Oncoplastic Breast Cancer Reconstruction

Breast cancer management has been one of the most rapidly evolving fields within plastic surgery for the last twenty-five years. In order to understand how we got to where we are now, we must be students of history.

Breast reconstruction and breast cancer treatment are partners that have developed together. Modern breast cancer management began with the age of the radical mastectomy. This aggressive surgery improved life expectancy but left patients with extensive scarring and very poor cosmetic results.

As our understanding of breast cancer grew, the concept of combining removal of the cancer alone (lumpectomy) and radiation therapy was introduced as an equally safe and effective means of treatment. The mutilating mastectomy surgeries fell out of favor. Mastectomy survives today in a modified form in which most of the skin of the breast and, occasionally, even the nipple areolar complex is maintained.

Breast reconstruction has kept pace with the changing breast cancer management techniques. When a mastectomy is the treatment of choice a variety of reconstructive options may be offered. These range from implant / tissue expansion techniques to microsurgical procedures that move pieces of the patient's healthy tissues to the mastectomy site. Structural fat injections transfer fat from the abdomen or thighs to the breasts to treat more subtle contour deformities produced by the surgical cancer treatment process. The reconstruction of a mastectomy can produce a very gratifying result. At its best, a breast reconstruction can even have better aesthetics than the original breast.

The majority of the breast cancers in the U.S. are managed with tumor removal (lumpectomy) followed by radiation. In most cases, this management leads to an acceptable cosmetic outcome in the year after treatment. There, however, remains a group of women who do not respond well, cosmetically, to this routine management. After the completion of their treatment, their aesthetics are mediocre to poor. These women may be candidates for an oncoplastic breast reconstruction at the time of their lumpectomy.

Oncoplastic reconstructions are blends between cancer surgeries and breast reconstructions. In these patients, the plastic surgeon and the cancer surgeon co-operate to produce the most favorable breast shape prior to radiation therapy. The surgery creates a more youthful appearing breast while eliminating the open space created by the lumpectomy. This allows the radiation oncologist to maximize treatment without producing a significant distortion in the breast at the site of tumor removal. The goal is to avoid a breast deformity after radiation. Breast deformities after radiation are much more difficult to correct, because the radiated breast tissue does not heal as well as normal breast tissue.

Most significant breast deformities after radiation therapy now require a return to mastectomy and a more involved reconstruction since tissue expanders alone are not reliable in radiated areas. If the deformity after radiation can be avoided altogether with an "up front" procedure for those at risk, then the goal of good breast aesthetics after cancer treatment can be achieved.

At greatest risk for this deformity are those women with smaller, ptotic (sagging) breasts and larger breast tumors. Plastic surgeons have reliably used surgical techniques employed in oncoplastic reconstructions for decades in breast reduction and breast lift surgeries.

The oncoplastic breast reconstruction is another in the array of modern surgical techniques available to women with breast cancer. For more information on state of the art breast reconstruction, please contact us.