Oncoplastic Surgery: Unilateral Procedures May Be Enough

Oncoplastic Surgery: Unilateral Procedures May Be Enough

Take-Home Message:

When considering oncoplastic surgery for breast cancer treatment, a woman may not be obligated to have surgery on the unaffected side.

Gardfjell, A. et. al.

Patient satisfaction after unilateral oncoplastic volume displacement surgery for breast cancer, evaluated with the BREAST-Q™

World J Surg Oncol 2019 Jun 5;17(1):96
Doi: 10.1186/s12957-019-1640-6

Oncoplastic surgery is being used increasingly for breast cancer treatment. When a lumpectomy (partial mastectomy) is decided upon, an oncoplastic technique can remove enough tissue to clear the disease and, at the same time, restore breast shape. This is done by repositioning some of the remaining tissue within the breast. Often, surgery on the contralateral (nondiseased) breast is performed at the same time to achieve breast symmetry. It is expected that this symmetry will result in the highest patient satisfaction.

These investigators, working in Sweden, questioned the necessity of contralateral surgery. They enrolled over 140 women who had received oncoplastic surgery for breast cancer and who had no surgery on the opposite breast. These women were at least 1 year out from radiation therapy. They completed questionnaires that addressed breast satisfaction, psychosocial well-being and sexual well-being.

Regarding breast appearance, a large number of participants expressed satisfaction with the appearance (88.3%), size (86.7%) and shape (88.3%) of the operated breast. Additionally, a large number of women (78.3%) expressed satisfaction with the symmetry between their breasts. Women who had full axillary lymph node dissections, neoadjuvant chemotherapy and low breast density tended to be less pleased with the appearance of their breasts.

Only 11% of the women expressed interest in surgery on the contralateral breast for symmetry.

This study supports consideration of only performing oncoplastic surgery on the breast that contains cancer and leaving the unaffected breast alone. It is possible that operating on the unaffected breast for symmetry is not necessary for many women, and that breast size and shape after unilateral surgery are equivalent (or close to equivalent) more often than expected.

However, one should consider that these women – over a year out from their treatments – simply had no interest in returning to surgery after having resumed all of their life routines. Additionally, the women in this study may not reflect the experiences of women in other nations, where breast size and cultural beliefs would make bilateral oncoplastic surgery more desirable. Nonetheless, this information could be reassuring to a woman and her surgeon if they decided, for whatever reason, to only operate on the affected breast.