Oncoplastic Breast Conserving Surgery

What is oncoplastic breast conserving surgery?

Oncoloplastic breast conserving surgery (OBCS), also called oncoplastic reconstructive breast surgery, is a type of surgery that removes tumours and preserves the natural contours of the breast to achieve optimal clinical and aesthetic goals.

It is aimed at preventing undesired consequences of breast cancer surgeries that can result in excessive scarring and indentation.

By combining oncological surgery and plastic surgery techniques, OBCS helps patients recover better physically and emotionally.

It is often coupled with radiotherapy as part of breast cancer treatment and is shown to result in a low cancer recurrence rate.

In most cases, OBCS is performed as part of a lumpectomy so that:

• Only one surgery is needed.
• More tissues can be removed, which is ideal for larger tumours requiring cancer-free margins.
• It achieves symmetrical breasts, avoiding spinal imbalance and chronic back and shoulder pain.
• Reconstruction can be done before radiation therapy (used to eradicate any remaining cancer cells), which can affect the skin and make future surgeries more challenging.

Oncoplastic breast surgery techniques

Some common oncoplastic breast surgery techniques include:

Volume displacement/rearrangement

The tissues in the breast are repositioned to fill in the space left after tumour removal.

Mastopexy or breast lift

After removing the tumour and excess tissues, the skin around the breasts is tightened and the breasts are raised and repositioned to sit higher on the chest.

Reduction mammaplasty or breast reduction

Besides removing the cancer, a larger amount of breast tissue is also removed in both breasts to reduce their size equally.

Volume replacement using nearby tissue flaps

If there is not enough tissue left behind after a lumpectomy, flaps of tissue may be used to fill in the space.

These flaps can be taken from the side of the body or upper back.

Volume replacement with fat grafting

This technique uses fat cells harvested from elsewhere in the body through liposuction to make up the volume lost after a lumpectomy.

Serial sessions of fat grafting allow both volume and the natural contour of the breast to be achieved.

Why is oncoplastic breast conserving surgery preferred?

Oncoloplastic breast conserving surgery (OBCS) can be used as part of breast cancer treatment to remove the cancer while preserving the natural appearance of the breast.

Additional benefits of oncoplastic surgery

OBCS can also:

• Replace a mastectomy (the total removal of the breast) in women who require more than 20% of their total breast volume removed due to a large tumour.
• Avoid deformities when cancers are removed from certain aesthetically-sensitive locations such as behind the nipple, and the inner and lower quadrants of the breast. These locations are prone to obvious deformities if the defect is not repaired following tumour removal.
• Be a bonus for women with existing issues such as ptosis (sagging), macromastia (excessive size) or lack of breast symmetry in addition to cancer removal.

When is oncoloplastic breast conserving surgery not suitable?

Oncoplastic breast conserving surgery (OBCS) can be used for a range of breast cancers and breast types.

OBCS is not advised for:

• Inflammatory breast cancer
• Extensive breast cancer involving the whole breast
• Women who underwent lumpectomy and radiation and have had cancer recurrence within the same breast

What are the risks and complications of oncoplastic breast conserving surgery?

In general, oncoplastic breast conserving surgery (OBCS) is a safe surgery.

Some potential side-effects specific to OBCS include:

• Fat necrosis. This arises from poor blood supply to some parts of the breast tissue that have been shifted and remodelled.
• Scar tissue formation. Hardening of the skin at the site of the incision. This can cause stiffness, pressure or pain.
• Seroma. Fluid filling the space where the cancerous tissue has been removed.
• Swelling. Short-term breast swelling, which is normal after surgery.

Most of these problems are not serious and can be managed and monitored.

How do you prepare for oncoplastic breast conserving surgery?

Before the operation, your doctor may recommend for you to undergo some scans and tests.

This will help identify where the tumours are and help your doctor decide which surgical plan is most suitable.

If you are taking any medication or herbal supplements, you should inform your doctor. You may need to adjust or stop taking some medication (e.g. aspirin, blood thinners) before the procedure.

What can you expect during oncoplastic breast conserving surgery?

This surgery is done under general anaesthesia so you will be asleep during the procedure.

Estimated duration

The length of surgery varies depending on the type of cancer and form of reconstructive surgery.

Generally, oncoplastic breast conserving surgery takes 2 – 4 hours depending on whether symmetrisation surgery to the other breast is done.

During the procedure

During the surgery:

• The area will the cleaned and marked.
• An incision will be made on a carefully placed scar to allow your surgeon to access the tumour. These scars are hidden along skin creases or around the areolar to minimise obvious scarring.
• Your surgeon will carefully remove the tumour together with a rim of healthy tissue called the 'margin'. This margin is tested immediately to ensure it is free from cancer cells.
• In most cases, some axilla or underarm lymph nodes will also be removed through a sentinel lymph node biopsy procedure. These 'sentinel' nodes are the first lymph nodes to come into contact with cancer cells from the breast. Testing them immediately confirms if there is spread of cancer cells beyond the breast. More lymph nodes may be removed if the test shows cancer spread in the sentinel lymph nodes.
• The breast is then reconstructed through various OCBS techniques to achieve symmetry with the other breast.

After the procedure

Most patients stay 1 – 2 days in the hospital after OBCS.

Some pain and discomfort is expected in the first week following surgery, but you will be given medications to manage the pain.

After OBCS, you may need to follow up with radiation therapy as part of your cancer treatment. Your doctor and care team will advise you on the treatment regime tailored to your specific condition.

Care and recovery oncoplastic breast conserving surgery

Most people can resume normal daily activities as soon as 2 – 3 days after OBCS. Light exercises may resume 2 weeks after.

In the first few days after surgery:

• Keep the surgical area clean and dry. The dressings covering the wound provides a waterproof seal to allow the wound to heal optimally
• Take pain medication as advised.

In the first few weeks after surgery:

• You will be prescribed a surgical compressive bra to be worn for 4 – 6 weeks after surgery. This provides support and minimises discomfort.
• You should avoid strenuous activity in the first 1 month after surgery.
• You may commence light exercises 2 weeks after surgery.