What is an 'Oncoplastic' Procedure?

Hi, I'm an expert in oncoplastic breast reconstruction, and use the term to mean reconstruction of a breast, specifically and only in the setting of breast conservation. I don't use the term when referring to post mastectomy reconstruction.There are many different techniques that exist, however the over-riding goal of the operation is to allow a 'lumpectomy' to be performed, while at the same time rearranging breast tissue to assure that there is no deformity after healing and radiation. The reason oncoplastic reconstruction is necessary is that even small lumpectomies can and do result in deformities.  Often, these patients will be advised to have mastectomies instead to avoid this deformity.  If an oncoplastic technique is used, even large lumpectomies can be performed, and often can yield a breast that is more youthful and shapely than before surgery!  In my practice, I routinely offer and perform surgery on the opposite breast at the same time, so that the final result will be symmetric.

Oncoplastic reconstruction is just saying that breast reconstruction is done along with a mastectomy. Make sure a plastic surgeon is involved in the reconstruction. In fact, I would strongly advise you insist on it.

is easiest to understand oncoplastic surgery as a mind set, or way of approaching the treatment of breast cancer. At its simplest level, oncologic surgery describes the approach to eradicating the cancer, and plastic surgery describes the manipulation of tissues or use of foreign materials such as implants to reconstruct the area treated for the cancer.  Combining these two approaches, oncoplastic surgery is how the surgeon uses the techniques of both specialties to remove the cancer and leave the most natural appearing reconstruction behind.  For example, rather than simply doing a lumpectomy and conserving the natural breast, the oncoplastic approach might remove the tumor and perform a lift or reduction at the same time, to enhance the appearance of the breast...

This usually refers to the combination of plastic surgery with the removal of the tumor using a breast conserving procedure done during lumpectomy.

In terms of breast reconstruction, oncoplastic surgery has been described as a combined approach to the treatment and reconstruction of patients with breast cancer.   In the plastic surgery literature, this has been most commonly described in lumpectomy or partial mastectomy surgery in patients with sagging or large breasts.   The plastic surgeon can outline an incision for a breast reduction or lift through which the breast cancer surgeon can remove the tumor.    
In the immediate setting, the tumor is removed and then the plastic surgeon performs a lift or reduction to preserve and improve the shape and size of the breast.   The downside to this is that the breast could shrink or harden after radiation, which will be necessary.    There is also the possibility of a positive margin.

In the delayed setting, the tumor is removed and nodes are sampled.   Once final pathology confirms clear margins, the plastic surgeon proceeds with reduction or lift of the breast prior to radiation.   I prefer this method in my practice, as I am confident that the cancer has been completely removed prior to beginning my reconstruction.

The contralateral breast can commonly be addressed during the primary procedure, but some may prefer to delay until after radiation.  

I wish you a safe and healthy recovery.

 

Paul S. Gill, M.D.

Gill Plastic Surgery

Houston Double Board Certified Plastic Surgeon

Oncoplastic surgery can improve the final shape of the breast after breast-conserving surgery without compromising cancer care. When a lumpectomy will or might distort a woman’s breast, the remaining tissue can be sculpted to realign the nipple and areola and give the breast a natural appearance. By rotating breast tissue to fill defects created by the lumpectomy or partial mastectomy (in a manner similar to what is done during a breast reduction or breast lift) breast shape can be better preserved. In addition, the opposing breast can also be modified, for example with a breast reduction or breast lift, to improve symmetry. These procedures are usually done on an outpatient basis.

Because surgery is completed prior to radiation, wound-healing problems that occur with significant frequency with post-radiation surgery are minimized, and only a single surgery is necessary.

If you think you may benefit from oncoplastic breast surgery, consultation ahead of lumpectomy surgery is suggested.

Oncological surgery is the surgery dedicated to the removal of cancers. In the past removal of cancer took precedence over the appearance of the scar and final appearance. An oncoplastic procedure is one in which plastic surgery concepts of scar direction, blood supply, tissue handling are all employed in cancer removal to bring about a much more acceptable appearance.