Oncoplastic & Reconstructive Surgery
Advanced Procedures
Why Breast Oncoplasty
Complete Tumor Removal
Ensures complete tumor removal with clear margins
Cosmetic Outcomes
Maintains cosmetic outcomes without compromising oncological outcomes
Breast Conservation
Reduces the need for breast conservation in many cases
Clinical Guidelines
Contraindications for Breast-Conserving Surgery
Absolute Contraindications
Mastectomy is recommended
- Inflammatory breast cancer or invasive breast cancer with extensive skin or dermal lymphatic involvement
- Diffuse suspicious or malignant-appearing microcalcifications
- Inability to clear multiple positive pathologic margins after one or more re-excision attempts
- Homozygous ATM mutation (often leads to ataxia-telangiectasia syndrome)
- Multicentric disease
Relative Contraindications
Mastectomy should be considered, but BCT may be appropriate
- Patients with a known genetic predisposition to breast cancer
- Pathologic p53 mutation (Li-Fraumeni syndrome)
- Active connective tissue disease involving the skin (eg, scleroderma or lupus)
- A history of prior radiation therapy to the affected area
Who is a good candidate?
Tumor Factors
Single tumor <5cm , small tumor in large breasts and in a location allowing wide excision.
Cosmetic Acceptability
Tumor location and size allow for removal with minimal change to breast appearance
Patient Factors
Desire to preserve breast , willingness to undergo radiation therapy post BCS
Oncoplastic Lumpectomy Techniques
There are many different approaches to oncoplastic lumpectomy. They're categorized as Level 1 or Level 2, depending on how complex they are.
With all of these approaches, the surgeon pays attention to the position of the nipple and areola, adjusting its location as needed while maintaining its blood supply.
Volume Displacement, Rearrangement & Aesthetic Scar Placement
Level 1
- Here the surgeon removes a segment of breast tissue including the tumor. In this, less than 20% breast tissue is removed while maintaining shape and contour of breast. The tissue defect in breast which occurs after surgical removal of tumor is corrected by mobilising adjacent normal breast tissue into the defect.
Complex Volume Displacement & Replacement
Level 2
- Level-2 procedures are applied in cases that require removal of 20% to 50% of the breast volume. The volume loss is replaced by local tissue flaps, mastopexy, or reduction mammoplasty.
Volume Oncoplastic Reduction with Breast Lift (Mastopexy)
- The surgeon removes the portion of the breast that contains the cancer and then performs a breast lift. This procedure addresses sagging breasts (ptosis) or excess skin. To make the breasts symmetrical, the surgeon can also perform a breast lift on the other side.
Significant Oncoplastic Reduction (Reduction Mammaplasty)
- If a woman has very large breasts, the surgeon can remove the cancer and a larger amount of surrounding tissue as part of a breast reduction. The surgeon would also reduce the size of the other breast to match.
Volume Replacement Using Nearby Tissue Flaps
- Flaps of tissue from the side of the body (near the breast) or the upper back can be moved into the breast area while still attached to their blood supply (this is called a pedicled flap). The surgeon may use flaps if there is not enough nearby tissue to fill in space left behind after the lumpectomy (in a smaller-breasted woman, for example) or if a woman wants to maintain her breast size.
Volume Replacement with Fat Grafting
- Surgeons can use this technique later on, after you complete radiation therapy, to fill in areas of the breast as needed or to ensure the breasts are symmetrical (balanced).