Oncoplastic surgery gives breast-cancer patients another choice

Making  the decision between a mastectomy and a lumpectomy can be a very difficult choice for a woman newly diagnosed with breast cancer. Today, I read about a new procedure called oncoplastic surgery, which offers women another alternative. For suitable cases, a woman may opt to have cancerous tissue removed and their breast repaired cosmetically — all in one surgery.

“We borrowed a few techniques from plastic surgeons, from augmentation to lifts, to use in breast-cancer patients,” said Dr. Susan Cash, a breast surgeon at Baystate Medical Center. “We have the ability to remove cancer with good margins, and we’ve observed decreased recurrence rates with a much more cosmetically acceptable breast.”

Traditionally, women with breast cancer would have the cancerous tissue removed by one surgeon — through either a lumpectomy or mastectomy — and later undergo a separate procedure with a plastic surgeon for either repair or reconstruction.  But oncoplastic surgery essentially merges the two fields. Cash and Dr. Holly Mason, Baystate’s director of Breast Surgical Services, are among a slowly growing number of cancer surgeons  in the US, becoming trained in these cosmetic techniques that better preserve the breast’s shape with fewer procedures and less trauma.

Although, statistically, most women who have a choice prefer the less-invasive lumpectomy over mastectomy, the choice between the two procedures incorporates factors ranging from whether it’s important to keep the breast — in which case lumpectomy with radiation might be the call — to how anxious the patient is about reoccurrence; some patients worry less about this possibility after a mastectomy.

Both procedures have disadvantages, however. Because lumpectomy is usually followed by several weeks of radiation, the timing of reconstruction can be thrown off, and the risk of reoccurrence is higher. Additionally, the tissue will not safely tolerate additional radiation if there is a recurrence in the same breast after lumpectomy, meaning a second cancer in the same breast will usually necessitate a mastectomy.

As for choosing mastectomy, it can have more post-surgery side effects and a longer recuperation time — in addition to the permanent loss of the breast and the likelihood of additional reconstructive surgeries.

Oncoplastic surgery lessens some of these impacts. Making plans for breast reconstruction at the same time as cancer surgery, some doctors say, can speed the pace of recovery, both physical and psychological. Combining procedures may also reduce the risk of complications from successive surgeries.

In a typical lumpectomy, the surgeon makes an incision, removes the cancerous tissue, and then closes the opening, which often leaves the breast with a disfiguring dent. In oncoplastic surgery, however, a wedge is removed, and then tissue under the skin is pulled together to close the defect.

Doctors who pioneered the procedure say it not only maintains the shape of the breast, but usually its sensation and lactation capability as well. An oncoplastic approach may be taken by two surgeons teaming up to do cancer removal and reconstruction in the same operation.

“You need a dedicated breast surgeon willing to do these techniques and to have good relationship with a plastic surgeon in order to take care of these patients with oncoplastic techniques,” Mason said.

You can read this article in full at BusinessWest Online