Oncoplastic Approach to Breast Cancer Surgery

Breast cancer Treatment. Things you need to know.


Early stage breast cancer is a term we use to describe breast cancers which are small, (measuring up to 2 cm, which is about an inch) with the lymph nodes that are either free of cancer, or only 1-3 lymph nodes have cancer in them. Women with early stage breast cancer have many excellent options for surgery that are both safe and effective. Mastectomy, removal of the entire breast and the nipple, is always an option for treating breast cancer, but rarely is mastectomy NECESSARY. Breast conserving surgery is a lumpectomy, removal of the cancer with a rim of healthy tissue around the cancer, followed by radiation, which is giving electrons to the breast to kill any cancer cells in the tissue around where the cancer was found. For women with early stage breast cancer, lumpectomy with radiation has the same survival rate as mastectomy. Put another way, removing your entire breast will not guarantee you will live longer. In my experience taking care of women with breast cancer, they can list the things they want to accomplish in the treatment of their breast cancer. And most often, the order of importance is the same.

First and foremost, they want the cancer GONE. Secondly, they don’t want to have to worry about the cancer coming back. Next, they don’t want a breast that looks mutilated or deformed, and finally, they want to get back to their life the way it used to be, and not have to be reminded every day that they had breast cancer. In my surgical practice I find that breast conserving surgery combined with Oncoplasty is one of the best ways to accomplish all those goals.


What is Oncoplasty?

Oncoplasty is an approach to breast cancer surgery in which two important things happen. Most importantly, the breast cancer is removed safely and efficiently, with a rim of healthy tissue around it. Next, the cancer is removed through the same type of incisions that a plastic surgeon would make if the breast were to be lifted up (to get rid of the droopiness) or reduced in size for cosmetic reasons. Removing the breast cancer in this way gives the surgeon the opportunity to fix the defect caused by the lumpectomy, and also to tighten up the skin, and give the breast a round, firm appearance. After radiation, the breast maintains its natural firm contour and shape, and doesn’t develop dimples, puckers or divots so commonly seen when oncoplasty is not used. Often, the non cancer breast is lifted to create the look that the breasts are more equal both in size, and in nipple position. Studies show that 30% of women are not satisfied with their cosmetic result after standard lumpectomy. Alternatively, women who have oncoplastic surgery are dissatisfied with their cosmetic result only 6% of the time.

Dr. Juliann Reiland – What is Lumpectomy?

Most women do not have perfectly equal breasts. Oncoplasty is not about making your breast perfect, but more about making them look similar, and having scars that are not as obvious or deforming as standard lumpectomy scars. I tell my patients, that I cannot promise their breasts will look like twins, but more likely they will look like sisters.

Today, most breast surgeons do not practice oncoplasty independently. Some breast surgeons will consult a plastic surgeon and the two surgeons will work together for the cancer operation, and to fix the defect. Other general surgeons and breast surgeons will perform their standard lumpectomies, and if the patient is not satisfied with the results, refer them to a plastic surgeon to try to fix the problem. However, this usually requires more surgery to repair the defect. If radiation treatments have already been performed, there may be little the plastic surgeon can do to correct the defect and the patient must accept the defect for life. In my practice, I am one of a few surgeons who does her own oncoplasty. Typically, if a patient has a breast size smaller than a DD bra cup, I perform oncoplasty, with a breast lift or equalization procedure to the other side if needed. When a woman’s breasts are larger, or she desires a breast reduction procedure, a plastic surgeon will perform the reduction at the time of the original breast cancer surgery.

Dr. Juliann Reiland discusses how oncoplasty combines the latest plastic surgery techniques with breast surgical oncology.