Oncoplastic Breast Conserving Surgery Information

Katherine Gale, Oncoplastic Breast Surgeon

Oncoplastic breast conservation surgery (oBCS) is surgery for breast cancer that optimises both the oncological and cosmetic outcomes.
 
The techniques used in BCS enable more women to preserve their breast and reduce the number of mastectomies. There is less risk of further surgery for positive margins and local recurrence.
 
Following oBCS, whole breast radiotherapy is recommended to achieve equal survival outcomes to that of mastectomy.

Oncoplastic Breast Options:

1. Volume Displacement; (Glandular flaps & Therapeutic Mammaplasty). Used for medium/large breasts with a degree of ptosis. This technique reconstructs the defect after partial mastectomy (BCS) with the added benefit of a breast reduction/lift, and makes radiotherapy safer.
 
2. Volume Replacement; (Chest Wall Perforator Flaps (CWPF). Used for small/medium sized breasts to reconstruct the BCS defect, or to maintain the size and shape of the breast, and avoid scars on the opposite breast for symmetrisation. This involves recruiting-tissue usually from the chest wall-involving movement of skin and fat with its blood supply.

Benefits of oBCS:

· Cancer is removed with clear margins
· Soft sensate breast is maintained
· Redundant tissue under the arm may be used to fill the space left in the breast after cancer removal
· Simultaneous cancer removal and breast reduction to relieve symptoms of macromastia

Volume Displacement

Therapeutic Mastopexy is a procedure which elevates breast tissue and the nipple while removing a small cancer. This picture below shows where incisions and scars will be in a Wise pattern Therapeutic Mammaplasty (inverted T scar).

Volume Replacement; LICAP Flap (Lateral Intercostal Artert Perforator) Flap, LTAP (Lateral Intercostal Artery Perforator) Flap and TDAP (Thoracodorsal Artery Perforator) Flaps

This operation replaces the removed cancerous tissue with spare tissue from the chest wall (fat and skin) restoring its shape and size helping to avoid shrinkage that can occur after radiotherapy. Muscle is left intact in this operation maintaining arm/chest wall function. Minimal scarring is on the chest wall hidden in the bra line. Most of the surgery on the breast-including lymph node-is performed through the same scar.

All operations carry risks. Your surgeon will discuss these with you.