Breast conservation therapy (BCT), also known as breast oncoplastic surgery, is one approach for women with breast cancer where the lesion is removed and breast tissue is preserved. Occasionally the patient requires partial reconstruction using their own tissue at the time of lumpectomy. Albert Losken, MD, an Emory plastic surgeon, notes that this approach combines the principles of oncology with those of plastic surgery, and is beneficial for numerous reasons.
“Breast cancer surgeons are typically faced with two conflicting issues,” says Dr. Losken. “Their primary goal is to remove as much tissue as possible for effective cancer control, while at the same time trying to preserve breast tissue to prevent a poor aesthetic outcome. By working together as a team, we are able to address these issues simultaneously, maximizing both the cancer and cosmetic outcomes.”
Emory surgeons Mark D. Walsh, MD, Grant W. Carlson, MD, and Albert Losken MD, are among a select group of surgeons performing this procedure. Dr. Walsh explains that before breast oncoplastic surgery, breast cancer surgeons just removed the cancerous tissue, which often resulted in an undesirable cosmetic outcome.
“Oncoplastic surgery enables the surgeon to remove more tissue and ensure clear margins, while minimizing the potential for a breast deformity. Not every patient can have breast conservation, but oncoplastic breast-conserving surgery will enable patients to save their breast. Whether the defect is small or large,” says Dr. Losken, “the oncoplastic approach allows for preservation of breast shape through breast tissue rearrangement or local flap replacement plastic surgical procedures. Surgery on the opposite breast, such as a lift or a reduction will often improve results and maintain symmetry.”
In women who are not candidates for BCT or who require total mastectomy, many good options still exist. Some women may be candidates for the “nipple-sparing” mastectomy which along with immediate reconstruction can give very natural results. Surgeons replace breast tissue with implants or their own tissue taken from the back or lower abdomen (DIEP or TRAM flap). The reconstructed breast should have the same shape, feel and nipple. The nipple may retain some sensation. This is often an option for women who are at high risk of breast cancer and wish to have their breast removed as risk reducing surgery.
The most important thing to remember is that Emory Breast Center surgeons can perform the most innovative breast reconstruction techniques. “Our goal is to remove the cancer and keep the appearance of the patient’s natural breast,” says Dr. Walsh.