Oncoplastic Reconstruction

What is Oncoplastic Reconstruction?

Oncoplastic reconstruction is a specialised surgical technique used in the treatment of breast cancer. This approach combines the principles of oncologic surgery, which focuses on effectively removing cancerous tissue, with plastic surgery techniques aimed at preserving or restoring the breast's appearance.

Who is Suitable for Oncoplastic Reconstruction?

Oncoplastic reconstruction is suitable for patients who are undergoing breast-conserving surgery (BCS) and wish to maintain or improve the aesthetic appearance of their breasts post-surgery. Ideal candidates for oncoplastic reconstruction typically include:

Patients with Partial Mastectomy: Those who are undergoing or have undergone a partial mastectomy where a significant portion of the breast tissue is removed, and there is a potential for cosmetic deformity.
Patients with Larger Breasts: Individuals with larger breasts may benefit more from oncoplastic techniques, as they often have more tissue available for reshaping and filling surgical defects.
Patients Concerned About Cosmetic Outcomes: Those who are particularly concerned about the visual and symmetrical appearance of their breasts post-surgery.
Patients with Tumours in Challenging Locations: Oncoplastic techniques may benefit patients with tumours located in challenging parts of the breast that are difficult to remove without causing significant cosmetic changes.
Patients Undergoing Radiation Therapy: Oncoplastic reconstruction can also be suitable for patients who will undergo radiation therapy after surgery, as the techniques can help in managing the cosmetic changes that might result from radiation.

Benefits of Oncoplastic Reconstruction

Improved Aesthetic Outcomes: One of the primary benefits is the improved cosmetic appearance of the breasts post-surgery. The techniques used in oncoplastic surgery help maintain the natural shape, size, and symmetry of the breasts, even after significant tissue removal.
Enhanced Psychological Well-being: Preserving or enhancing the breast's appearance can significantly boost a patient's self-esteem and psychological well-being, which are crucial during and after cancer treatment.
Increased Options for Breast Conservation: Oncoplastic techniques can allow for more extensive removal of cancerous tissue while still preserving the breast, which might expand the eligibility for breast-conserving surgery to patients who would otherwise require a full mastectomy.
Reduced Need for Additional Surgeries: Oncoplastic reconstruction often reduces the need for further corrective surgeries by addressing the cosmetic outcome during the initial surgery.
Simultaneous Cancer and Cosmetic Surgery: This approach allows for the treatment of cancer and cosmetic reconstruction to be completed in one procedure, reducing overall recovery time and the number of surgeries a patient must undergo.

Types of Oncoplastic Reconstruction

Oncoplastic reconstruction techniques can be broadly categorised into two types based on the extent of tissue removal and the subsequent reconstructive needs:

Volume Displacement Techniques: These are used primarily when smaller sections of the breast are removed. Techniques include:
Local Tissue Rearrangement: Adjusting and reshaping the remaining breast tissue to fill in the defects left by tumour removal.
Therapeutic Mammaplasty: Combining tumour removal with reduction mammaplasty techniques is particularly useful in women with larger breasts.
Volume Replacement Techniques: Used when larger portions of the breast are removed, and there isn’t enough remaining tissue to reshape the breast:
Flap Reconstructions: Tissue from other parts of the body, such as the abdomen (TRAM flap), back (latissimus dorsi flap), or buttocks (SGAP flap), is used to replace the lost volume.

Alternative Options to Oncoplastic Reconstruction

For patients who may not choose or be suitable for oncoplastic reconstruction, there are other options available:

Traditional Breast Reconstruction
Simple Lumpectomy without Reconstruction
Complete Mastectomy
External Prostheses

Preparation Before an Oncoplastic Reconstruction

Consultation with Specialists: Patients should meet with a breast oncologic surgeon and a plastic surgeon. These discussions will cover the specifics of the cancer, the planned surgery, and the expected cosmetic outcomes.
Medical Evaluations: Comprehensive medical evaluations, including blood tests, imaging studies (like mammograms and MRIs), and possibly a biopsy to assess the nature and extent of the cancer.
Discussing Expectations and Outcomes: Clear communication about the expected outcomes, potential risks, and recovery timeline is essential.
Preoperative Instructions: These may include guidelines on eating, drinking, medication adjustments, and smoking cessation to reduce surgery risks and improve healing.
Arranging for Recovery: Planning for post-operative care, including help at home, time off from work, and transportation arrangements for post-surgery visits.

Oncoplastic Reconstruction Procedure

Oncoplastic reconstruction generally takes place during the same operation as the cancer removal surgery. The procedure can vary widely but typically follows this process:

Anaesthesia: The patient is placed under general anaesthesia.
Cancer Removal: The surgeon removes the cancerous tissue, ensuring clear margins to minimise the risk of cancer recurrence.
Reconstruction: Immediately following tumour removal, the reconstructive phase begins:
Volume Displacement: If only a portion of the breast is removed, the surgeon may use the remaining tissue to reshape the breast, possibly performing a breast lift or reduction for symmetry.
Volume Replacement: For larger defects, the surgeon may use a flap of tissue from another part of the body to reconstruct the breast.
Symmetry Procedures: Surgery on the opposite breast may be performed to enhance symmetry.
Closure: The incisions are closed with sutures, and drains may be placed to remove excess fluids.
Hospital Stay: Depending on the extent of the surgery, a short hospital stay may be necessary.

Oncoplastic Reconstruction Recovery Plan

A well-planned recovery is vital for the best outcomes after an oncoplastic reconstruction:

Physical Rest and Gradual Activity Resumption: It’s crucial to rest initially but gradually increase activity as recommended to promote healing.
Wound Care: Proper surgical site care is necessary to prevent infection.
Monitoring for Complications: Awareness of potential signs of infection, abnormal swelling, or changes in breast appearance.
Lymphedema Prevention: Exercises or precautions to prevent lymphedema, especially if lymph nodes were involved in the surgery.
Follow-Up Care: Regular follow-ups to assess cosmetic outcomes and any need for further corrective procedures.

Oncoplastic Reconstruction Prognosis

The prognosis following oncoplastic breast reconstruction is generally positive, with many patients experiencing satisfactory cosmetic results and quality of life improvements. This procedure allows for effective cancer removal while maintaining the appearance of the breast, which can significantly enhance a patient's psychological and emotional well-being. Moreover, oncoplastic reconstruction has shown similar recurrence rates to conventional breast cancer surgeries, indicating that it is an effective option for cancer control.

Oncoplastic Reconstruction Risks

Infection: Any surgery introduces a risk of infection at the incision sites.
Bleeding and Hematoma Formation: Excessive bleeding or blood collection under the skin can occur, sometimes requiring additional surgery.
Scarring: While surgical techniques aim to minimise visible scarring, all surgeries leave some scars, and the appearance can vary widely among individuals.
Changes in Breast Sensation: The sensation of the nipple and breast skin may change temporarily or permanently.
Asymmetry: Differences in size, shape, or position between the breasts may remain and require further corrective surgery.
Complications from Flap Surgery: If the reconstruction involves moving tissue from one part of the body to another (flap surgery), additional risks like reduced blood flow to the transferred tissue can cause tissue death.
Delayed Healing: Particularly in patients who are smokers or have diabetes, healing may be slower and more complicated.
Recurrence of Cancer: As with any cancer surgery, there is a risk that not all cancer cells are removed, which could lead to recurrence.

Breast Aesthetics

Breast aesthetics involve various procedures aimed at improving the appearance of breasts.

Breast Asymmetry

Breast asymmetry occurs when breasts differ in size, shape, or position. It's a common issue for many women, though the degree of asymmetry varies greatly. Surgical correction is an option for those for whom the asymmetry is significant or causes emotional or physical discomfort. Surgical options can include:

Augmentation of One or Both Breasts: One or both breasts may be augmented to balance size differences.
Reduction of One or Both Breasts: Similarly, reducing the size of one or both breasts can help achieve symmetry.
Lift: This can be performed on one or both breasts to correct differences in their positioning or shape.

Addressing breast asymmetry aims to achieve a more balanced appearance and can help improve personal comfort and self-confidence.

Implant Reconstruction

Implant reconstruction is a type of breast reconstruction that involves using a breast implant to recreate the breast mound after mastectomy (removal of the breast due to cancer or other disease). This method can be performed as either an immediate reconstruction (at the same time as the mastectomy) or as a delayed reconstruction (after recovery from mastectomy and any other necessary treatments).

There are primarily two types of implants used: saline and silicone. Silicone implants are often preferred for their more natural feel, though both types have their advantages and considerations.

The reconstruction can involve direct implant placement or a two-stage process where a tissue expander is initially inserted to stretch the skin and create space for the final implant.

Recovery varies but generally involves several weeks of reduced activity post-surgery. The aesthetic results of implant reconstruction can vary based on several factors, including the type of implant, the surgical technique used, and individual healing processes.