Written By: Erik A. Hoy, MD and Jennifer S. Gass, MD on November 3, 2021
When patients are diagnosed with cancer of the breast, they often say they experience a broad range of initial thoughts and emotions. Certainly, a common fear is whether or not they will survive the experience, how long they will live, and more. Luckily, in the United States, the majority of breast cancers are very treatable, and most patients will ultimately become “survivors”.
Care New England was a leader in adopting tomosynthesis mammography, and now ten years of annual digital tomosynthesis mammography has led to the detection of even smaller and less aggressive breast cancers.
At Care New England, we are always striving to enable women to live out their otherwise natural lifespan and bear witness to all of life’s events. Still, as a breast cancer survivor, the cancer treatment experience can take time to move from the forefront of one’s psyche and still for some leave long-lasting scars.
For decades, cancer surgeons have sought out surgical techniques with fewer long-term complications and unwanted side effects to help deliver their patients from being cancer-stricken to cancer survivors. For many women in the New England region, Care New England and Women & Infants Hospital have been their partners in that effort.
At Care New England, every breast cancer patient is cared for by an interdisciplinary team of doctors to define the best comprehensive treatment plan for her and her particular breast cancer subtype. The team includes not only doctors but specialists in cancer genetics, psycho-social supports, and physical and occupational therapy.
Once an overall treatment plan is defined, and the surgical component of the plan is identified, a breast cancer surgeon’s goal is to execute the best surgery with techniques that minimize the surgical scar and breast deformity. Most patients today have very small cancers detected by tomosynthesis mammography that require simple techniques.
Still, some cancers can occur in cosmetically sensitive regions of the breast, even if detected early, occupying a larger area of the breast. In these situations, our latest approach “oncoplastic breast surgery” combines world-class methods to mark cancer for removal by the breast surgeon and to partner with our plastic surgeons to use their unique techniques to avoid deformity, and preserve the natural contour of the breast. Additional novel tumor bed identification techniques help to focus and limit the radiation therapy which often follows these surgeries.
Lumpectomy or partial mastectomy surgeries remove the portion of the breast that is involved in the tumor, along with a safe margin around that tumor. If the “lump” to be removed is too big, or the breast smaller relative to this resection, then a patient can be left with a contour deformity, a dent, or divot that serves as a reminder of their former malignancy. At Care New England, our surgeons have refined their techniques to safely remove the tumor cells, to avoid these deformities when possible, and to repair them when necessary.
One way our plastic surgeons address these problems is to reshape the remaining breast tissue so that the space is filled, the contours re-sculpted. By pairing a cancer surgery with a breast reduction or a breast lift, what might have been a deformity can become an oncoplastic reconstruction. The breasts are lifted and reshaped with the nipples recentralized, often leading to a more youthful appearance; so a patient who may have otherwise been recommended for a mastectomy with reconstruction can leave the hospital with her breast reshaped, with good sensation, and cancer-free. Patients won’t find this approach at most hospitals yet, regardless of the institution or metropolitan area.
Partial mastectomy (aka lumpectomy) is a well-accepted treatment for small to medium-sized tumors in a localized area of the breast. Many studies have proven that lumpectomy paired with radiation has a cure rate equivalent to that of mastectomy for these appropriately-selected cases. In women with relatively larger breasts for their overall chest size, an oncoplastic reduction can allow for removal of a greater “margin” area around the tumor and has improved rates of clear margins for tumor removal.
Saving a woman’s breast, when she is the appropriate candidate for this procedure, does not decrease the effectiveness of her cancer surgery. At Care New England, plastic surgeons routinely perform breast reduction on both breasts with the breast surgeon performing the lumpectomy for the cancerous side.
The postoperative results often approach those of breast reduction or a cosmetic breast lift (mastopexy). The incisions and the shape tend to be symmetric for both breasts, making it hard to discern which of the breasts had cancer. Of course, there are methods to correct any residual discrepancies, but most of the time these are not required. Patients are often happier with improved upper body comfort and freedom and with their self-image.
In summary, oncoplastic breast reduction surgery can help breast cancer surgeons treat women with localized breast cancers. It can also improve a patient’s cosmetic and physical outcome and help her to avoid mastectomy and reconstruction. Oncoplastic surgery is the culmination of a team approach for our patients, with their breast cancer surgeons and their reconstructive surgeons working together to preserve a patient’s natural appearance while completely removing cancer. It provides the potential to help restore and sometimes improve a patient’s breast size and shape and to help restore our patients to health and wellness.
Early detection of breast cancer can save your life. Schedule your annual mammogram.
Co-Authored by:
Erik A. Hoy, MD
Plastic Surgeon
Women & Infants Hospital
Clinical Assistant Professor of Medical Science,
Brown University
Jennifer S. Gass, MD
Chief of Surgery; Director of the Breast Health Center
Emeritus Breast Fellowship Director
Women & Infants Hospital
Professor of Surgery and Obstetrics and Gynecology,
Brown University