Oncoplastic Breast Conservation
What is Breast Conservation Surgery?
Breast conservation surgery is breast cancer surgery that involves removal of part of the breast with the intention of removing the cancerous area from your breast whilst maintaining healthy breast tissue. The majority of breast cancers can be treated in this manner and when completed successfully in combination with breast radiotherapy achieves similar outcomes in terms of cancer treatment when compared with mastectomy. Options for breast conservation surgery following a diagnosis of breast cancer are becoming more varied and Mr Hawkins offers a wide range of breast conservation procedures within his oncoplastic practice. These techniques aim to reduce the cosmetic impact of breast cancer treatment whilst achieving the very best cancer outcomes.
Some of the surgical/oncological options that Mr. Hawkins offers include;
Often performed through remote incisions (around the nipple-areolar complex or periphery of the breast) to keep scars away from visible areas and prevent deformity of the breast. These procedures are usually possible if less that 10-15% of the breast is removed during the removal of a cancerous area within the breast. When the cancer has been successfully excised in its entirety and combined with post operative radiotherapy this treatment achieves similar cancer outcomes to a mastectomy (removal of the whole breast).
These techniques involve the removal of a cancerous area within the breast in association with a plastic surgical breast reduction (mammoplasty) procedure. Therapeutic mammoplasty techniques are varied (WISE pattern, Vertical Scar, Round Block etc.) and Mr Hawkins is proficent in a range of mammoplasty procedures allowing him to adapt his technique to your individual circumstance. Therapeutic mammoplasty techniques can be employed to increase the proportion of patients who may appropriately avoid mastectomy and can involve removal of greater the 50% of the original breast volume. This allows the breast to be conserved in patients who may have relatively large tumours who would not have been eligible for breast conservation using traditional non-oncoplastic wide local excision procedures.
Chest Wall Perforator Flaps are increasingly being used to treat breast cancers where relatively large areas of the breast need to be removed as part of a breast cancer surgery. This approach allows the patients own soft tissue (flap) to be used to provide volume replacement for excised breast tissue. This tissue is then brought into the breast whilst maintaining blood supply through small blood vessels on the patients chest wall. Mr Hawkins has experience in the use of a range of Chest Wall Perforator flaps (LICAP, LTAP, AICAP) and will advise if this is felt to be applicable to your situation.
Traditionally chemotherapy is given following surgery but increasingly chemotherapy agents are given before surgery (also termed Neo-adjuvant treatment) in order to shrink breast cancers prior to surgery. Whilst giving neoadjuvant chemotherapy is thought to be the same as post surgery chemotherapy in terms of impact on overall survival, it does offer some important advantages when used in the correct situation.
These include "down-staging" of breast cancer tumours which may make breast conservation possible, whereas before chemotherapy mastectomy may have been the only option. In addition a patient can gain a useful insight into the effectiveness of the chemotherapy in their own case by watching the effect of these agents on their cancers size and stage. These treatments are recommended and administered through the multidisciplinary team approach, including the advice and expertise of a specialist oncologist.
Inevitably in certain situations mastectomy (removal of the whole breast) is the only treatment that will effectively treat a breast cancer dependant upon your individual circumstance. This may be because the tumour in the breast is too large to allow breast conservation or where attempts at breast conserving surgery have failed to achieve adequate clearance. In addition sometimes a patient may request a mastectomy even when breast conservation is possible (e.g. where there is an increased familial breast cancer risk). In these situations a patient may elect for a simple mastectomy (without reconstruction) or a mastectomy in combination with whole breast reconstruction.
Even where a patient elects for a simple mastectomy the oncoplastic philosophy persists ensuring that patients receive a mastectomy scar that is as easy to live with as possible and avoids excess skin being left behind. Increasingly women are choosing breast reconstruction following mastectomy either at the time of the initial surgery (immediate reconstruction) or at a later date (delayed reconstruction), Mr Hawkins offers a wide range of breast reconstruction techniques and is able to guide you through your options in order to achieve the best outcome for your individual situation (see Reconstructive and Restorative Surgery).
What is Breast Conservation Surgery?
Breast conservation surgery is breast cancer surgery that involves removal of part of the breast with the intention of removing the cancerous area from your breast whilst maintaining healthy breast tissue. The majority of breast cancers can be treated in this manner and when completed successfully in combination with breast radiotherapy achieves similar outcomes in terms of cancer treatment when compared with mastectomy. Options for breast conservation surgery following a diagnosis of breast cancer are becoming more varied and Mr Hawkins offers a wide range of breast conservation procedures within his oncoplastic practice. These techniques aim to reduce the cosmetic impact of breast cancer treatment whilst achieving the very best cancer outcomes.
Some of the surgical/oncological options that Mr. Hawkins offers include;
- Wide local excision of the breast with glandular reshaping.
Often performed through remote incisions (around the nipple-areolar complex or periphery of the breast) to keep scars away from visible areas and prevent deformity of the breast. These procedures are usually possible if less that 10-15% of the breast is removed during the removal of a cancerous area within the breast. When the cancer has been successfully excised in its entirety and combined with post operative radiotherapy this treatment achieves similar cancer outcomes to a mastectomy (removal of the whole breast).
- Therapeutic Mammoplasty.
These techniques involve the removal of a cancerous area within the breast in association with a plastic surgical breast reduction (mammoplasty) procedure. Therapeutic mammoplasty techniques are varied (WISE pattern, Vertical Scar, Round Block etc.) and Mr Hawkins is proficent in a range of mammoplasty procedures allowing him to adapt his technique to your individual circumstance. Therapeutic mammoplasty techniques can be employed to increase the proportion of patients who may appropriately avoid mastectomy and can involve removal of greater the 50% of the original breast volume. This allows the breast to be conserved in patients who may have relatively large tumours who would not have been eligible for breast conservation using traditional non-oncoplastic wide local excision procedures.
- Chest Wall Perforator Flaps
Chest Wall Perforator Flaps are increasingly being used to treat breast cancers where relatively large areas of the breast need to be removed as part of a breast cancer surgery. This approach allows the patients own soft tissue (flap) to be used to provide volume replacement for excised breast tissue. This tissue is then brought into the breast whilst maintaining blood supply through small blood vessels on the patients chest wall. Mr Hawkins has experience in the use of a range of Chest Wall Perforator flaps (LICAP, LTAP, AICAP) and will advise if this is felt to be applicable to your situation.
- The use of Neo-adjuvant Chemotherapy (down-staging).
Traditionally chemotherapy is given following surgery but increasingly chemotherapy agents are given before surgery (also termed Neo-adjuvant treatment) in order to shrink breast cancers prior to surgery. Whilst giving neoadjuvant chemotherapy is thought to be the same as post surgery chemotherapy in terms of impact on overall survival, it does offer some important advantages when used in the correct situation.
These include "down-staging" of breast cancer tumours which may make breast conservation possible, whereas before chemotherapy mastectomy may have been the only option. In addition a patient can gain a useful insight into the effectiveness of the chemotherapy in their own case by watching the effect of these agents on their cancers size and stage. These treatments are recommended and administered through the multidisciplinary team approach, including the advice and expertise of a specialist oncologist.
- Proceeding to Mastectomy.
Inevitably in certain situations mastectomy (removal of the whole breast) is the only treatment that will effectively treat a breast cancer dependant upon your individual circumstance. This may be because the tumour in the breast is too large to allow breast conservation or where attempts at breast conserving surgery have failed to achieve adequate clearance. In addition sometimes a patient may request a mastectomy even when breast conservation is possible (e.g. where there is an increased familial breast cancer risk). In these situations a patient may elect for a simple mastectomy (without reconstruction) or a mastectomy in combination with whole breast reconstruction.
Even where a patient elects for a simple mastectomy the oncoplastic philosophy persists ensuring that patients receive a mastectomy scar that is as easy to live with as possible and avoids excess skin being left behind. Increasingly women are choosing breast reconstruction following mastectomy either at the time of the initial surgery (immediate reconstruction) or at a later date (delayed reconstruction), Mr Hawkins offers a wide range of breast reconstruction techniques and is able to guide you through your options in order to achieve the best outcome for your individual situation (see Reconstructive and Restorative Surgery).
