Oncoplastic breast-conserving surgery
Therapeutic Mammaplasty
This term refers to an operation in which a wide local excision is performed with a breast lift or breast reduction. In suitable women, this operation can make preserving the breast possible, when otherwise a mastectomy would be necessary. In other women it can allow a wider excision of the cancer - Our studies show that it can half the chances of requiring further surgery to achieve complete excision of the cancer compared to standard wide local excision. It can also improve the cosmetic result and reduce or eliminate deformity caused by removing breast tissue. In some women with very large breasts it can also reduce the adverse effects of radiotherapy, which can be more severe in such cases.
It is usually performed as a bilateral operation (both breasts) so that the breasts are symmetrical. In certain situations a mammaplasty on just the affected breast may be possible. Recovery and aftercare following this operation is the same as for a breast reduction or breast lift. Most women stay one or two nights in hospital
LD Miniflap
This operation involves replacing tissue removed as part of a wide local excision with tissue from the back. 2 operations are required: the first is a wide local excision alone in which up to half the breast may be removed. The defect resulting from this is filled with fluid (that gradually absorbs over 3 - 4 weeks) to temporarily preserve the breast shape.
Once it is known that the wide margin of tissue removed around the cancer is normal (under the microscope) and the cancer is completely removed, a second operation is performed (approximately 2 weeks afterwards) to bring some tissue, including muscle, from the back around to the breast to fill the defect in the breast. Recovery after this operation is similar (usually a little quicker) as after a mastectomy with LD flap reconstruction.
LICAP Flap
This operation involves replacing tissue excised from the breast with tissue from the side of the chest. It can be an excellent option for ladies with cancers in the outer part of the breast. It is usually performed at the same time as the wide local excision and does not add much to the overall recovery time. Typically with this operation there are no scars on the breast but a longish scar in the bra line.
TDAP Flap
This operation is similar to the LD miniflap but dos not take any muscle from the back, just the tissue overlying the muscle. As with the LD miniflap, it is usually performed as two operations to make sure that margins of excision are clear first. Because the muscle is not taken, recovery time is quicker than the LD miniflap.
Finding a "Positive" out of a "Negative"
Some women with large breasts may prefer to be smaller. It is sometimes an option to perform a breast reduction at the same time as a wide local excision. In fact, in suitable women, it can often make this operation easier and can allow a very wide margin of normal tissue to be excised around the cancer. Some women have ptotic (droopy) breasts. In such cases it is usually an option to perform a breast lift at the same time as a wide local excision.