Another option is oncoplastic breast surgery, an emerging discipline in which breast conservation surgery combines oncologic or cancer treatment principles with plastic surgical techniques. “The goal is to completely remove the cancer, with good surgical margins, while maintaining or improving cosmesis,” said Clinical Associate Professor Veronique Tan, Consultant and Breast Surgeon, Division of Surgery & Surgical Oncology, National Cancer Centre Singapore (NCCS), a member of SingHealth Group.

Established plastic surgical techniques to reduce or lift breasts may be used with cancer surgery to reshape a breast, resulting in a cancer-free breast that is of normal shape, albeit of a smaller size. A breast reduction on the opposite breast may be performed at the same time for better symmetry.

Women with smaller breasts can opt for volume-replacement breast-conserving surgery or partial breast reconstruction, where the soft fatty tissue from the side of the chest is rotated to fill the space created in the breast after the cancer is removed.

“Oncoplastic breast surgery isn’t for everyone, but it extends the option of breast-conserving surgery to more patients,” said Dr Veronique Tan.

The philosophy behind oncoplastic breast surgery is that “we want good cancer removal, we want survival, and we want a good long-term aesthetic outcome – because our patient is going to live”, said Dr Tan, who recently completed a one-year oncoplastic training programme at the UK’s Nottingham Breast Institute.

The key, said Clnical Associate Professor Benita Tan, Senior Consultant, Sengkang General Hospital (SKH) Breast Service, is for patients to consider carefully what they want to do. “Many patients think that if they are diagnosed with cancer, they must have surgery immediately and have the whole breast removed.”

“It’s not true. Breast cancer surgery is never truly an emergency. Unless you have a cancer that is growing very fast, which is uncommon, or have complications of a very advanced cancer, you can usually take a few weeks to decide,” she said.

Keeping the breast with oncoplastic surgery

Oncoplastic breast surgery is an emerging discipline that combines plastic surgical techniques with breast-conserving surgery. If conservation surgery is found to be appropriate, the option can help the patient avoid a mastectomy and the disadvantages associated with a full breast removal – the need for breast reconstruction, numbness and sensory loss of the breast mound and nipple. The conserved breast is warm, soft, has sensation and feels and moves as part of the patient's body.

In oncoplastic surgery, the cancer and a rim of surrounding normal breast tissue are removed, and the remaining breast is then reshaped. The aim is to avoid distortions and recreate a normal-shaped breast, albeit of smaller size. Alternatively, adjacent fatty tissue may be used to fill a defect in the breast that had resulted from the removal of the cancer. In instances where the cancer is large, its removal will cause a dent in the breast and alter the position of the nipple. The fatty tissue is moulded to occupy the space created from cancer resection. The patient then receives radiation therapy to the remaining part of the breast.

Ref: K21