In the 70s, clinical trials showed that in the surgical treatment of breast cancer local excision of the tumor (partialmastectomy or lumpectomy), followed by post-operative radiation therapy, has a therapeutic result equivalent to that of total mastectomy. This way, most women can now avoid mastectomy, an especially amputating procedure accompanied by intense psychological stress.
The main objective of partial mastectomy (i.e. the removal of the part of the breast that contains the tumor) is preserving the breast and guaranteeing a woman's normal appearance. However, in a lot of cases (up to 30%), this objective is not completely achieved due to the deformity of the breast. This deformity may appear immediately after surgery or develop gradually in the course of time leading to an aesthetically poor result.
The main causes of breast deformity after a partial mastectomy are the following:
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Resection of a large part of the breast
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Big tumor in relatively small breast
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Position of the tumor ("tough" quadrants such as the inner part of the breast)
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Inappropriate placing of the surgical incisions (position and orientation)
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Post-operative radiation therapy
The solution to this problem is provided by Oncoplastic Surgery, which was developed and advanced mainly since the 00s.
Oncoplastic Surgery refers to the resection of the tumor (partial mastectomy or lumpectomy) and immediate reconstruction of the defect by means of plastic surgery techniques (local parenchymatous flaps, muscular flaps or free flaps). The techniques applied are either exactly the same as the plastic surgery techniques (reduction mammoplasty, mastopexy) or modified to cover the needs of surgical oncology.
Oncoplastic Surgery includes:
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Removal of the tumor with free margins
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Immediate remodeling of the defect of the breast to improve the aesthetic outcome
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Symmetrization (usually mastopexy or even reduction) of the healthy contralateral breast, where necessary
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Nipple reconstruction, where required
Breast reconstruction after a mastectomy is a separate field of Oncoplastic Surgery in the wider sense.
Oncoplastic Surgery achieves an excellent aesthetic outcome, offers the possibility of removing a larger part of the breastwith higher oncological safety and reduces significantly the need for mastectomies.
