“Ask Dr. HKSH” - Oncoplastic Breast Surgery

Dr. CHEUNG Ho Hung, Billy

Specialist in General Surgery

1. Is mastectomy mandatory for breast cancer patients?

For patients with breast cancer, the tumour needs to be surgically removed. There are several types of surgery. One of them is breast-conserving surgery, which involves removal of the cancerous area and some normal breast tissues while leaving the majority of the breast intact. Another is conventional mastectomy, which removes the entire breast, including the areola and nipple. The third option is mastectomy with reconstruction, suitable for patients who wish to keep the body contour after mastectomy. They can have the breast rebuilt with their own body tissues or synthetic implants.

2. What are the characteristics of oncoplastic breast surgery?

If patients want to preserve the breast, breast-conserving surgery is a viable option. It ensures complete removal of cancer cells by excising the tumour and some normal breast tissues. The breast tissues and skin are then sutured by doctor.

If the tumour is relatively large, or its location may significantly affect appearance, oncoplastic breast surgery can be considered. With planning of surgical incisions and breast tissue rearrangement before surgery, this approach is more likely to meet one’s expectation with an ideal cosmetic outcome.

3. Is oncoplastic breast surgery suitable for all breast cancer patients? What preoperative assessments are needed to decide suitability?

Oncoplastic breast surgery is a type of breast-conserving surgery, and doctor must ensure complete tumour removal during the procedure. Thorough preoperative assessments are required not only to determine the size and extent of tumour, but also to confirm if it has invaded the nearby tissues, such as the skin or underlying muscles.

Furthermore, doctor must confirm the absence of other suspicious tumours in the breast. This enables preservation of healthy breast tissues and thorough removal of all cancerous tissues, thereby achieving complete removal. Surgeon must also make sure that the patient can undergo post-operative radiotherapy, which can significantly reduce the risk of recurrence.

4. How is oncoplastic breast surgery performed?

Doctor needs to consider multiple factors before performing oncoplastic breast surgery. The first one is one’s suitability for oncoplastic breast surgery. As previously mentioned, the procedure must achieve complete tumour removal for postoperative radiotherapy. Based on tumour location and size as well as breast size and shape, surgeon will discuss with the patient the optimal incision site, the volume of breast tissue to be excised, and the use of local tissues for reconstruction. Both the areola and nipple may need to be repositioned closer to the centre of the breast to achieve symmetry with the opposite breast and a more acceptable appearance.

During surgery planning, surgeon may often consider several key incision sites, such as the areola, the lower breast fold, the axilla, or the lateral side of the breast. Scars in these areas are easier to conceal, and will become less visible once healed. Surgeon may also consider a circular or doughnut-shaped incision around the areola, as it can keep the scar hidden inside the areola and preserve a more natural breast shape. If the tumour is located near the areola and nipple, a central resection surgery may be considered to remove both parts. Even with the areola and nipple excised, surgeon can still rebuild the breast with the surrounding tissues, and achieve a desirable aesthetic outcome.

For patients with larger or ptotic breasts, surgeon may also perform reconstruction surgery on the asymptomatic breast during cancer resection. It can achieve better symmetry, even improvement in breast ptosis.

5. Will oncoplastic breast surgery affect subsequent treatment?

As long as the tumour is completely excised, patients can proceed with necessary subsequent treatments after recovery from oncoplastic breast surgery. Breast reconstruction has no adverse impact on later treatments.