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7 November 2019

Oncoplastic breast conserving surgery: Surgical techniques

Oncoplastic breast conserving surgery has emerged as a third and more aesthetic option between conventional/standard breast conserving surgery and mastectomy. Oncoplastic breast conserving surgery includes two fundamentally different approaches: 1) Volume replacement and 2) Volume displacement.
 

Conventional/standard breast conserving surgery

To understand the cosmetic principles behind the two new different approaches, a description of the conventional/standard breast conserving treatment is necessary. The goal of the surgery is to remove the tumor and marginal tissue while damaging the breast as little as possible. However, the surgeon needs to remove enough testable tissue to determine if the cancer is limited to the tumor itself or if the cancer has spread. The surgeon makes an incision over the targeted malignancy or around the areola if the tumor is accessible from that site, and cuts out the tumor, along with a small layer of tissue surrounding the tumor[1].


Illustration 1 [A].

1) The volume displacement technique​

Opposed to conventional/standard breast conserving surgery, volume displacement oncoplastic surgical techniques have become increasingly popular as a strategy for improving aesthetic outcomes and extending the option of breast conservation therapy. They often involve breast reduction or breast lift reconstructive techniques to facilitate resection of medium to large breast volumes on the side of the breast cancer and accompanied with symmetry contra-lateral breast reductions or breast lifts. Volume displacement procedures are only suitable for patients with enough remaining healthy breast tissue to allow reconstruction of the breast[2].
 
Some of the typical incisions for oncoplastic volume displacement are shown below. The stars mark the position of the tumor(s). The type of incision preferred depends a.o. on the localisation of the tumor.

Illustration 2 [B].

2) The volume replacement technique

Volume replacement involves breast conserving surgery and immediate reconstruction of the breast with the transposition of the woman’s own tissue from elsewhere on the body[3]. As it is a breast conserving treatment, only partial reconstruction of the breast is needed. Typically, the tissue (named “mini-flap” or “flap”) used for the partial reconstruction comes from the region below the breasts or from the upper back (named Latissimus Dorsi or LD flap), but tissue from other parts of the body, like the abdomen, can also be used. During volume replacement surgery, the tumor cavity is filled by mini-flaps to replace the tumor and the tissue excised.

Volume replacement techniques will be more suited to women who do not desire surgery to the opposite breast and who have a large tumor compared to breast volume[4].

Breast conserving surgery and partial breast reconstruction can be carried out either simultaneously as a one-stage procedure, or using a two-stage approach. Although patients prefer a one-stage procedure, it requires confirmation of complete tumor excision using frozen-section analysis during surgery[5]. The frozen section procedure is a pathological laboratory procedure to perform rapid microscopic analysis of a specimen and the principal use of the frozen section procedure is the examination of tissue while surgery is taking place[6]

Illustration 3 [C].: Local flap transferred. Original blood supply is maintained (known as pedicled flap)

Illustration 4 [D].: Flap where original blood supply is not maintained (known as free flap)

 

Generally about volume displacement and volume replacement techniques

Volume displacement techniques have some advantages over volume replacement techniques: The surgery is shorter in duration, it is less extensive, and there is no donor-site morbidity. However, in patients who do not desire surgery to the opposite breast, with small breast size or a large tumor compared to breast tissue, volume displacement may not be appropriate. In these cases, volume replacement techniques may be useful[7].
 

The need for a post-op bra after surgery

Many surgeons and breast care nurses recommend the use of a post-op bra after both conventional/standard breast conserving surgery as well as after volume displacement and volume replacement surgery, as the bra offers the very important support, fixation and stabilisation of the treated breast.

A post-op bra will also hold dressings in place after surgery, reducing dressing change frequency, which again reduces infection risk.

To accommodate the insertion of drains, the bra fabric and the underbust band are both made of soft and flexible fabric. Furthermore, loop bands placed at the ribbon band of the bra (like e.g. the Carefix Marianne bra) will help fixate the drainage bulbs to avoid any uncomfortable dragging of drain tubes and it will ease the handling of the entire drainage system.

The functional purpose of post-op bras is to create hemostasis and reduction of edema to minimise infection risk and speed up the healing process in general. In this way, the post-op bra supports the surgical outcome. It may vary from surgeon to surgeon how much compression is preferred. The level of compression can always be regulated through the choice of size.

Some post-op bras are pocketed and hence double-layered, which again provides improved compression and fixation as well as the option to wear lightweight textile puffs. A bra and a loose textile puff bring comfort and improve the body image, by giving the body an aesthetic and symmetric appearance in case of asymmetry.

The support from a post-op bra may also reduce post-surgical pain and soreness of the sensitive skin and underlying structures, making recovery more comfortable.

As a post-op bra offers protection, the woman may feel more safe, particularly when she regains mobility shortly after surgery.

If the post-op bra features a high back, it will help prevent strains and pains in the neck, shoulders and the upper back by adding support to help the woman maintain normal body posture (posture correction).

Typically, the bra is worn for a minimum of 6-8 weeks after breast conserving surgery. The bra has to be worn both day and night for the first weeks. Subsequently, the bra can be worn only in daytime.

Carefix post-op bras

Our Carefix assortment of seamless post-op bras accommodates all the above criteria and offers a perfect choice of post-op bra after all types of breast cancer surgery. To assess and validate our range of post-op bras and accessories suitable for both conventional/standard breast conserving surgery, volume displacement and volume replacement, click the photos below.

Lisa art.no. 3471  Mary, art.no. 3343  Marianne, art.no.3373 Anna, art.no.3270 Breast puffs, art.no.8108 
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