Oncoplastic Breast Surgery

Oncoplastic Breast Surgery

Associate Professor Youwanush Kongdan, MD.

Oncoplastic breast surgery combines cancer removal techniques with reconstructive and cosmetic surgery to achieve two critical goals: effective cancer control and optimal breast aesthetics. This innovative approach ensures patients not only receive the necessary medical care but also maintain or improve the natural appearance of their breasts. Oncoplastic breast surgery can be broadly categorized into two types:

1. Breast-Conserving Oncoplastic Surgery, where the breast is preserved while removing the tumor.

2. Mastectomy with Reconstruction, where the entire breast is removed and reconstructed to restore its appearance.

1. Breast-Conserving Oncoplastic Surgery

This type of surgery is suitable for breast cancer patients undergoing breast-conserving surgery and is particularly beneficial in the following situations:

• Large tumors relative to breast size: Tumors that are too large to remove without significantly altering the breast shape can be managed by reshaping the remaining tissue.

• Large or sagging breasts: Breast lift or reduction techniques can be incorporated for better symmetry and aesthetics.

• Multiple tumors: Patients with multiple lesions in the breast may benefit from these advanced techniques.

• Tumors near the nipple: Oncoplastic methods can address challenges in preserving the breast’s natural appearance in these cases.

• Unfavorable locations affecting aesthetics: Tumors in areas that would leave visible deformities can be removed with reconstruction to restore symmetry.

Techniques for Enhanced Breast Appearance

• Tissue Repositioning: Fat or tissue from adjacent areas is used to fill the void left after tumor removal.

• Bilateral Adjustments: A simultaneous breast lift or reduction on both sides ensures symmetry, especially for patients with large breasts.

• Radiation Therapy Facilitation: By reducing the breast size during surgery, complications from post-operative radiation therapy can be minimized.

2. Breast Reconstruction After Mastectomy

For patients requiring a mastectomy, oncoplastic surgery provides options for reconstructing the breast. These techniques range from innovative approaches to remove the breast to sophisticated reconstruction methods that enhance the breast’s natural appearance.

Advanced Mastectomy Techniques

• Skin-Sparing Mastectomy: Preserves the breast skin, creating a natural "envelope" for the reconstructed breast. Only skin directly adjacent to the tumor is removed, allowing for improved aesthetic outcomes.

• Nipple-Sparing Mastectomy: Suitable for tumors smaller than 2-3 cm and located more than 2 cm from the nipple. Preserving the nipple significantly enhances the reconstructed breast's appearance.

• Nipple-Sparing Mastectomy with Intraoperative Radiation Therapy (IORT Nipple) is a surgical technique that preserves the nipple and the entire breast skin. This technique involves localized radiation therapy during surgery (Intraoperative Radiation Therapy - IORT) at the nipple, which enhances the safety of nipple preservation and reduces the risk of cancer recurrence in the nipple area. This method is suitable for all patients who can have the tumor completely removed, regardless of the size of the tumor or its distance from the nipple

Reconstruction Options

1. Autogenous Reconstruction (Using the Patient’s Own Tissue):

   • Common donor sites include the abdomen and back, where tissue is transplanted to create a new breast.

   • Advantages: Natural feel, high safety for long-term outcomes, no foreign materials.

   • Disadvantages: Requires a longer surgery (4-6 hours) and leaves additional scars at donor sites.

2. Implant-Based Reconstruction:

   • Silicone implants are increasingly popular due to advancements in materials, offering options like teardrop shapes for a natural appearance alongside traditional round implants.

   • Implants are available with either smooth or textured surfaces, that prefer smooth rather than textured preference and medical advice.

Innovations in Implant Placement

• ADM (Acellular Dermal Matrix): Enhances implant coverage and positioning by using a biocompatible sheet to support the implant, improving the breast's appearance.

• Titanized Mesh: A cutting-edge technique where a large ADM sheet or mesh is used to create a pocket for the implant above the muscle. This avoids traditional sub-muscular placement, reducing post-operative pain and achieving a more natural contour.

• VDO assisted mini LD flap with Silicone: This procedure uses endoscopic surgery from the incision at the breast to dissect part of the back muscle along with subcutaneous fat, which is then moved to cover the silicone implant, resulting in a more natural appearance."

Advantages of Oncoplastic Surgery

• Comprehensive Cancer Care: Combines tumor removal with immediate reconstruction, minimizing the number of surgeries.

• Enhanced Aesthetics: Patients report higher satisfaction due to the natural appearance and symmetry of their breasts post-surgery.

• Improved Quality of Life: Patients regain confidence and psychological well-being following the restoration of their breast appearance.

• Facilitated Radiation Therapy: In cases involving large breasts, reduction techniques can reduce complications associated with post-operative radiation.

Conclusion

Oncoplastic breast surgery is an advanced approach that merges cancer treatment with reconstructive and aesthetic principles. Whether through breast-conserving surgery or complete reconstruction after mastectomy, this method empowers patients to fight cancer without compromising their confidence or body image. Namarak Hospital offers state-of-the-art oncoplastic procedures, ensuring every patient receives personalized, expert care tailored to their needs.

Considerations

Results from oncoplastic surgery vary by individual, influenced by factors such as tumor size, breast shape, and patient health. While the techniques offer significant benefits, they require experienced surgeons and careful patient selection to ensure optimal outcomes.

Note: Individual results may vary; consult a qualified physician for a personalized treatment plan.