BREAST CANCER
PLASTIC SURGERY and BREAST CANCER
Plastic surgeons work on a daily basis on the breasts. They are required to treat different breast diseases, including cancers of the breast.
The training of plastic surgeons includes courses in specialized units for the treatment of breast cancer, including cancer centres. Because of their training and their day to day activity, plastic surgeons are naturally involved in the various stages of the management of breast cancer.
Reconstructive plastic surgery is the surgery of repair. It has taken on an important place in the management of patients with breast cancer. This is especially true now that patients are no longer willing to live with a mutilation, especially as they are now well aware that reconstructive options exist. Plastic surgeons may well contribute to the extirpative surgery, and in the management of the aftermath of treatment of breast cancer.
The plastic surgeon with his own skills may take his place too in different situations:
Treatment of « simple » breast cancer
If breast cancer requires only one surgical excision (other than treatment with chemotherapy or radiotherapy), it can be done by a plastic surgeon just as it can by a breast surgeon. His skill and expertise permit him to perform a lumpectomy, sentinel lymph node biopsy and a lymph node dissection (removal of lymph nodes in the axilla) if necessary. Under his guidance, and depending on his specialisation and his place in the multidisciplinary team, he may or may not deal with your case. You can contact your plastic surgeon, and if he does not perform this surgery, he will direct you to a member of his multidisciplinary team who can deal with your case. Very often, the oncological surgeon performs the management of the initial cancer, and then the patient is later sent on to the plastic surgeon for reconstruction or correction of aftermath.
Oncoplastic conservative treatment
If the tumour volume is significant especially at the lower pole of the breast, its simple excision may cause significant morphological aftermath. In this case, excision of the tumour is accompanied by a remodelling of the breast to avoid important postsurgical deformation.
These techniques are remodelling techniques of plastic surgery applied to cancer treatment, hence the term oncoplastic surgery. These mammoplasty techniques are used daily by plastic surgeons and may therefore be applied in the treatment of known breast cancer.
The conservative treatment of breast cancer can achieve the surgical excision of the tumour and remodelling of the remaining breast to minimize the aftermath at the same time. It is logical that it be performed by plastic surgeons, in collaboration or not with a gynaecological or oncological surgeon. In some cases the oncologist or gynaecologist has received training on oncoplasty and carries out the extirpation alone. He then sends the patient to the plastic surgeon for correction of possible sequelae.
Treatment by mastectomy and immediate reconstruction
In some cases (mostly whenever wall radiotherapy after surgery is not done) mastectomy may be followed by reconstruction in the same operation: this is called immediate reconstruction. These techniques are based on the use of flaps using tissue from the patient or the use of breast implants. These plastic surgery techniques are used in mastectomy with immediate reconstruction to restore the volume and shape of the breast. The plastic surgeons are able to advise you, give you all the information, and deal with these procedures, often in collaboration with the oncologist or gynaecological surgeon, if a mastectomy has been planned.
Despite all the care in the treatment of breast cancer, therapeutic sequels may occur. Plastic surgery may also contribute its technical expertise to correct these deformities:
Aftermath of conservative treatment
A plastic surgeon trained in oncoplastic techniques will do everything to minimize the risk of aftermath. If they exist, plastic surgery may contribute to correct any distortion.
This is a complex situation that requires care by plastic surgeons with special experience in this field.
Aftermath after mastectomy
Mastectomy, which involves removing the entire breast, is less common now because of the possibility of conservative surgery. However, when necessary, a delayed breast reconstruction can be proposed. The plastic surgeon must then restore the shape and volume of the breast; in a second operation, he will reconstruct the nipple and areola and if necessary a symmetrisation of the contralateral breast will also be proposed. The techniques might rely on prostheses or tissue from the patient in the form of flaps (autologous reconstruction). These interventions have been developed by plastic surgeons and are taught during their training. Plastic surgeons are naturally breast reconstructive surgeons. After the mastectomy, you can consult a plastic surgeon to consider reconstruction, which usually takes place 1 year after the end of radiotherapy.
Is oncoplasty a specialisation?
Oncoplasty is a set of plastic surgical techniques (mammoplasty techniques used daily in morphological breast surgery) applied to breast cancer surgery. There is no diploma-based specialisation in oncoplasty. present oneself as an oncoplastician is an abuse of title, which can be confusing. This term should not be used, especially by surgeons who have not graduated from the specialty in plastic surgery. Oncoplastic surgery is practiced by surgeons trained in mammoplasties, where plastic surgeons are first line because it is their core business.