How Oncoplastic Surgery Gives Women More Natural Breasts After Cancer

Surgery is the gold-standard breast cancer treatment, but some techniques leave women flat-chested or with lopsided breasts. Today, many women can benefit from oncoplastic surgery, or oncoplasty, which offers a more natural breast shape so patients can look and feel more confident after surgery.

Oncoplasty is a combination of a cancer surgery (onco) and plastic surgery. The goal is to achieve a natural look after breast cancer removal by reconstructing the patient’s breast tissue to retain a cosmetically-pleasing shape without using implants. This technique is a major advancement for women with breast cancer. Years ago, all patients received mastectomies in an attempt to reduce the risk of recurrence as much as possible.

Today, we know that less radical techniques are effective and that it’s important for women to feel like themselves again after treatment is complete. Additionally, plastic surgery that is done as part of breast cancer treatment is covered by insurance. The beauty of oncoplasty is twofold:

• The cancer removal and breast reconstruction can be done in one procedure so a woman doesn’t have to deal with a misshapen breast or multiple surgeries.
• We can perform the procedure in such a way that scars are nearly unnoticeable and, for many patients, leave the nipple and surrounding tissue intact for a more natural look.

Not all patients are candidates for a partial mastectomy. Some patients may need to undergo a mastectomy or complete removal of the breast. For those patients we also have many reconstructive options where we recreate a breast in a cosmetically favorable way.

LISTEN: Dr. Wehner Discusses How Oncoplastic Surgery Can Benefit Breast Cancer Patients in the Medical Intel Podcast.

How Does Oncoplastic Surgery Work?

Oncoplastic surgery begins with a partial mastectomy to remove the cancer. An incision is designed to help minimize scaring in the most visible areas of the breast. The surgeon then removes the cancer. Once the surgeon is happy with the amount of tissue removed, the surgeon will rearrange the breast tissue that is left. The goal is to fill in the created defect so that the remaining breast retains a natural shape and contour. The patient then goes home the same day with nothing more than a supportive bra. I tell all patients they can shower the next day, and very few patients require strong pain medication after the procedure.

When patients have very large, heavy breasts, we have the option to give the patient a breast reduction and a lift during the same surgery when we remove their breast cancer. This allows the surgeon to remove the tumor, decrease the weight burden from the previously large breast, and make radiation therapy easier and more effective.

Some breast surgeons partner with plastic surgeons to perform oncoplasty together. Other surgeons, myself included, have advanced training in plastic surgery and can perform the entire oncoplastic procedure. In either approach, the goal is to treat breast cancer while giving patients the opportunity to retain their self-confidence and sensuality after surgery.

What If I Need a Mastectomy?

When the size and location of the tumor allow, we can make an incision below the affected breast between the muscle and skin and work toward the top of the breast to remove tissue while leaving the breast envelope—the skin, nipple, and areola complex (the colored area around the nipple)—intact. We then recreate the breast tissue with an implant or other tissue from the body. This technique often is called a skin- and nipple-sparing mastectomy. I tell women it’s like wearing earrings—the nipple doesn’t perform like it used to, but having it there can make a patient look and feel better.

The best candidates for nipple-sparing surgery are thinner women who have smaller breasts, generally between an A and C cup. For women with larger breasts, we can use a two-stage approach in which we first surgically reduce the size of the breast before doing the nipple-sparing surgery.