Necessary breast cancer surgery removes the affected tissue. However, breast aesthetics concern many patients. The look and feel of the breast may be tied to a feeling of normalcy.
Oncoplastic surgery consists of removing the lump and reshaping the breast. It combines breast cancer surgery with plastic and reconstructive surgery techniques. The shape of the breast is preserved as much as possible while extracting the cancerous tissue.
Dr. T. Salewa Oseni explains how oncoplasic surgery works.
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Oncoplastic Surgery
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Learn more about T. Salewa Oseni, MD
T. Salewa Oseni, MD, FACS-Southern New Hampshire Health
T. Salewa Oseni, MD is a member of the Division of Surgical Oncology at the Massachusetts General Hospital. She specializes in breast surgery with a pending appointment as an Instructor in Surgery for Harvard Medical School.Learn more about T. Salewa Oseni, MD
Transcription:
Oncoplastic Surgery
Bill Klaproth (Host): What is oncoplastic breast surgery? Are you a candidate? And how can it help you maintain a natural look and feel to your breasts after surgery? Here to tell us more about oncoplastic breast surgery is Dr. Salewa Oseni, breast surgery specialist at Southern New Hampshire Health. Dr. Oseni, thank you so much for your time today. So take us through this. Oncoplastic surgery only works with a lumpectomy, not a mastectomy. How does a woman choose which surgery to have?
Dr. Salewa Oseni, MD, FACS (Guest): Well thanks for having me on this program. Breast cancer is essentially an individualized treatment plan in this day in age, and so the decision as to whether or not to have a mastectomy or a lumpectomy is a decision that you should have after a discussion with your surgeon. It is usually unique as to whether or not you have early stage disease, and by that we mean disease that is confined just to the breast that can be treated with a lumpectomy and radiation in most cases or a mastectomy. With a discussion with your surgeon, they'll let you know the kind of tumor you have, and whether or not you are a candidate for either of those surgeries. Most women are.
Bill: And what are the common reconstruction options after breast surgery?
Dr. Oseni: So with breast surgery, when you have a lumpectomy, you're essentially going to keep your breast. All we're going to do is take out the lump and you will likely have radiation in many cases, but your breasts are still going to be there. And so you'll have a scar on the breast, it may be a little different than the other side, and it may be a little smaller. With a mastectomy, the entire breast is gone. We take out all of the breast tissue and that is when we have to talk about reconstruction. There are different kinds of mastectomy. There is the skin sparing where we take the nipple but we leave most of the skin. There's nipple sparing where we don't take any skin and leave the nipple. And then with reconstruction there are two big categories. What we call implant-based reconstruction and that's where when we take out the breast we put in an implant, either a silicone or a saline implant, or we do a tissue reconstruction which is where we take tissue from some other part of your body, usually the abdominal region or sometimes the back or the shoulder region, and we put that into the breast space to fill that cavity.
Bill: So Dr. Oseni, what then is an oncoplastic lumpectomy?
Dr. Oseni: So an oncoplastic lumpectomy is relatively new, as in the last five years. And what we found was when we do a lumpectomy, sometimes depending on the location of the tumor, it can leave a poor cosmetic outcome. If you have a tumor in the cleavage portion of your breast, these are areas that are visible, and we don't want to scar there. That would be a good candidate for an oncoplastic lumpectomy. But also more importantly, if you have a large area in your breast that has cancer larger than we typically see, which maybe more than - just to give a number - like two centimeters, if it's a large tumor, where before we would say you need a mastectomy to treat this, now we can take a bigger lumpectomy and move the rest of the breast tissue around to fill that space so that you don't have to have a mastectomy anymore, and that's what we call an oncoplastic lumpectomy. We're taking out the lump but it's usually a larger lump and we're just moving the breast around to fill the space that we have made.
Bill: So that's really good news for a lot of women. So when is an oncoplastic lumpectomy recommended?
Dr. Oseni: So an oncoplastic lumpectomy is something you should talk about if you want to- certainly if you want to keep your breast. If you've been diagnosed with breast cancer, and you want to have a lumpectomy but you find that an additional lumpectomy may not be sufficient and they're recommending a mastectomy, it is certainly worth it to talk to a breast specialist who does oncoplastic lumpectomy to see if that may be an option for you.
Another category are women who have large breasts. If you have large breasts, then you have a lot of tissue that we can move around to fill the defect, and a lot of times we can give you a breast lift at the same time of the lumpectomy to fill that defect.
And then lastly, if you have a cancer in one of the locations of the breast that are not great areas, as I mentioned the cleavage, the other area is along the inframammary fold where the bra lies, those areas are not great areas to have a traditional lumpectomy because you will notice a defect afterwards. The breast can sink in and it can be a little obvious. And so those would be women who should consider finding a breast specialist to talk about oncoplastic breast surgery.
Bill: Dr. Oseni, let me ask you this, who then is an ideal candidate for an oncoplastic lumpectomy?
Dr. Oseni: The ideal candidate for an oncoplastic lumpectomy would be a woman who has a double D size breast or even a large C or a D cup breast who has a relatively moderate size tumor, maybe a two or three centimeter tumor. That is a patient that we can do the lumpectomy, get good margin, and also keep the shape and the contour of the breast. It may be smaller than the other size when we're done, but it will be higher and it will essentially have a breast lift. That would be a good candidate for an oncoplastic lumpectomy.
Bill: Let me ask you this, Dr. Oseni, is there a difference in recovery time with this type of surgery?
Dr. Oseni: Not in terms of hospital stay. For lumpectomies you will go home the same day, it's a same day procedure, and in most cases you're able to recover usually within seven to ten days, and those seven to ten days there will be no heavy lifting or no strenuous activity. Sometimes with an oncoplastic lumpectomy, you will have a drain that stays in for a few days and we teach you how to use it, but essentially the recovery is very similar to a regular lumpectomy.
Bill: And Dr. Oseni, if a patient needs radiation after the operation, does that limit the oncoplastic surgery options?
Dr. Oseni: That's an excellent question. It doesn't, not anymore. Now we have a lot of new technology that lets us mark in the breast where exactly the tumor was. There are- we could do that sometimes the surgeon will leave clips behind. A lot of women are familiar with when they get a breast biopsy, the radiologist leaves a clip or a marker so that the surgeon knows where to go. Now with surgery we do the same thing. When we take out the breast cancer, for a lumpectomy we can leave a clip or we can leave a marker so that the radiation oncologist knows where the cancer was and where to go and where to target when your treatment starts. So it's not an impediment to having radiation afterwards.
Bill: And what about the team, Dr. Oseni? What is a multi-disciplinary team and why should a woman have one?
Dr. Oseni: So one of the best news about breast cancer is that the care and the treatment is incredibly individualized. Now with breast cancer, it is one of the solid tumors that we actually know on the microscopic level what is going on. We could tell you the kind of receptors your cancer has, whether it's estrogen receptor positive or progesterone receptor or the HER2. And based on all of these things, we can give you the best treatment plan for you, whether or not we should do surgery alone, surgery with radiation, surgery with radiation and chemotherapy. And so you want to have all of these options discussed before you start your treatment ideally so that there's a plan, and then all of your doctors know what the plan is, and they are on the same page. And that's what a multi-disciplinary team is. You have a surgeon, a breast surgeon on the team, you have a surgical- a medical oncologist who would be the person that gives chemotherapy, you would have a radiation oncology who is the person that gives radiation, and we all talk about your case, and give you the best course of action for your particular cancer. And so you want to go to a center that has that, and talk to all of these specialists before you embark on your care.
Bill: And lastly, Dr. Oseni, if you could wrap it up for us, what else do we need to know about oncoplastic breast surgery?
Dr. Oseni: Oncoplastic breast surgery gives you the opportunity to keep your breasts. You get to maintain the breast, the shape and contour of the breast, but most importantly and it's always important to keep this in mind, our mission is curing your cancer, and the first step is always taking out your cancer. We always do that, and even with oncoplastic lumpectomy, the goal is let's get rid of the cancer, and then we want to make sure that we do the best with the breast afterwards and it looks and feels great.
Bill: Well that's a good reminder and a great mission. Dr. Oseni, thank you so much for your time today. For more information please visit www.SNHHealth.org. That's www.SNHHealth.org. This is Simply Healthy, a podcast by Southern New Hampshire Health. I'm Bill Klaproth, thanks for listening.
Oncoplastic Surgery
Bill Klaproth (Host): What is oncoplastic breast surgery? Are you a candidate? And how can it help you maintain a natural look and feel to your breasts after surgery? Here to tell us more about oncoplastic breast surgery is Dr. Salewa Oseni, breast surgery specialist at Southern New Hampshire Health. Dr. Oseni, thank you so much for your time today. So take us through this. Oncoplastic surgery only works with a lumpectomy, not a mastectomy. How does a woman choose which surgery to have?
Dr. Salewa Oseni, MD, FACS (Guest): Well thanks for having me on this program. Breast cancer is essentially an individualized treatment plan in this day in age, and so the decision as to whether or not to have a mastectomy or a lumpectomy is a decision that you should have after a discussion with your surgeon. It is usually unique as to whether or not you have early stage disease, and by that we mean disease that is confined just to the breast that can be treated with a lumpectomy and radiation in most cases or a mastectomy. With a discussion with your surgeon, they'll let you know the kind of tumor you have, and whether or not you are a candidate for either of those surgeries. Most women are.
Bill: And what are the common reconstruction options after breast surgery?
Dr. Oseni: So with breast surgery, when you have a lumpectomy, you're essentially going to keep your breast. All we're going to do is take out the lump and you will likely have radiation in many cases, but your breasts are still going to be there. And so you'll have a scar on the breast, it may be a little different than the other side, and it may be a little smaller. With a mastectomy, the entire breast is gone. We take out all of the breast tissue and that is when we have to talk about reconstruction. There are different kinds of mastectomy. There is the skin sparing where we take the nipple but we leave most of the skin. There's nipple sparing where we don't take any skin and leave the nipple. And then with reconstruction there are two big categories. What we call implant-based reconstruction and that's where when we take out the breast we put in an implant, either a silicone or a saline implant, or we do a tissue reconstruction which is where we take tissue from some other part of your body, usually the abdominal region or sometimes the back or the shoulder region, and we put that into the breast space to fill that cavity.
Bill: So Dr. Oseni, what then is an oncoplastic lumpectomy?
Dr. Oseni: So an oncoplastic lumpectomy is relatively new, as in the last five years. And what we found was when we do a lumpectomy, sometimes depending on the location of the tumor, it can leave a poor cosmetic outcome. If you have a tumor in the cleavage portion of your breast, these are areas that are visible, and we don't want to scar there. That would be a good candidate for an oncoplastic lumpectomy. But also more importantly, if you have a large area in your breast that has cancer larger than we typically see, which maybe more than - just to give a number - like two centimeters, if it's a large tumor, where before we would say you need a mastectomy to treat this, now we can take a bigger lumpectomy and move the rest of the breast tissue around to fill that space so that you don't have to have a mastectomy anymore, and that's what we call an oncoplastic lumpectomy. We're taking out the lump but it's usually a larger lump and we're just moving the breast around to fill the space that we have made.
Bill: So that's really good news for a lot of women. So when is an oncoplastic lumpectomy recommended?
Dr. Oseni: So an oncoplastic lumpectomy is something you should talk about if you want to- certainly if you want to keep your breast. If you've been diagnosed with breast cancer, and you want to have a lumpectomy but you find that an additional lumpectomy may not be sufficient and they're recommending a mastectomy, it is certainly worth it to talk to a breast specialist who does oncoplastic lumpectomy to see if that may be an option for you.
Another category are women who have large breasts. If you have large breasts, then you have a lot of tissue that we can move around to fill the defect, and a lot of times we can give you a breast lift at the same time of the lumpectomy to fill that defect.
And then lastly, if you have a cancer in one of the locations of the breast that are not great areas, as I mentioned the cleavage, the other area is along the inframammary fold where the bra lies, those areas are not great areas to have a traditional lumpectomy because you will notice a defect afterwards. The breast can sink in and it can be a little obvious. And so those would be women who should consider finding a breast specialist to talk about oncoplastic breast surgery.
Bill: Dr. Oseni, let me ask you this, who then is an ideal candidate for an oncoplastic lumpectomy?
Dr. Oseni: The ideal candidate for an oncoplastic lumpectomy would be a woman who has a double D size breast or even a large C or a D cup breast who has a relatively moderate size tumor, maybe a two or three centimeter tumor. That is a patient that we can do the lumpectomy, get good margin, and also keep the shape and the contour of the breast. It may be smaller than the other size when we're done, but it will be higher and it will essentially have a breast lift. That would be a good candidate for an oncoplastic lumpectomy.
Bill: Let me ask you this, Dr. Oseni, is there a difference in recovery time with this type of surgery?
Dr. Oseni: Not in terms of hospital stay. For lumpectomies you will go home the same day, it's a same day procedure, and in most cases you're able to recover usually within seven to ten days, and those seven to ten days there will be no heavy lifting or no strenuous activity. Sometimes with an oncoplastic lumpectomy, you will have a drain that stays in for a few days and we teach you how to use it, but essentially the recovery is very similar to a regular lumpectomy.
Bill: And Dr. Oseni, if a patient needs radiation after the operation, does that limit the oncoplastic surgery options?
Dr. Oseni: That's an excellent question. It doesn't, not anymore. Now we have a lot of new technology that lets us mark in the breast where exactly the tumor was. There are- we could do that sometimes the surgeon will leave clips behind. A lot of women are familiar with when they get a breast biopsy, the radiologist leaves a clip or a marker so that the surgeon knows where to go. Now with surgery we do the same thing. When we take out the breast cancer, for a lumpectomy we can leave a clip or we can leave a marker so that the radiation oncologist knows where the cancer was and where to go and where to target when your treatment starts. So it's not an impediment to having radiation afterwards.
Bill: And what about the team, Dr. Oseni? What is a multi-disciplinary team and why should a woman have one?
Dr. Oseni: So one of the best news about breast cancer is that the care and the treatment is incredibly individualized. Now with breast cancer, it is one of the solid tumors that we actually know on the microscopic level what is going on. We could tell you the kind of receptors your cancer has, whether it's estrogen receptor positive or progesterone receptor or the HER2. And based on all of these things, we can give you the best treatment plan for you, whether or not we should do surgery alone, surgery with radiation, surgery with radiation and chemotherapy. And so you want to have all of these options discussed before you start your treatment ideally so that there's a plan, and then all of your doctors know what the plan is, and they are on the same page. And that's what a multi-disciplinary team is. You have a surgeon, a breast surgeon on the team, you have a surgical- a medical oncologist who would be the person that gives chemotherapy, you would have a radiation oncology who is the person that gives radiation, and we all talk about your case, and give you the best course of action for your particular cancer. And so you want to go to a center that has that, and talk to all of these specialists before you embark on your care.
Bill: And lastly, Dr. Oseni, if you could wrap it up for us, what else do we need to know about oncoplastic breast surgery?
Dr. Oseni: Oncoplastic breast surgery gives you the opportunity to keep your breasts. You get to maintain the breast, the shape and contour of the breast, but most importantly and it's always important to keep this in mind, our mission is curing your cancer, and the first step is always taking out your cancer. We always do that, and even with oncoplastic lumpectomy, the goal is let's get rid of the cancer, and then we want to make sure that we do the best with the breast afterwards and it looks and feels great.
Bill: Well that's a good reminder and a great mission. Dr. Oseni, thank you so much for your time today. For more information please visit www.SNHHealth.org. That's www.SNHHealth.org. This is Simply Healthy, a podcast by Southern New Hampshire Health. I'm Bill Klaproth, thanks for listening.