Oncoplastic Surgery: Advancement in Breast Cancer Surgery
As a referring provider, it's crucial to understand that oncoplastic surgery is now an integral component of breast cancer surgery, especially when breast conservation is desired. By incorporating aesthetic techniques in lumpectomy and mastectomy procedures, we significantly expand the range of surgical options available to patients with breast cancer. In addition to improved patient satisfaction and cosmesis, oncoplastic surgery has also been shown to improve oncologic outcomes with lower positive margin and re-excision rates.
What is oncoplastic breast surgery?
The American Society of Breast Surgeons defines oncoplastic breast surgery as the incorporation of volume displacement or replacement techniques to repair the defect created by performing an oncologic partial mastectomy. This allows for wider tumor excision while maintaining or improving the appearance of the breast. These techniques expand the breast-conserving surgical options for larger size, multifocal, or multicentric tumors.
Oncoplastic breast surgery plays a significant role in treating larger areas of non-palpable tumors such as ductal carcinoma in situ or invasive lobular carcinoma, where bracketing techniques are utilized. There is also an emerging role for oncoplastic surgery in patients with larger tumor sizes who clinically respond to neoadjuvant therapies.
Who are good candidates for oncoplastic breast surgery?
- Patients with single or multiple tumors in the breast where removal would create cosmetic defects (up to 50% of their breast volume).
- Women with larger, ptotic breasts who are open to breast reduction or mastopexy.
- Those eligible for breast-conserving surgery (lumpectomy) and plastic surgery (mammaplasty, mastopexy).
What are the benefits of oncoplastic surgery?
- Allows removal of more breast tissue with a lower rate of positive margins and re-excision of margins
- New data suggest lower rates of locoregional recurrence
- Addresses breast deformity before radiation therapy
- Usually requires only one surgery
- Can improve breast symmetry
- May alleviate symptoms of large breasts
What types of oncoplastic procedures are available?
The type of procedure depends on defect size relative to breast size:
- Small defects: Local tissue rearrangement
- Medium defects: Breast reduction or lift techniques
- Large defects: Breast reduction and local tissue rearrangements, rotational/advancement flaps
Who performs oncoplastic surgery?
Breast surgeons and plastic surgeons are trained in oncoplastic techniques along with a multidisciplinary team of experts.
What are the potential complications?
Compared to standard breast conserving surgical procedures, oncoplastic breast conserving surgery has similar rates of hematoma, infection, seroma, conversion to mastectomy, and delay in adjuvant treatment due to postoperative complications. With oncoplastic breast reduction, there is a slightly increased rate of nipple sensation loss, nipple necrosis and incisional dehiscence.
How do long-term results compare to standard lumpectomy?
Studies now show improved oncologic outcomes when compared with standard breast conservation therapy. Cosmetic satisfaction is higher with oncoplastic approaches due to improved breast symmetry and shape.
The Breast Oncology Program at Moffitt Cancer Center is a high-volume surgical program. Our surgeons have gained the highest level of expertise from regularly performing complex breast cancer procedures, such as oncoplastic surgery. The skill of our surgeons translates directly into a better treatment experience for our patients, and in combination with our progressive surgical technologies, allows us to remove tumors that were once thought to be inoperable while optimizing cosmetic results.
We encourage you to refer qualifying breast cancer candidates to Moffitt for oncoplastic breast surgery. To refer a patient, complete our online form or contact a physician liaison. As part of our efforts to shorten referral times as much as possible, online referrals are typically responded to within 24 - 48 hours.
