Cancer Treatment
After the diagnosis of breast cancer, many patients take a treatment path similar to the one described below. Treatment is dependent on many factors, and it is common for patients to undergo treatment plans that look different to this one.
  1. Discovery of cancer
  2. Surgery to remove breast cancer/s, lymph node assessment, reconstruction of affected breast/s (optional)
  3. Chemotherapy (if required) [Note: in certain cases, chemotherapy is provided before surgery]
  4. Radiation therapy (if required)
  5. Anti-hormone treatment (if required)
The recommended treatment plan for each patient is formulated by a team of specialists from the different fields involved in cancer treatment (surgeons, medical oncologists, radiation oncologists, pathologists, radiologists, and breast care nurses). The combined effort helps ensure that the patient's treatment is optimised to the specific circumstance of that patient.
Cancer Australia provides more information on breast cancer that readers may find helpful.
The section below describes oncoplastic surgical treatment for breast cancer in greater detail.
 
 
Oncoplastic Surgery
Oncoplastic surgery is a sequence of surgical procedures that removes cancer/s from the body ("onco"), as well as reconstructs the part of the body affected by the cancer ("plastic").  In the past, it was most common for breast cancer surgery to be performed by two surgeons. A breast surgeon would perform the surgical removal of the cancer; and a plastic surgeon would subsequently perform the reconstruction of the breast. More recently, it has become more common to have one surgeon, who is proficient in both cancer removal and breast reconstruction, to perform both treatment procedures for the patient. These surgeons are known as oncoplastic surgeons.
Cancer Removal
Breast cancers are removed from the body using one of two techniques: mastectomy, or breast conserving surgery.
A mastectomy is the surgical removal the entire breast. This can be performed on one or both breasts, depending on what the patient requires. It is important to note that while the intention of a mastectomy is to remove all the breast tissue, a small percentage of breast tissue will always remain. Consequently, risk of breast cancer recurring in such scenarios still exists. Mastectomies used to be the standard path of treatment for most breast cancer patients in the past. Today, mastectomies are still commonly performed, but typically recommended for patients with specific cancer characteristics (e.g. large cancers, or multiple cancers in one breast). Mastectomies are also performed on patients whose family histories indicate a significantly higher risk of developing breast cancer (e.g. BRCA gene mutation). In such cases, the mastectomies are performed for preventative purposes. 
Breast-conserving surgery (also known as wide local excision, lumpectomy, or partial mastectomy) is the removal of the breast cancer, along with a margin of breast tissue surrounding the cancer; the remaining breast tissue is unaffected. The margin is removed with the cancer to help ensure that the entire cancer as well as any cancer cells at the periphery are safely removed. In rare cases, cancer cells may still be found in the margin and a further procedure may be required to remove more tissue. Where used appropriately, breast-conserving surgery presents a key advantage over the mastectomy: the patient is able to retain a significant portion of her breast. Studies have shown that patients who undergo breast-conserving surgery have higher satisfaction levels than patients who undergo mastectomies (even with reconstruction). Additionally, other studies have shown that with regard to cancer recurrence, patients who undergo breast conserving surgery and radiotherapy have the same outlook as patients who undergo mastectomies.
Breast Reconstruction
Often after cancer is removed, the affected breast no longer appears the same as before and does not match the appearance of the other breast. If uncorrected, this can negatively affect patients physically, emotionally, and psychologically. Breast reconstruction may help to restore the appearance of the breast. While a 100% restoration of the appearance of the breast is not assured, it is encouraging to note that the range of simple and advanced reconstructive techniques available today enables high satisfaction levels in the majority of patients. The specific reconstruction technique most appropriate for a patient will depend on several factors including the characteristics of the cancer, the type of cancer removal performed, the patient's body type, and the patient's personal preferences. The surgeon will discuss these factors with each patient to ensure that the appropriate treatment is recommended.
Breast Reconstruction is typically performed using one of four categories of techniques:
1. Implant-based reconstruction
2. Reconstruction employing free flaps
3. Reconstruction employing regional flaps
4. Mammoplasty
(Note: these procedures are described briefly and summarised below. More detailed information on these procedures can be obtained from the surgeon.)
1. Implant-based reconstruction
In the context of breast cancer surgery, this form of reconstruction uses the implant to replace the volume of the breast after a mastectomy. Implants come in numerous shapes and sizes, and the surgeon will select the implant that best restores symmetry between the breasts. In most cases of implant-based reconstruction, a patient may achieve a superior cosmetic outcome by having fat transferred from one part of her body (e.g. tummy area or thighs) into the affected breast. This helps to achieve a more natural look and feel for that breast, and is known as fat grafting.
2. Reconstruction employing free flaps
After a mastectomy, a patient may prefer to undergo reconstruction without the use of an implant. Or, the skin around the area of the affected breast may be insufficient to accommodate an implant. In such cases reconstructing the breast from tissue taken from another part of the patient's body (known as a "flap") may be considered. While a flap may be taken from different areas of the body, a common part of the body that may be used is the skin and fat around the abdomen area. A section of fat and skin is taken from the lower abdomen, and transferred to the breast area. The blood vessels and skin are carefully reconnected to ensure both healthy blood supply and a good cosmetic result.
3. Reconstruction employing regional flaps
In the case where breast-conserving surgery is performed on a patient with small-to-moderate sized breasts, and where the removed cancer leaves behind a significant cavity, tissue from or around the breast (e.g. below the armpit) may be  reshaped and used to fill in the cavity. In such a situation, the breast-conserving surgery and flap-based reconstruction is an alternative treatment plan to a mastectomy followed by implant-based reconstruction. In certain situations, instead of using an implant, a larger regional flap may be used to reconstruct a breast after a mastectomy. This flap is taken from the upper back (latissimus dorsi) area.
4. Mammoplasty
Mammoplasty are a group of surgical procedures that aim to reshape and modify the appearance of the breast. In the context of breast cancer, mammoplasty is only performed on patients who undergo breast-conserving surgery and are typically suited for larger-breasted women. They fall into one of two categories: (A) therapeutic mammoplasty, and (B) reductive mammoplasty. Therapeutic mammoplasty is carried out on the breast that is affected by cancer. After the cancer is removed, the remaining breast tissue is reshaped to fill in the cavity left behind by the cancer, resulting in a more natural appearance for the affected breast. A reductive mammoplasty is the reduction and reshaping of the breast unaffected by cancer, and its aim is to create symmetry between both breasts.
All information on this page is provided only as a reference, and does not constitute medical advice. Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.

Telephone: 02 9121 6201

North Shore: Level 4, Suite 3A, North Shore Private Hospital, 3 Westbourne Street, St Leonards NSW 2065

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Email: practice@oncoplasticsurgery.com.au

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