“Currently, breast surgery is a combination of cancer treatment surgery and the application of plastic surgery techniques. That is, breast reconstruction is performed to replace the breast that has been removed. Previously, breast cancer surgery was frightening because it involved removing the entire breast, resulting in an unsightly scar. Breast-conserving surgery often yielded poor results with breast distortion and deformity. The oncoplastic surgery method is a new option that better addresses both cancer treatment and maintaining breast aesthetics.” Dr. Hasan Muhammad, breast surgeon and breast cancer specialist, Breast Care Clinic, Phyathai 1 Hospital, said.
Oncoplastic: Treatment Without Losing Self-Confidence
Oncoplastic refers to surgery for certain cancers, such as head and neck cancers, where sometimes a large amount of tissue must be removed, causing facial deformities. This type of surgery is reconstructive, meaning the cancer is removed while preserving the appearance, shape, and function of the affected organ. For example, in cancers of the eye socket or face, the cancerous part is excised, and reconstruction is done by adding new shapes, including artificial eyes and eyebrows, to restore the appearance and maintain a sense of normalcy.
This technique is also applied to the breast. Surgery removes the breast cancer, such as removing the entire breast or just the tumor, and medical materials are used to reconstruct the breast to look the same or better than before, improving the overall appearance.
In the past, breast cancer required complete removal of the breast, which impacted patients’ lives and confidence. Some patients feared surgery and avoided treatment. The new “reconstructive surgery” technique reduces patients’ concerns about losing their breasts.
Some patients need to have the entire breast removed because the cancer is widespread in multiple areas. Removing all breast tissue results in a flat chest, which patients find unacceptable.
The concept to solve this problem began developing in the European medical field, with surgical techniques and innovations evolving over decades. Western women are sensitive about their breasts, and losing them can feel devastating. This surgical development in Europe has advanced significantly and succeeded. In Thailand, awareness has only increased in recent years, especially since breast cancer is now the most common cancer among women.
“For breast cancer patients who must have the entire breast removed, the surgical plan must be designed to determine which parts can be preserved and how to reconstruct the breast. The skin that covers the breast must be preserved to maintain the appearance, while inside, medical materials such as silicone are used to rebuild the breast. During surgery, the skin is not removed; only the tissue inside is taken out.”
New Breasts Must Use Teardrop-Shaped Silicone Only!
“Teardrop-shaped silicone must be used, with gel inside that maintains its shape. The surface of the material should be textured to reduce the risk of capsular contracture. Essentially, we use breast implants, but the type varies depending on the purpose. For breast augmentation, one type is used; for breast cancer reconstruction, another type is used. Careful planning is required to determine the appropriate size. For women who have had tissue removed due to cancer, we insert a silicone implant and cover it with the patient’s skin. The implant must be placed properly under the muscle, with a layer of chest muscle covering it. This is a surgical technique; we do not simply place the implant and cover it with skin. The pocket under the chest muscle must be carefully dissected.
Actually, there are many types of breast reconstruction. Some use abdominal or back muscles, but those traditional methods involve multiple surgeries and cause more pain and complications, so their popularity has declined.
Choosing the right silicone is important because if a round implant is used, the breast will look unnatural and round, like a cup stuck on the chest, which looks odd compared to the natural breast on the other side.”
No More Crooked Breasts, Sagging, Size Increase or Decrease – We’ve Got It Covered!
“Breast cancer surgery involves two methods: removing only the cancerous part, called breast-conserving surgery, or removing the entire breast. Breast-conserving surgery means the tumor must be small and localized, not large or multiple scattered tumors. The problem with breast conservation is that after surgery, the breast often becomes distorted, especially after radiation therapy.
However, using oncoplastic techniques can reduce distortion by applying plastic surgery methods, such as removing the tumor and reducing the size of large breasts. For patients with large breasts and breast cancer, after surgery, the breast size decreases, so the other breast must be reduced to match for balance and aesthetics, which improves patient satisfaction.
From my surgical experience, in Thai patients, if the other breast remains beautiful after cancer surgery, we preserve it and do not operate immediately. Before surgery, we design and measure to select the implant size. The skin is preserved by removing only the cancerous tissue inside. The implant is placed under the muscle, and the nipple is preserved. After surgery, the skin will lift, and the implant is inserted to create a new breast. The other breast will be reconstructed later to match size and shape.
If the patient wants to enlarge the other breast that is not cancerous, we ask at the beginning about their preference: whether they want it bigger, the same size, smaller, or just cancer treatment. We then inform the patient about the expected outcome. If the patient wants the other breast improved, we can perform a lift to prevent sagging.
If the patient wants to enlarge the other breast, we use an expandable implant called a tissue expander. We do not insert the final implant immediately but plan the desired size and gradually expand the skin over about 8 months. Once the skin is fully expanded and can accommodate the final implant, we determine the appropriate sizes for both breasts. The cancer is cured, and the breast is enhanced aesthetically.
Most Thai patients only want the cancer removed, so we insert silicone into the affected breast to make it look as natural as possible without requesting surgery on the other breast. If the patient requests surgery on the other breast, we perform it. In Europe, most breast cancer patients have the other breast augmented simultaneously.”
No Need for Massage, No Worries About Hard New Breasts or Capsular Contracture
“Currently, caring for silicone gel breast implants is not complicated, especially with textured silicone placed under the muscle, which results in a very low risk of capsular contracture, about 10% at most.
Capsular contracture risk may increase if the patient undergoes radiation therapy. Some patients do not need radiation. For breast reconstruction, silicone gel implants are recommended. However, if radiation is required, this method is not recommended; it is better to avoid it and treat the cancer first. Radiation can affect the implant and possibly the wound, theoretically, though practically it is rare. We inform patients that radiation after implant insertion may increase wound risks and affect aesthetics, but the chance is less than 20%.
For early-stage breast cancer (stage 1-2), with small tumors that can be completely removed, patients are usually suitable for silicone implants.
Breast massage after implant insertion is generally not recommended. Massage is needed for round implants to prevent capsular contracture, but these implants are placed under the muscle, not in breast tissue. Therefore, capsular contracture is less of an issue because the muscle covers the implant, and there is no breast tissue left to cause contracture.
Regarding durability, implants last about 10 years. These are not permanent. After 10 years, if the other breast changes shape or sags significantly, revision surgery may be needed to reduce the other breast and replace the implant with a more suitable size. If the patient is satisfied with the current implant, only minor adjustments may be necessary in the future.
Pol. Lt. Col. Dr. Hasan Muhammad
Specialist in Surgical Oncology
Breast Care Center, Phyathai 1 Hospital
