Oncoplasty

What is Oncoplasty?

Breast-conserving surgery has become standard. In treatment approaches, factors like cosmetic outcomes, quality of life, and patient satisfaction have started to gain significant importance. As a result, reconstruction efforts with plastic surgery have begun to take place during the same session after oncological procedures. Such surgical approaches are grouped under the heading of Oncoplastic breast surgery.

Oncoplastic breast surgery, which emerged as a solution to the aesthetic loss in these limbs that are an important part of sexual identity in women after surgical breast cancer treatment, is the combined application of oncological surgery and plastic surgery principles. It is an innovative approach that eliminates cancer while preserving and reconstructing the natural appearance and feeling of the breast in breast cancer treatment.

It involves the use of plastic surgical techniques to reshape or reconstruct the remaining breast after the cancerous tissue is removed.

This surgery requires very careful planning, with the goal of balancing oncological needs with aesthetics. In other words, oncoplastic surgery is a technique used in the treatment of breast cancer in women, which prevents some cosmetic deformities while allowing for more extensive excision and, in some cases, broadening the limits of breast preservation.

Oncoplastic surgery not only removes the cancer but also helps in creating a cosmetically pleasing breast after treatment by preventing excessive scarring and deformities.

Oncoplastic breast surgery, in addition to helping in the creation of a healthy physical appearance, also assists in the emotional recovery of women after cancer surgery, restoring their confidence and sense of femininity.

What is Oncoplastic Breast Surgery?

Oncoplastic breast surgery refers to the combined planning of an aesthetic procedure that will create a better cosmetic result in the breast along with the surgical intervention required due to breast cancer. The method is implemented by combining the principles of oncological surgery and plastic surgery. Thus, both women who will undergo surgery due to breast cancer have plastic surgery planned at the same time, and women who have lost their breast due to cancer are given the chance to regain a new breast.

Results of Oncoplastic Breast Surgery

Oncoplastic breast surgery allows for excision with wider surgical margins. Local recurrence rates can be reduced when combined with adjuvant radiotherapy (RT). Unlike breast-conserving surgery, oncoplastic surgery has not yet been fully established as reliable from an oncological standpoint. There are still no well-planned studies in the literature that prove the oncological reliability of oncoplastic surgery. Therefore, patient selection must be done very carefully. Patients should be evaluated before surgery in collaboration with radiation oncologists and medical oncologists.

How is Oncoplastic Surgery Performed?

In oncoplastic surgery, it is necessary to determine the tumor bed where the "additional dose" of radiotherapy will be applied. Due to volume reductions and surgical techniques, difficulties arise in determining the tumor bed in these types of patients. Clips have been placed to define the tumor bed after surgery. However, it is not always possible to clearly define this area due to the applied surgical technique. In some cases, seromas (serous fluid accumulation in the dead space after breast cancer surgery) have been observed to extend beyond the tumor bed in oncoplastic surgery series.

What are Oncoplastic Techniques?

Oncoplastic techniques vary depending on the tumor's spread in the breast. Oncoplasty can be performed in the following ways:

• Filling the tumor cavity with surrounding healthy breast tissue: This is used when the tumor is not very large. The surrounding breast tissues of the tumor are separated from the subcutaneous tissue. This separated tissue is then shifted into the cavity. The tissues are brought together with stitches, thus filling the tumor cavity.
• Filling the tumor cavity with the muscle tissue surrounding the breast: This procedure is used when the tumor is large and preserving the breast is difficult. A protective mastectomy and implant surgery are applied to the nipple, areola, and breast skin. In addition to the breast surgeon, a plastic surgeon must also participate in the surgery.
• Reduction mammoplasty: In large and sagging breasts, the size of the breast is reduced. The procedure is called reduction mammoplasty when the tissue containing cancer is removed with the appropriate technique along with breast reduction surgery.

What is the Purpose of Oncoplasty?

The purpose of oncoplasty is to prevent breast loss. Breast cancer is a challenging process. The progression of the disease varies according to its stage. Many treatments are required for patients to overcome this process and regain their health. One of the treatments is surgery. As a result of the surgery, a person may have to lose one or both of their breasts. Even if the person regains their health, the loss of this body part may lead to psychological issues. In this case, oncoplasty allows the person to regain their former appearance.

Oncoplastic breast surgery, which emerged as a solution to the aesthetic loss in these limbs that are an important part of sexual identity in women after surgical breast cancer treatment, is the combined application of oncological surgery and plastic surgery principles. It is an innovative approach that eliminates cancer while preserving and reconstructing the natural appearance and feeling of the breast in breast cancer treatment.

It involves the use of plastic surgical techniques to reshape or reconstruct the remaining breast after the cancerous tissue is removed.

Why is Oncoplastic Surgery Preferred?

Until recently, most breast cancer surgeries required the removal of the entire breast, which had a negative psychological impact on the patient. With oncoplastic surgery, one of the most important issues of breast cancer patients, the loss of bodily integrity and disruption of self-image, is addressed before it becomes an issue. In oncoplastic surgery, while one breast is removed due to cancer, the other breast, for example, an excessively large or deformed one causing discomfort to the patient, is also operated on. Thus, the patient undergoing surgery due to breast cancer can leave the surgery with two healthy and well-shaped breasts, boosting their morale.

What Other Purposes is This Method Used For?

Oncoplastic surgery is also used today in high-risk patients to remove breast tissue before cancer develops and replace it with a prosthesis or create a breast using the patient's own tissue. This reduces the risk of breast cancer by 90%, though it does not completely eliminate it. Since this application can be misused by patients and surgeons, it is crucial to correctly define the indications (necessity) for this procedure.

Breast Cancer Treatment with Oncoplasty

Oncoplastic surgery can be applied in early-stage breast cancer. It is a problem-solving approach evaluated by multidisciplinary oncology councils and applied to well-selected patient groups. In locally advanced cases, mastectomy is usually the standard approach.

What is the Oncoplasty Process?

The oncoplasty procedure is performed with the patient being discharged the day after surgery. It is not a highly painful procedure. The fluid from the drain placed in the surgical area is expected to decrease by 25 mm daily. Once this reduction occurs, the patient goes for a check-up and the drain is removed. It is important to attend follow-up appointments as determined by the doctor.