Oncoplastic techniques are designed to maintain the breast’s shape even after radiation.
3. Potential Risks:
- As with any surgery, there are risks such as infection, bleeding, delayed wound healing, or asymmetry. Some patients may require revision surgery to correct any cosmetic issues or complications.
4. Follow-Up:
- Long-term follow-up with regular mammograms or imaging studies is essential for monitoring breast health after oncoplastic surgery, especially if a lumpectomy was performed.
Conclusion:
Oncoplastic breast surgery offers a unique combination of cancer treatment and cosmetic enhancement, making it a valuable option for women facing breast cancer surgery. It allows for the safe removal of cancer while maintaining or improving the breast’s appearance, providing both physical and emotional benefits. Hyderabad Breast Clinics is one of the select few centres in India that can offer Breast Conservation using Oncoplastic techniques. Our expert surgeons have decades of experience in breast cancer care and further they have extensive experience in Oncoplastic surgical techniques.