Oncoplastic surgery is an establish approach that combines conserving treatment for breast cancer and plastic surgery techniques. It allows wide excisions and prevents breast deformities by immediate reconstruction of large resection defects. The procedures are mostly useful for resection of 20-40% of the breast - a group of patients normally treated by mastectomy in the past.
Four features are integral to oncoplastic breast surgery: (i) Appropriate surgery for cancer excision. (ii) Partial reconstruction to correct wide excision defects. (iii) Immediate reconstruction with the full range of available techniques. (iv) Correction of volume and shape asymmetries relative to the contra-lateral healthy breast. There are two fundamentally different approaches: (i) volume-replacement procedures, which combine resection with immediate reconstruction by using local flaps (glandular, fasciocutaneous, and latissimus dorsi mini-flaps), and (ii) volume-displacement procedures, which combine resection with a variety of different breast reduction and reshaping techniques, according to the location of the tumor.
Oncoplastic surgery increases the oncological safety of breast-conserving treatment because a much larger breast volume can be excised and wider surgical margins can be achieved. Moreover, a "surgical screening" of the contra-lateral breast allows the diagnosis of occult cancers. Among oncoplastic approaches, a very unique technique is the possibility of implant use (augmentation mammaplasty) in case of quadrantectomy and simultaneous delivery of intraoperative radiotherapy to the tumor bed.
At the time of your lumpectomy, the surgical oncologist will remove the tumor and the lymph nodes. The plastic surgeon will perform a bilateral breast reduction or lift, removing breast tissue from the cancerous breast as well as modifying the normal breast. The procedures generally involve an incision around the nipple and areola, a vertical incision from the nipple to the lower fold of the breast, and a horizontal incision in the fold of the breast.
Sometimes it is difficult to preserve the blood supply to the nipple during surgery. In these cases, a “free nipple graft” is the only way the nipple may be preserved. This involves removing the nipple and replacing it on the breast similar to a skin graft after the breast reduction or lift is complete.
The disadvantage of a free nipple graft is the resulting nipple numbness and inability to breastfeed. This technique is used only as a last resort if your surgeon feels that the nipple may not be saved otherwise. You should talk to your surgeon about this prior to the procedure.
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