Oncoplastic breast surgery is a relatively new surgical option for patients undergoing treatment for breast cancer.
There is some confusion about the difference between oncoplastic and reconstructive surgery of the breast. Some doctors and patients
consider them the same and others separate them.
For me, reconstructive surgery refers to reconstruction of breast after mastectomy, or breast removal surgery. It can be performed either immediately at the time of mastectomy by a plastic surgeon, or years after mastectomy. Regardless, in my mind, it refers to reconstruction after breast had been removed completely.
Oncoplastic surgery, in my mind, refers to reconstruction of the breast after lumpectomy, when only part of the breast had been removed. Commonly it uses similar or the same techniques as reconstructive surgery after mastectomy (that is where confusion is).
Oncoplastic surgery combines the removal of breast cancer as part of lumpetomy as well as immediate reconstruction.
Reconstructive methods include procedures performed on the same and opposite breast. They include breast reduction, breast lift, breast re-arrangement, fat grafting, implants, local and distant flaps and other procedures. Usually these procedures are performed on the patients at the time of lumpectomy prior to radiation treatment.
Oncoplastic breast surgery has been designed for improved aesthetic outcome for women undergoing lumpectomy.
Commonly the patients are not informed about reconstructive options prior to lumpectomy. After lumpectomy had been done most patients end up having radiation treatment. The problem is that after radiation many oncoplastic reconstructive options are no longer available to those patients.
For example, breast re-arrangement surgery, fat grafting and some implants cannot be performed after radiation.
Sometimes general breast surgeons have difficulty obtaining clear margins and they are concerned about final breast appearance also. they choose to remove a little less to decrease the deformity and then send that patients for radiation. After radiation is done, the final deformity is usually much worse. At that point the only option for reconstruction is flap.
Potentially, if the surgeon is able to remove more breast tissue around the tumor and avoid radiation all together, by using immediate breast re-arrangement and fat grafting or implants, far better cosmetic result is possible.
I recommend getting evaluated by a trained plastic surgeon BEFORE undergoing lumpectomy to make sure that use of oncoplastic surgical techniques can be warranted.