Oncoplastic Breast Reconstruction

Patients diagnosed with breast cancer are typically offered one of two methods for surgical management of the disease; mastectomy or breast conservation therapy.  Mastectomy is the surgical removal of all breast tissue and a variable amount of overlying breast skin.  The reconstructive needs of these patients is obvious as there is no breast tissue left behind thereby requiring either an implant or a transplantation of their own tissue to recreate the breast mound.  Patients who are a candidate for and elect to undergo breast conservation therapy are treated with the surgical removal of the portion of the breast afflicted by the cancer along with a margin of noninvolved breast tissue while leaving the remainder of the breast tissue untouched.  Following the removal of this tissue patients undergo several cycles of radiation therapy.  This strategy for treating breast cancer has demonstrated equal rates of survival to mastectomy and is the most common form of breast cancer treatment employed today.  Inherent to this form of treatment are a host of possible cosmetic deformities in the remaining breast tissue.  A new and rapidly growing field in breast reconstruction is geared at correction of these deformities either before or after they appear and is known as Oncoplastics.

Possible cosmetic deformities that can arise as a result of breast conservation therapy include retraction of surrounding tissues, painful scars, asymmetry to the breast that was not operated on, wound healing difficulties, infections, and alteration of reconstructive options should mastectomy be required in the future. Although the majority of patients are satisfied with their cosmetic results following conservation; for those unlucky enough to have a poor cosmetic result, treatments are available to improve the look and feel of the breast tissue. 

Ideally patients who are high risk for having a poor cosmetic result are actually treated BEFORe their lumpectomy and radiation. Working together with the breast cancer surgeon our plastic surgeons can perform procedures at the same time as the lumpectomy surgery to lessen ultimate the impact of radiation on the tissues.  Ideal candidates for this procedure are patients with small breasts who will require large excisions, patients with large, drooping breasts who will require large excisions or those patients who will require multiple excisions on the same breast as part of their treatment.  These surgical techniques typically involve a form of breast lift or breast reduction and likely a lift or reduction on the normal breast for improved final symmetry.

In patients who have already undergone breast conservation therapy and now have deformity of their breast surgical options are indeed available.  The ideal method for reconstructing these patients, known as flap reconstruction, involves transferring tissue into the defect that has not been subject to the effects of radiation.  The transfer of non-radiated tissue into a deformed breast is a powerful tool that can restore an aesthetically pleasing shape while improving the feel and sometimes pain associated with a severe deformity.  Our surgeons are trained in the most up to date techniques for accomplishing this goal including the use of perforator flaps, thereby eliminating the morbidity associated with traditional techniques that required sacrifice of surrounding muscle. 

If you believe you are a candidate for oncoplastic breast surgery please discuss this with your breast surgeon and call us to make an appointment today!

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