Not all breast cancers require removal of the entire breast. In an early stage, or after size reduction by chemotherapy; removal of a cancerous lump along with adequate normal breast around it, is sufficient. This surgery is called Breast Conservation surgery. This surgery often needs Radiotherapy afterwards. Advantages of this approach are preservation of the breast and a shorter duration of surgery.
However, a simple approximation and closure of these defect will lead to bad scars and contractions leading to a deformed breast mound and appearance. Hence principles of cosmetic surgery are combined with principles of cancer surgery to lead a new stream of breast surgery called “Oncoplasty”. With better therapies and improving survival rates, it becomes important to consider a positive psycho-social impact of a cosmetically acceptable surgery over a deformed breast.
Placement of the scar and remodeling of the breast are the two important aspects of “Oncoplasty”. A scar that lies underneath the breast or along the flank or near the areola are inconspicuous scars which offer the best cosmetic results. However, the surgeon needs to be experienced enough to be able to access the cancer from these remote scars, without compromising on the cancer control. The surgeon would also mobilise or shift the remainder of the breast fat left (Remodeling) after cancer lump removal to achieve a good cosmetic result.
There may be many different oncoplasty approaches that can be used depending on the location and size of tumor and body shape of the patient. These approaches need to be individualized and a detailed counseling should be done to explain chosen method and the pros and cons.
However, cosmetic appearance should never threaten the cancer clearance, which should always remain the priority.