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Oncoplastic Breast Surgery

FIVE

Oncoplastic Breast Surgery

For more information on Oncoplastic Breast Surgery, please contact the GP Liaison Team on:

T: 020 7234 2009

, or visit

www.londonbreastspecialist.co.uk

Oncoplastic

Breast Surgery

chemotherapy or hormonal treatment

to shrink the tumour before surgery can

improve breast conservation rates even

further, as well as aesthetic outcomes of

breast cancer surgery.

Poor cosmetic outcome can be caused

by tumour location (central, upper-inner

quadrant, lower pole); in these cases,

volume displacement or replacement

techniques of nearby tissue into the defect

and a combination of breast reduction

and nipple-areola repositioning techniques

can refashion the breast. The outcome is

usually a smaller-sized breast, which has

a good shape without any distortions or

indentations.

Revolutionary developments in

lipomodelling (fat transfer) techniques

have given us another tool to improve

the aesthetic outcomes of breast

conservation surgery and reconstruction;

by transferring adipose tissue from other

areas of the body to the breast or into

flaps used for reconstruction, indentations

can be corrected, poor breast shape can

be improved and asymmetry caused by

volume loss is adjustable without using

an implant (combining autologous LD,

abdominal flaps with lipomodelling).

Unfortunately, a mastectomy is still

needed for multifocal or large tumours,

where down-sizing is not achievable with

chemotherapy; or, for ladies who have

a high genetic risk of developing breast

cancer (risk-reducing surgery).

Evidence shows that with skin sparring

or skin-reducing mastectomy and

immediate reconstruction, the optimal

oncologic control is achievable and

the aesthetic outcomes can be

significantly improved.

Acellular Dermal Matrices (ADM) is

a reconstructive tissue matrix that

supports tissue regeneration; it is

derived from porcine or bovine skin

that undergoes processing by removing

cells. In the field of implant-based

reconstructions, the usage of ADM has

gained wide popularity and acceptance.

Since its introduction around ten years

ago, materials and techniques have

significantly improved in their quality

and achievable outcomes.

It optimises the aesthetic results of an

implant-based reconstruction by providing

additional tissue for implant coverage and

support (internal bra-hammock effect),

and can help hide implant visibility by

masking the appearance of wrinkles or

ripples, creating a more natural-looking

breast.

Where adjuvant radiotherapy is needed

following mastectomy, there is increasing

evidence that the use of ADM will reduce

the risk of capsule contraction at a later

stage; improving the aesthetic outcomes

of an implant-based reconstruction, and

reducing complications.

High patient satisfaction and good long-

term outcomes are only achievable by

adopting an evidence-based approach

to breast cancer management; focusing

on principles of surgical oncology and

oncoplastic surgery, where cosmetics are

as important as the efficient treatment

of disease.

An innovative approach to match optimal cancer

management with best aesthetic outcomes