Oncoplastic surgery is a separate specialty of plastic surgery, which is a combination of oncology, which deals with the treatment of breast cancer, and breast surgery. The procedure allows cancer patients to have the tumor removed and the affected area reconstructed at the same time, thus the patient’s self-confidence remains intact.
THE ONCOPLASTIC SURGERY PROCEDURE
Previously, in the case of malignant breast tumors, the removal of the tumor area and the breast was followed by chemotherapy, radiotherapy and, much later, breast reconstruction surgery. With oncoplastic surgery, the cancerous area is removed, and the shape of the breast is restored at the same time. Patients wake up after the operation to find that they have undergone breast reconstruction at the same time as the oncological procedure. Not only does this reduce the surgical risks and time factor, but most importantly, patients can wake up with confidence having regained the symbol of their femininity immediately after a physically and emotionally demanding illness.
Prior to the operation, the exact treatment plan is determined by the oncology care team comprising the oncologist, surgeon, plastic surgeon, radiologist and other specialists. The team decides whether breast-conserving or a mastectomy surgery is needed. In the former case, only part of the breast is removed, in which case the breast is usually restored to its original shape using techniques used in aesthetic surgery, often with correction of the other breast. In breast removal surgery (mastectomy), some form of a separate vascular flap graft is necessary to replace the missing tissue, or this in combination with the placement of breast implants. The surgery is performed according to oncological protocols: complete removal of the tumor with a surgical margin, including a lymph node biopsy and other procedures as required by the protocol.
There are several modes of partial or total removal and reconstruction of the breast, and at Dr. Rose Private Hospital we perform the following surgeries:
Breast removal, breast tumor removal surgery
- Breast ablation: complete removal of the breast with oncological indication, with removal of the sentinel lymph node and if necessary, the entire axillary lymph node, including histological examination.
Duration: 60-120 minutes depending on whether it is a single or bilateral mastectomy
- Breast sector resection: with oncological indication, the breast tumor is removed together with a surgical margin, followed by reconstruction of the breast by modelling the remaining breast tissue. In this procedure, the sentinel lymph nodes of the affected side are removed, or if necessary, also the entire axillary lymph nodes (with 2 histological examinations).
Duration: 60 minutes
Immediate reconstructive surgeries
- Immediate reconstruction after mastectomy with implants on one or both sides: with oncological indication, removal of the entire glandular tissue on one or both sides, immediate reconstruction with implants, with TiO2Mesh where necessary.
Duration: approx. 90 minutes
- Breast reconstruction using the LD (latissimus dorsi) vascular flap: with oncological indication after mastectomy, mainly for reconstruction of small- to medium-sized breasts. The selected back muscle, utilized with the retention of the blood vessels supplying it, is guided under the skin of the lateral chest wall to be fixed in the appropriate position to make up for the volume and skin deficiency of the breast. It can be used for either delayed or immediate breast replacement, with or without an implant, with contralateral (opposite) breast correction.
Duration: approx. 180-240 minutes, including 2 nights in hospital
- TRAM flap reconstruction: breast reconstruction with transverse rectus abdominis flap breast reconstruction surgery. With oncological indication, a flap formed from the lower abdomen is used to make up for the volume and skin deficiency of the breast, with or without an implant, with correction of the other breast.
Duration: approx. 180-240 minutes, with 2 nights in hospital
WHAT HAPPENS DURING SURGERY?
Oncoplastic surgery is always performed under general anesthesia. The appropriate surgical technique will be chosen by our plastic surgeon according to your specific needs, and each case requires an individual assessment and surgical plan. If necessary, our plastic surgeon will use special techniques to achieve the best results. Examples include the LD or TRAM flap procedures. These two methods involve the transfer of skin tissue from other parts of the body to the breast, with LD involving the back muscle (latissimus dorsi) and the TRAM flap replacing the missing breast tissue with tissue from the lower abdomen. Our plastic surgeon may also use specific tools, expanders or TiO2Mesh to achieve the right result. Combined breast reconstruction utilizing your own tissue and using implants is an intervention that requires a high level of experience, and our plastic surgeon will discuss each step of the procedure in detail with you during your pre-operative consultation, from planning to scar location. The duration of the oncoplastic surgery varies from case to case, taking 1-4 hours. After the operation, depending on the results of the surgical histopathological examination, additional oncological treatments recommended by the oncology team will take place.
After your oncoplastic surgery, you will need to spend one or two nights in our Private Hospital to rest in a comfortable and pleasant environment after the operation and to begin your recovery under safe conditions. The following morning, our plastic surgeon will examine the site of the operation and the area must not be exposed to water for a week. You will need to wear a special bra for 4 weeks after the oncoplastic surgery, which we will provide for you. You should avoid any strenuous physical activity for two weeks after the operation, but after this period you can gradually resume your daily activities, and after the third week you can start to do light exercise. Avoid sunbathing and solarium or sauna use for two months after the operation.
At specified times, you will be called back for oncological check-ups and treatments by the oncology care team and for surgical check-ups by our plastic surgeon. The healing time for external scars is approximately 6 months, while internal scars take 2 years to heal completely. To promote scar healing, the use of scar treatment creams is recommended. Although we try to eliminate all risk factors during the preoperative examinations before oncoplastic surgery, unforeseen complications may occur. At the first consultation, your plastic surgeon will inform you about these and how to avoid them.
After oncoplastic surgery, scar lines remain on the skin, both in visible and non-visible areas. The surgical scars are permanent but gradually fade over time. The breast takes its final shape after six months to a year.