The “Silver Lining” Of Breast Cancer Surgery

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Breast cancer is the number one cause of cancer among women in South Africa. In the past, surgery to remove breast cancer did not focus on how the breasts would look after the procedure, but rather solely on the medical outcome of removing the cancerous tissue – something that caused many women great discomfort and embarrassment, adding to the distress of their cancer diagnosis.

Fortunately, this has changed, and an aesthetic approach to breast cancer treatment called oncoplastic breast surgery offers women the chance to have their breast/s reconstructed at the same time that the cancer is removed.

Dr. Bruce Lelala, a plastic surgeon at The Specialist Laser and Cosmetic Institute (SCIN) in Hyde Park who recently completed his fellowship in microsurgery and oncoplastic breast surgery at the Nottingham Breast Institute in the UK, explains that oncoplastic breast surgery, which was born out of a need for better cosmetic results after breast cancer surgery, involves removal of the breast cancer using plastic surgery techniques and the simultaneous reconstruction of the defect created when the cancer is removed.

“The tumour is removed with adequately wide cancer-free margins and then the plastic surgeon uses specialized reconstructive techniques to reshape and contour the breast. It can also involve procedures to achieve breast symmetry and the reconstruction of the nipple and areolar when necessary. Women who require a mastectomy can also opt for immediate breast reconstruction and some women who would previously have been urged to undergo a mastectomy can elect to rather have oncoplastic breast surgery.”

According to Dr. Lelala, some women who have early-stage breast cancer may be able to have cancer removed with a simple breast reduction or breast lift procedure, and says that a reduction in breast volume has added benefits as it allows for a more uniform dose distribution of postoperative radiotherapy.

“Women with sagging or droopy breasts can expect an oncoplastic mastopexy to give them a more uplifted and shapelier breast. “For large and heavy breasts an oncoplastic breast reduction will result in a more comfortable size and shape. In smaller breasts, plastic surgery techniques such as perforator flap surgery or microsurgery are used to achieve a good cosmetic outcome with breast-conserving surgery.”

Dr. Lelala advises that the surgical care of breast cancer has evolved over the years from radical and extensive removal of all breast tissue to less aggressive removal of the affected lump or segment of breast tissue. “This type of surgery is known as breast-conserving surgery, however poor cosmetic results are often experienced after standard breast-conserving surgery due to things such as an unfavourable tumour to breast size ratio, or if the tumour is located in an unfavourable position in the breast.

With oncoplastic techniques we enjoy far better cosmetic outcomes as we place the incision in an area remote from cancer and use plastic surgery techniques to improve the cosmetic outcome, preventing excessive scarring and deformities.”

And the further good news is that oncoplastic breast surgery followed by radiation therapy is comparable to total mastectomy with respect to recurrence and survival. And for women who have already undergone breast cancer removal surgery and who now suffer from abnormal breast appearance, there is the option of undergoing delayed oncoplastic breast surgery to restore the breast to a more natural appearance.

“Oncoplastic breast surgery offers wonderful results, and my patients are often surprised and delighted to learn that breast cancer surgery can actually improve the shape and appearance of their breasts – it can be an unexpected silver lining for an otherwise worrying diagnosis and surgery. However, it is important to highlight the fact that not all breast cancers are the same and oncoplastic breast surgery is not always suitable in all situations.

Speak to your oncologist and surgical team and consider all options pre-surgery,” concludes Dr. Lelala. For more information on oncoplastic breast surgery contact Dr. Bruce Lelala at SCIN at +27 (0)10 350 0800, or email hydepark@scinmed.com