This is a new way of surgery for breast cancer which combines the principles of Oncosurgery along with Plastic & Reconstructive surgery. This gives a more cosmetic result so the patient does not have to live with a deformed or asymmetric breast after removal of the cancer.

This surgery is best performed by a team approach of trained breast surgeons and plastic surgeons. Breast surgeons who are properly trained in Oncoplastic surgery can also perform some of these procedures at the time of breast cancer removal.

Appearance of the breast post-cancer surgery has a significant impact on a woman’s self-image, relationships and lives in general.

Who is a candidate for Oncoplastic Breast surgery?

There are a range of surgical options available, so we consider every woman as a potential candidate for Oncoplastic surgery. However there are a few cases where this type of surgery may not be appropriate such as:

• Women with small breasts or unfavourable tumor to breast ratio.
• A previous history of multiple lumpectomies.
• A previous history of radiation.
• Multifocal disease

Team approach of Mumbai Breast Specialists to ONCOPLASTIC surgery

The patient is evaluated by both the Breast surgeon and the Plastic surgeon, and they will then discuss the surgical approaches. They will formulate an individual plan after evaluation of the multiple components of each patient’s clinical presentation and radiological findings.

Initial assessment by the breast surgeon includes -

• Amount of cancerous breast tissue to be removed.
• Pre- existing Anatomy of the patients’ breasts - size and volume.

Assessment by the plastic surgeon includes-

• Is there excessive skin drooping, ie, ptosis.
• Evaluation of the opposite breast for symmetry.
• Patients’ desires and her satisfaction with the current appearance of her breasts.

The key is to simultaneously plan both the oncologic approach as well as the approach to cosmesis before starting the cancer removal surgery.

So for a patient undergoing a partial mastectomy, the plastic surgeon will draw the reduction pattern and the location of the incisions on the breast prior to starting the surgery. The Breast surgeon will then excise the cancer followed by the plastic surgeon performing the breast reduction. (Hyperlink to the breast reduction page) A mastopexy or breast lift can also be done at this time. (Link to mastopexy page). Communication between the team members is very important to ensure blood supply to the nipple and areola is preserved when removing breast tissue.If volume needs to be added to the breast, there is a choice of implants versus flaps from the patient’s own body, or a combination of both.

How is Oncoplastic surgery performed?

There are many classifications of oncoplasty procedures. A simple way to look at it is whether the surgery involves re-distribution of existing volume or the volume replacement.This means that if a lumpectomy is planned, volume advancement techniques can be used. Whereas if a partial mastectomy is planned, volume replacement techniques may be required.

There are many techniques which range from simple to complex depending on the degree of surgical skill required.

Basic/Lower level procedures

These include lumpectomies of upto 20-25% of total breast volume with local advancement of tissues for reconstruction. Most of these techniques can be performed by a Breast surgeon with specialized Oncoplastic training.

By mobilising adjacent tissue into the lumpectomy defect, the normal contour of the breast is maintained without sinking or concave deformity seen after lumpectomy alone. While advancing breast tissues it is very important that the nipple should not get shifted to an abnormal position.

Upper Level Procedures

Volume Displacement

When larger amounts of breast tissue (>25% of total breast volume) need to be removed a reduction mammoplasty with mastopexy has to be performed. A mastopexy may be added if needed.

After the Breast surgeon removes the tumor with surrounding margin of normal breast tissue, the plastic surgeon will reconstruct the breast by moving the breast tissue and moving the nipple with it’s blood supply to a new location at the centre of the new, smaller breast mound.

Volume Replacement-

When very large amounts of tissue are removed then using local tissue arrangement can lead to distortion of the breast and an unnatural appearance. For such patients the removed volume has to be replaced by using tissue flaps from the back (LD flap) or abdomen (TRAM flap). Some patients may opt for breast implants with fat transfer or a 2 stage - tissue expander followed by permanent implant.

Your plastic surgeon will counsel you on the right option for you depending on the size of the opposite breast, how much tissue will be removed and the amount of postoperative radiation.

Is surgery on the opposite breast necessary?

The plastic surgeon will discuss with you if you want a procedure on the opposite breast to get symmetry with the affected breast. Some patients may opt for contra lateral mastectomy with immediate reconstruction if they are BRCA positive.

What are the benefits and risks?

Benefits

Single stage session to get symmetrical reconstructed breasts. You feel whole and natural after the surgery which improves your emotional well being. The opposite breast can be reduced or lifted at the same time.

Risks

Recurrence of the cancer.

What is the risk of local recurrence with ONCOPLASTIC surgery?

3 - 15% with Oncoplastic surgery which is almost the same as with a complete mastectomy 2-10%.

What do I do after the procedure?

Many patients treated with lumpectomies will require post-operative radiation therapy (link to Radiotherapy page). Sometimes after Oncoplastic tissue rearrangement, identifying the true lumpectomy cavity may be difficult. Therefore your Breast surgeon will leave behind titanium clips at the cancer site which can be seen on X-ray/CT scan. The radiation oncologist will do a planning CT scan before starting radiation.