Oncoplasty or Breast Reconstruction

  • Oncoplasty or Breast Reconstruction:

    Breast reconstruction includes both partial and whole breast reconstruction
    Oncoplasty includes adding plastic surgery procedures to breast cancer surgery, to allow for a better breast shape, better placement of scars and offer breast conserving surgery to women with larger tumours or needing larger / wider excision due to tumour size or multiple tumours in the same area of the breast.

  • It can include partial breast reconstruction using various flaps or fat and skin from the area on the side of the breast or below the breast from the anterior abdominal wall or from the back.

  • Additionally in some oncoplastic procedures where appropriate, scars can be placed away from the tumor and be hidden near the areola or lower breast crease ( inframammary crease)

  • Whole breast reconstruction:

    Is a surgical procedure performed to rebuild a woman's breast(s) after undergoing a mastectomy for breast cancer treatment.

  • It aims to restore the appearance of the breast, improve body image, and enhance the patient's quality of life. Breast reconstruction can be performed at the same time as the cancer surgery (immediate reconstruction) or after a delay (delayed reconstruction).

  • Options for partial or whole breast reconstruction:
  • Perforator / Pedicled Flaps:

    Perforator flaps are a specialized type of surgical technique used in breast reconstruction which involves the transfer of skin, fat, and blood vessels from a donor site to reconstruct a specific area, such as the breast mound. Perforator flaps are distinct from other flap-based procedures because they selectively preserve the perforating blood vessels.

    Perforator flaps used for partial reconstruction include intercostal artey perforatory flaps, thoraco-epigastric perforator flaps. Pedicled flaps include the latissimus dosi flap. In this procedure, the surgeon utilizes the latissimus dorsi muscle, which is located in the back, to transfer it along with skin and fat to the chest area to create the breast mound. The blood supply for the flap often remains attached to the muscle, allowing it to be tunneled under the skin to the chest. The LD flap can be used alone or in combination with implants to reconstruct the breast.

    Whole breast reconstruction options included pedicled flaps like TRAM/ VRAM ( transverse or vertical rectus abdominus muscle flap) or microvascular free flaps using options mentioned below.

  • Deep Inferior Epigastric Perforator (DIEP) Flap: Utilizes skin and fat from the lower abdomen while sparing the abdominal muscle by preserving the perforating blood vessels from the deep inferior epigastric artery.

  • Superior Gluteal Artery Perforator (SGAP) Flap: Uses tissue from the upper buttock region while preserving the gluteal muscle by preserving the superior gluteal artery perforators.

  • Inferior Gluteal Artery Perforator (IGAP) Flap: Similar to SGAP, but uses tissue from the lower buttock region by preserving the inferior gluteal artery perforators.
    Silicone implants / expanders can also be an option offered for whole breast reconstruction.

  • Therapeutic Mammoplasty:
  • This approach is particularly beneficial for women with larger breasts, ptotic breasts or tumors located in areas that could cause significant cosmetic deformity after a standard lumpectomy. The procedure involves the following steps:

  • The procedure involves the following steps:

  • Tumor Removal: The surgeon removes the cancerous tumor and a surrounding margin of healthy tissue to ensure complete tumor removal (clear margins).

  • Breast Reshaping: After tumor removal, the breast is reshaped and contoured to achieve symmetry and an aesthetically pleasing appearance. The surgeon may rearrange the breast tissue or perform a breast reduction or lift to achieve the desired outcome.

  • Suturing: The incisions are closed using surgical sutures to secure the breast's new shape.

  • Benefits of Therapeutic Mammoplasty:
  • Improved Cosmetic Outcome: By incorporating plastic surgery techniques, therapeutic mammoplasty can lead to a more symmetrical and natural-looking breast appearance.

    Psychological Benefits: Preserving the breast's appearance can have a positive impact on a woman's body image and self-esteem during and after cancer treatment.

    Breast Conservation: Therapeutic mammoplasty allows for tumor removal while maintaining a significant portion of the breast tissue, avoiding the need for a complete mastectomy in some cases.

    Single-Stage Procedure: In many cases, therapeutic mammoplasty can be performed in a single surgical procedure, reducing the overall treatment time.