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27 August 2019

Oncoplastic surgery: A better choice in cancer treatment

 

What is oncoplastic surgery?

Oncoplastic surgery represents the integration of plastic surgery techniques into breast cancer surgery to achieve aesthetic and cosmetic results, enhancing quality of life of the patients, without compromising control of disease.

The practice of oncoplastic surgery arose back in the 1990’s as the result of plastic surgeons pioneering to introduce improved aesthetic techniques into breast cancer treatment.

In this relatively new surgical specialty, the woman as an individual is treated, not just the cancer. With oncoplastic surgery, the cancer is removed and the cosmetic reconstruction is performed during the same procedure – which is a whole new approach to treating breast cancer.

In the first part of the surgery, the cancer surgeon removes the tumor. The plastic surgeon then steps into performing surgery on the breasts to make them more symmetrical, addressing any cosmetic issues as a phase of the surgery[1].

Ultimately, oncoplastic surgery is individualized to each patient and is a combination of science and art. The oncoplastic surgeon uses his or her expertise in oncology and aesthetics and balances these factors with patient motivations and preferences, tissue quality and breast size and shape, age, previous breast surgeries, comorbidities, tumour location and size to come up with a custom-made operation for each patient[2].

 

Advantages of oncoplastic surgery

  1. One advantage of oncoplastic breast surgery is that the cancer is typically removed with a wider margin of normal tissue around it, removing potential and undetected cancer cells that would otherwise remain located in the margin.
  1. With a single anesthesia and just a single hospitalization, patients can continue with radiation and/or chemotherapy if indicated.
     
  2. More than one cancer can be removed from the same breast using oncoplastic breast surgical techniques with an optimal cosmetic outcome, so it leads to increased breast conservation therapy[3].
     
  3. Additionally, a complete mastectomy compared to oncoplastic surgery is an operation with higher short- and long-term potential morbidity in addition to psychological stress of losing a breast. A mastectomy without reconstruction has the disadvantage of poor cosmetic improvement and gross breast asymmetry that oncoplastic surgery clearly does not[4]

Disadvantages of oncoplastic surgery

  1. It often requires a contralateral symmetry operation if the patient wants to have a symmetric outcome to facilitate bra wearing and obtain a good to excellent aesthetic outcome.
     
  2. Oncoplastic surgery still falls under the wing of breast conservation surgery and as such requires that at least whole breast radiation be given to the cancer-affected breast.
     
  3. There have been reports of fat necrosis, especially after smaller tissue rearrangement oncoplastic surgeries[5].
     
  4. Another disadvantage is that oncoplastic surgeries often leave longer scars and require an additional surgeon, usually the skill of a plastic surgeon. This means coordinating schedules and setting up another doctor visit, which increases the burden on the patient and may delay surgery.[6]

Oncoplastic surgery - a better option

With the oncoplastic surgical approach there is no doubt that the breast surgery has been taken to the next level. The improved local control of disease and generally improved aesthetic outcomes found in oncoplastic surgery compared to standard lumpectomy have undoubtedly led to an increased satisfaction rate amongst the women who are candidates for oncoplastic surgery.

 

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