Health

Oncoplastic Breast Conserving Surgeries: When Are They Used?

Oncoplastic breast surgery is a new surgical method that includes the removal of breast cancer using plastic surgical techniques for reconstructing the effect produced when the cancer is removed. It also involves the excision of the tumour with a wide free margin for achieving locoregional control and immediately remodelling the defect in order to improve the cosmetic results. Sometimes, the experienced breast consultant in London may also include contralateral breast symmetrisation and reconstruction of the nipple as well as areolar complex if necessary. It also involves immediate and delayed breast reconstruction after mastectomy.

The primary goal of oncoplastic surgeries is to resect the breast cancer with negative histology margins while preserving the breast’s contour. This technique merges the principles of oncology and reconstructive surgery by using a wide spectrum of aesthetic-enhancing techniques. Thus, it helps address tissue defects and existing reshaping and optimises cosmesis from breast cancer surgery. It aims at providing optimal local control while also managing cosmetically acceptable breasts. There are several oncoplastic surgery techniques that may be recommended by an experienced breast consultant in London to enhance the aesthetic results of mastectomy. These techniques have been categorised into various skill levels, such as lumpectomy, segmental resection, wide local excision and quadrantectomy. Most breast surgeons can perform basic procedures, but some complex techniques require a team approach with a plastic surgeon. Such techniques involve the use of implants and tissue flap reconstructions.

Patients with primary breast cancer can have the cancer removed with a reduction mammoplasty or a mastopexy for correcting the breast ptosis. Most of the standard breast-conserving surgeries yield poor cosmetic results. This can be due to many reasons, like an unfavourable tumour-to-breast size ratio or if the tumour is located in an unfavourable cosmetic position in the breast. Oncoplastic breast conservation often involves placing the incision in an area remote from cancer. Plastic surgical techniques like mastopexy and reduction mammoplasty are then employed to improve the cosmetic outcome.

However, not all patients are suitable for oncoplastic breast conservation surgery. These techniques are almost always followed by radiation therapy, which equates to total mastectomy in terms of local recurrence and survival. One of the major concerns with breast-conserving surgeries is unfavourable cosmetic results. Immediately after the surgery, breast tissue deformities can be seen, which can also develop over time, especially after radiotherapy. The severity of these deformities depends on the amount of breast tissue extracted, whether the skin has been resected at the time of excision, the size of the breast, the position of cancer, the use of postoperative radiotherapy, and the orientation of the surgical incisions on the skin. The greater the amount of tissue removed during the primary surgery, the higher the risk of poor cosmetic results will be. But a free margin of healthy tissue must be obtained around the tumour in order to reduce the risk of local recurrence and improve survival.

There are various advantages of undergoing oncoplastic breast conservation surgeries. One of them includes its ability to resect larger breast volumes. These surgeries also provide a wider free margin. Few patients will require re-operation and better cosmetic results will be obtained, especially for those who wish to reduce their breast size or those with a significant degree of ptosis. It also allows the patients recommended to undergo a mastectomy to have breast-conserving surgery. Breast surgeons also perform collateral procedures for contralateral reduction mammoplasty and symmetrisation. This additional benefit reduces the risk of breast cancer. Breast volume reduction also allows for a more uniform dose distribution of postoperative radiotherapy.

However, it would help if you also remembered that oncoplastic surgery has certain disadvantages. One of the major drawbacks includes a longer duration of surgery, as well as longer scars. The scars are usually placed in a position that will be hidden and not visualised postoperatively. Studies also indicate higher complication rates, especially with complex operations and when there is collateral breast surgery during the removal of primary cancer. Therefore, the surgeon must have significant timing and planning to perform the procedure together.

Medical Uses

Oncoplastic breast-conserving surgery has been widely accepted as an alternative to mastectomy since it provides the removal of the tumour while maintaining an acceptable cosmetic outcome. It is highly beneficial for specific patients. In the case of clinical stages I and II breast cancer, it is used in combination with radiotherapy and possibly chemotherapy. It is recommended that one or two sentinel lymph nodes are found to have cancer that is not extensive. In such cases, the lymph nodes are examined, and lymphadenectomy is not suggested as further evaluation as it results from the sentinel lymph nodes, which is enough to recommend treatment.

Breast conservation surgery is also used for biopsy-proven invasive breast cancer or biopsy-proven ductal carcinoma in situ. For assessing a tumour, the surgeon should inspect the ability to react to the tumour with clear margins while providing a cosmetic result that is acceptable to the patient.

Concluding

Oncoplastic breast-conserving surgeries have emerged as a popular alternative for women undergoing breast cancer surgeries. It helps them have good cosmetic results for their breasts and regain their self-confidence.

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