The word “oncoplastic” is a combination of the Greek words “onkos” (tumor) and “plastia” (to mold or shape). The concept of oncoplastic breast surgery is based on using reconstructive surgical techniques to shape the remaining breast after removing a mass or, alternatively, to form a new breast following excision of all of the breast tissue. Oncoplastic surgery also includes correction of unevenness between the breasts. Depending upon the extent of surgery, it may be necessary to operate on the opposite breast to achieve symmetry.
Oncoplastic surgery may be as simple as hiding a scar and rearranging the breast tissue to fill the gap created by the lumpectomy (“Level I”), or as intricate as combining a traditional lift and reduction with the tumor removal (“Level II”).
Depending upon the extent of surgery and the training of the surgeon, this may be performed exclusively by a breast surgeon or done in combination with a plastic/reconstructive surgeon.
A woman’s choice of treatment of a mass in the breast is incredibly personal. Oncoplastic surgery involves designing the operation to fit the patient: incorporating a woman’s goals for the operation, the size and location of the tumor, and the patient’s breast size and shape into the operative plan. It is very important for a woman to share with her surgeon what her cosmetic goals are for the operation. A woman may simply want her body to be restored as closely as possible to what was present before surgery. However, if a woman desires a lift with or without a reduction, this may often be incorporated into the surgical plan.
Furthermore, when the cancer involves more than one-quarter of the breast, it may be necessary to perform a lift/reduction as a means of avoiding a mastectomy.
LEVEL I ONCOPLASTIC LUMPECTOMY
Traditional lumpectomies involved placing the scar as close as possible to the cancer and allowing the cavity to fill with fluid. This often led the breast to heal with a depression or crater, especially after completion of radiation therapy. The goal of a Level I oncoplastic lumpectomy is to avoid this crater by shifting the surrounding breast tissue to fill that space. Furthermore, the scar may often be placed around the edge of the areola, under the breast, or in the armpit, so that the scar is hidden from view.
LEVEL II ONCOPLASTIC LUMPECTOMY
These procedures involve more advanced techniques for reshaping the breasts. They are often considered for women with large breasts or in cases where the breast tumor is larger.
As with other parts of the body, the skin of the breasts can stretch over time. This is called ptosis. Ptosis can be corrected by removing excess skin and lifting the nipple back to the center of the breast—a procedure known as a mastopexy. This breast lift can be combined with a lumpectomy to improve the shape of the breast.
If a woman desires her breasts to be smaller, excess breast tissue can be removed along with the lift—a procedure known as a reduction mammoplasty.
Compared to standard lumpectomies, both Level I and Level II procedures remove more breast tissue around the tumor. This is done to correct deformities and maintain breast shape. This means that there is a smaller chance of the need for a second surgery to clean up the margins around the cancer. These procedures may be perfect in women who have always thought about a breast reduction. They not only have the final outcome of smaller lifted breasts, but also less back, neck and shoulder pain. Health insurance generally covers these procedures with a diagnosis of cancer.
The image below depicts some of the oncoplastic surgical approaches:
Image Source: http://chiltonchong.com.au/oncoplastics/