Oncoplastic surgery for breast cancer

Who are the oncoplasticians?

Oncoplastic surgeons are breast cancer surgeons who have acquired additional training in plastic surgery in order to achieve a double objective: better patient care with the least possible after-effects. In the case of cancer removal, they perform the entire surgical procedure, from tumor removal to immediate reconstruction, during the same operation. More rarely, they are plastic surgeons who followed training in breast cancer surgery.

When to consult an oncoplastician?

In 2 situations:

• When a mastectomy is planned, in order to benefit from immediate reconstruction. In some teams, two surgeons are called in, an oncologist and a plastic surgeon, who operate as a “double team” or propose a reconstruction in a second phase.
• When a conservative treatment is at risk of creating a deformation of the breast, or even when the surgeon hesitates to perform a conservative treatment. In case of doubt, it is recommended to ask for a second opinion (recommendation of the Cancer Plan). Oncoplastic surgeons have techniques that allow them to preserve the breast and avoid a mastectomy in certain cases, with the same cure rate.

Oncoplasty: from consultation to surgery

In case of conservative treatment

When the tumor is small and breast repair is not a problem for trained surgeons. The use of oncoplastic surgery techniques is not necessary. However, there are more complex cases (large tumor or unfavorable location in the breast) where removal of the tumor will deform the breast, or even make the surgeon hesitate between conservative treatment and mastectomy. A second opinion from an oncoplastician surgeon will allow the consideration of more sophisticated repair techniques. Basically, the lumpectomy area will be filled immediately in order to reconstruct the initial shape of the breast without the use of a prosthesis. The choice of technique is detailed to the patient, specifying the size and position of the scar and the postoperative course (painless surgery, outpatient care or 24 hours stay maximum).

In case of mastectomy

Immediate reconstruction is most often possible. This reconstruction can be done either with a prosthesis or with the patient’s own tissue (this is called autologous reconstruction). The choice of reconstruction is decided with the patient during the preoperative consultation, detailing the advantages and disadvantages of each technique, but also the possible interactions between immediate reconstruction and cancer treatments (no interference with chemotherapy, but radiotherapy can sometimes modify the reconstruction). Thanks to advances in postoperative analgesia techniques, immediate reconstruction is usually painless. Hospitalization lasts from 24 to 48 hours.

The surgeon’s word on oncoplasty

Oncoplastic techniques were created in France and Germany in the early 1990s. Our team was at the origin of their development in France and in the world (work of Dr Clough since 1990, recognized as one of the initiators of oncoplastic surgery). They are considered everywhere as a major advance in breast cancer surgery and the American Society of Breast Surgeons has adopted the classification published in 2010 by our team. At the Paris Breast Center, all surgeons are experienced in these techniques: your case will be discussed in the MCM by all members of the team, i.e. 7 oncoplastic surgeons and more than 25 doctors participating in the MCM, in order to propose the surgical solution best suited to your case, taking into account cancer safety and the desire to eliminate disabling surgical sequelae.