Oncoplastic Breast Cancer Surgery
‘Surviving Breast Cancer without Breast is battle half won.’
The answer to this has been provided with evolution of techniques of Oncoplastic Breast Cancer Surgery, which involves resection of Breast cancer along with Neo(new) Breast formation, either in form of Breast Preservation(Conservation) or Breast Reconstruction. Oncoplasty in other words, means amalgamation of techniques of breast cancer resection and aesthetic breast correction providing safer cancer removal and preservation/reconstruction of breasts. The goals of Oncoplastic Breast Cancer Surgery are:-
1. Optimum Cancer Resection without any compromise on Oncological principles. In fact, oncoplasty helps to achieve better margin control leading to better cancer resection.
2. Optimum Neo Breast Formation. In fact, oncoplasty, aims to provide aesthetically better breast. ‘The new one should be better than the old one’.
In addition to providing superior cosmetic results, oncoplastic surgery also holds another benefit over traditional breast cancer surgery for women with large breasts. The radiation therapy used to treat breast cancer is more difficult for women with large breasts. Removing excess breast tissue through oncoplastic surgery reduces the complications of radiation therapy in these women.
Oncoplasty has two approaches, Volume Displacement and Volume Replacement.
Volume Displacement is a form of Breast Preservation, and the technique is utilized after lumpectomy or partial mastectomy when the residual defect (after cancer resection) is 30% or less of the original breast volume. This situation normally occurs when there is low volume disease and/or with females having large breasts The Neo Breast formation occurs by mobilizing and reshaping the residual or remnant Breast into new and better breast. The surgery is properly planned with the help of 3D virtual reconstruction of MRI or PET CT images, such that the tumor resection is performed as per the principles of Mammaplasty(Aesthetic Breast Surgery). The remnant tissue is then re -shaped into a new breast using techniques of Mastopexy(Breast Lift) during majority of times.
There are different techniques depending on the size and site of tumor, age of patient, type and nature of breast. They are enumerated as following :-
- Wize Pattern
- Round Block
- J Mammaplasty
- Lateral Mammaplasty
- Medial Mammaplasty
- Bat wing
- Reverse Wise Pattern
Volume Replacement Oncoplasty, comprises of surgical techniques utilized for Neo breast Formation when the residual defect formed after cancer resection is 30% or more of the orignal volume. The Neo Breast formation occurs by replacing the lost breast tissue from other portions of the body. It consists of harvesting tissue from other sites of the body and transfer the tissue onto the ablated breast site to form the Neo Breast using the technique of either pedicled or free tissue transfer. The most common sites of tissue harvest are either from back or lower abdomen. The tissue from the back is harvested in form Latissimus dorsi Myocutaneous or Adipofacial flap with blood supply from Thorcodorsal Vessels known as LD reconstruction. It is a pedicled form of tissue transfer suitable for partial mastectomy defects. In cases of low or small volume breasts, it can be used to fill complete mastectomy defects. The lower abdomen tissue harvest is in form of adipofacial or adipocutaneous tissue with blood supply from Deep Inferior Epigastric Vessels. It is a free tissue transfer, which means that tissue is harvested along with the blood vessels and these blood vessels are anastamosed with recepient blood vessels in the breast defect or axilla using techiniques of microvascular surgery. It is best suited for complete mastectomy defects. The woman gets rid of her breast cancer, gets a new breast and also gets a tummy tuck.
Prosthetic implants can also be used to form the New Breast after Mastectomy having very similar size and shape. These implants are being widely used world over for Prophylactic(Risk Reducing) Mastectomies for women who have high risk of developing Breast Cancer. This technique was used in the case of Ms. Angelina Jolie, the celebrity Hollywood actress, who had also undergone treatment for breast cancer. Implant based breast reconstruction also gives very good results in younger women with non ptotic( drooping or sagging) breasts but implants in such cases should be used with caution in settings which require the use of radiotherapy.
These techniques have made breast cancer surgery, a happy surgery bringing new zeal to life.
Dr Mandeep S Malhotra