Oncoplastic Surgery : is the application of plastic surgery techniques in breast cancer surgery to achieve the best possible outcome tailored to each patient. Besides completely removing the cancerous tumor, the surgical result should preserve the breast as a breast, maintaining its shape without distortion or unsightly scars. Consideration must also be given to the other breast, which may undergo reshaping or reduction surgery to maintain a symmetrical and aesthetically pleasing appearance suitable for each patient.
This Oncoplastic surgery can be applied both in total mastectomy and breast-conserving surgery, with the same goal of completely removing the cancer while preserving the breast’s appearance as close to the original as possible.
Oncoplastic Surgery for Patients Choosing Total Mastectomy
This refers to breast reconstruction surgery immediately following total mastectomy performed simultaneously with breast cancer surgery.
The principle is that breast cancer occurs within the breast tissue, which is covered by skin. Therefore, the entire breast tissue covered by skin must be removed, while preserving the skin and sometimes the nipple. Then, a material is placed to replace the removed breast tissue, and the skin is closed over it, resulting in a new breast shape as close to the original as possible.
Skin Sparing Mastectomy (SSM) : is a surgery that removes only the breast tissue beneath the skin while preserving the skin envelope of the breast. This method is typically used for patients who need total mastectomy and want immediate breast reconstruction. After surgery, the breast remains as before, but the inside is replaced with a substitute. Currently, silicone implants are recommended worldwide for this purpose. Preoperative planning is essential to select the type, size, shape, and projection to closely match the original breast removed.
The use of abdominal or back muscles to replace the breast is no longer popular or recommended due to the extensive nature of the surgery, unnecessary additional scars, negative impact on muscles, and long-term quality of life issues for patients. Therefore, this method has declined in popularity.
Nipple Sparing Mastectomy (NSM) : is similar to Skin Sparing Mastectomy but preserves the nipple and areola. The reason nipples were removed in SSM is based on the theory that cancer cells can spread through the milk ducts to the nipple, so the nipple must be removed.
However, current data shows that about 90% of cancers do not spread to the nipple as previously thought, leading to the concept of preserving the nipple when possible. NSM is not a standard procedure for all patients; it is selected for those with a low risk of nipple involvement. Criteria include small tumor size, sufficient distance from the nipple, and intraoperative examination of tissue beneath the nipple to confirm no cancer cells, which is sufficient to preserve the nipple.
Oncoplastic Surgery for Breast Cancer Patients Choosing Breast-Conserving Surgery
The goal of breast-conserving surgery is to completely remove the cancerous tumor with an adequate margin of normal breast tissue around it, while preserving the breast to look the same or better than before surgery. Only then can it be considered true breast-conserving surgery.
Common Problems in Breast-Conserving Surgery
- Inappropriate patient selection, such as those with high risk of recurrence or multiple tumors in different locations, who should not be recommended for breast-conserving surgery.
- Limitations in removing an adequate amount of tissue due to small breast size or large tumor size, which may result in insufficient tissue removal and increase the risk of cancer recurrence.
- Improper incision placement can cause unsightly scars and breast distortion, especially after radiation therapy, which is common and difficult to correct. Some cases require total mastectomy and reconstruction.
- Radiation therapy, which is mandatory after this surgery, can cause long-term breast shrinkage and distortion.
These problems can be greatly reduced by using Oncoplastic surgical techniques and careful surgical planning from the start to minimize errors and achieve the best possible breast appearance after surgery.
