Oncoplastic surgery is a relatively new practice of breast cancer surgery,
combining oncology principles with plastic surgery techniques. Based on the
stage of their cancer, women with breast cancer usually must choose between a
mastectomy (removal of the entire breast) and lumpectomy (removal of just the
tumor from the breast). With mastectomy, a woman can have reconstructive breast
surgery. With the breast conserving lumpectomy, a woman is often left with an
unsightly scar and depressed breast cavity. Oncoplasty breast surgery involves
completely removing the tumor but also gently reshaping the breast with the
remaining tissue so that women have the best possible cosmetic outcome from
their initial breast cancer surgery.
Although still a fairly rare
specialty, there are more and more of us getting this specialized training.
During my medical training, I was fascinated with plastic surgery, psychiatry
and oncology, so this specialty suits me well.
Another new type of breast cancer surgery that I’m excited about is
nipple-sparing mastectomy. We have a clinical study currently underway at the
JWCI Breast Center. It is for women who have breast cancer that does not involve
the nipple. It can be done for a single or double mastectomy. It involves taking
out the breast tissue – the dangerous part – but leaving behind the entire shell
of skin, areola and nipple. Then we replace that breast tissue with tissue from
another part of the body, such as the abdomen, or with an implant. This new
surgery offers a beautiful result, retaining the central feature of a woman’s
breast. It’s not as disfiguring or psychologically unpleasant as a conventional
mastectomy. We’re still monitoring the results for women who’ve had this new
surgery, to see if and how many have a recurrence, but we are very optimistic
about the long term outcomes.
No matter what type of surgery is indicated, the most important factor in
successful treatment for breast cancer is early detection. The more advanced the
cancer, the harder it is to treat effectively. Women over the age of 40 should
have a mammogram annually in addition to a regular breast exam with their
doctor. On average, mammography will detect about 80 to 90 percent of breast
cancers in women who have no symptoms.
By Helen Mabry, M.D., breast cancer surgeon and assistant director of the John
Wayne Cancer Institute Breast Center at Saint John’s Health Center.