Cancer
When someone is diagnosed with breast cancer, there are an overwhelming number of decisions to make about treatment. Among those decisions is what to do about breast preservation surgery.
For most patients, breast surgery goes down one of two paths: a lumpectomy (surgical removal of a tumor or tumors) or a mastectomy (surgical removal of the breast). Research shows both options have similar outcomes, in terms of survival rates.
Mastectomy Surgery: What to Know
However, breast surgery is about more than simply removing the cancer from the body.
“Breast cancer patients who undergo breast surgery endure not only the physical effects of the surgery, but mental and emotional effects, as well,” said Lori Medeiros, MD, Executive Director of the Breast Center for Rochester Regional Health. “For some patients, body image changes lead to depression, which can affect cancer survival rates.”
The field of oncoplastic surgery combines methods used in breast surgeries with surgical techniques used in plastic surgery. This helps providers to perform a lumpectomy instead of a mastectomy, which in turn allows a patient to undergo different types of breast reconstructive surgery.
One such approach combines a lumpectomy with a breast reduction surgery (reductive mammoplasty). Especially for patients with larger breasts who often live with back and shoulder pain and are more likely to experience dermatitis after radiation therapy, oncoplastic surgery offers relief in different ways.
“Patients who have a mastectomy and patients who have a breast reduction have about the same expected recovery period,” said Samuel Yost, MD, a plastic and reconstructive surgeon with Rochester Regional Health.
“Beyond the physical recovery, however, reduction may be better for some patients in the long term because it preserves body image, sensation, and sexual satisfaction for many women better than mastectomy,” Dr. Medeiros said.
With advances in breast cancer care, the role of radiation has evolved. One of the advantages of mastectomy used to be that it avoided radiation. However, research shows radiation reduces the risk of breast cancer returning locally in women with larger tumors or cancerous lymph nodes. For this reason, there has been a rapid expansion in the use of radiation even after mastectomy. For these patients, oncoplastic surgery offers helps to decrease the rate of complications.
The oncoplastic breast reduction procedure also has advantages over breast reconstruction that uses implants. If a patient with breast implants needs to undergo additional radiation later on, the implants can pose challenges down the road. Having radiation therapy around a breast implant can cause capsular contractures, in which the breast becomes tighter and more firm, and potentially causes the implant to shift upward in the chest. Implants can also increase the rate of infections and might lead to removal of the implant, which often requires additional surgeries and hospitalizations.
Since oncoplastic breast reduction preserves tissue, it avoids the use of implants and allows radiology oncologists to avoid having to radiate around an implant.
“We are able to help these patients out by not only removing cancer, but giving them an opportunity to choose how their breasts will look and feel after their treatment,” said Andrew Smith, MD, Director of Microsurgery at Rochester General Hospital.
Under New York state health law, these types of breast surgeries are covered by health insurance plans as reconstructive surgeries instead of cosmetic surgeries; they are not considered an out of pocket expense.
Beyond caring for patients in a medical setting, staying in tune with patients’ emotional health is a priority for breast cancer and plastic & reconstructive surgery providers. Studies show breast cancer patients with higher rates of stress are linked to poorer health outcomes.
Patients are often feeling a range of emotions about how their body looks and feels following their cancer treatment. These emotions can cause a lot of personal stress.
Relationships between breast cancer patients and their partners often face tests around this topic too. Patients may not feel comfortable with how they look around their partner, which can be a source of tension in the relationship – in addition to the significant challenges of the cancer diagnosis and recovery they have already gone through together.
For both the physical and emotional health of the patient, choosing oncoplastic surgery to remove the cancer and reconstruct the breasts all at once takes some of the emotional burden off of them.
“The good thing with what we do is that most patients will go on to live decades after their breast cancer treatment,” Dr. Medeiros said. “In the heat of the moment, most patients are overwhelmed and are not thinking about what their body might look like even a few months down the road. Our role along with our plastic & reconstructive surgery colleagues is to try to address the aesthetics side of a patient’s breast treatment so they don’t need to worry about it years later.”
