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Oncoplastic surgery combines the latest plastic surgery techniques with breast surgical oncology. When a large lumpectomy is required that will leave the breast distorted, the remaining tissue is sculpted to realign the nipple and areola and restore a natural appearance to the breast shape. The opposite breast will also be modified to create symmetry.
This is a good option for patients who are candidates for breast conservation therapy or lumpectomy, and are also candidates for breast reduction or mastopexy (breast lift).
How is oncoplastic surgery performed?
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.
What are the benefits of having oncoplastic surgery at the time of lumpectomy?
There are many advantages of having bilateral breast reduction or lift at the same time you are undergoing a lumpectomy:
- Allows for a larger amount of tissue to be removed, which is helpful is cases where the tumor is larger or when there is a concern about the ability to get negative margins.
- When a larger amount of tissue has to be removed, performing a matching procedure on the other breast provides better symmetry.
- Involves only one surgery.
- Surgery is completed prior to radiation, so you avoid the risks of wound-healing problems that can occur with a post-radiation surgery.
- Relief of symptoms of large breasts, if this was a problem before surgery.
These surgeries generally do not involve drains. They may be outpatient or possibly require one night in the hospital. Recovery time is six weeks, but most people usually feel better and are able to return to work in three to four weeks.