Partial breast reconstruction

Dr Johan van Heerden elaborates on partial breast reconstruction, an option for those who had breast-conserving surgery.

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What is partial breast reconstruction?

Partial breast reconstruction, also known as oncoplastic reconstruction, is an option for breast cancer patients who have had breast-conserving surgery (BCS), such as a lumpectomy or quadrantectomy (quarter of the breast is removed to treat breast cancer) and wish to recreate symmetry. These techniques also fall under the immediate breast reconstruction group.

Breast-conserving surgery implies that a mastectomy is not performed and, although the breast will be smaller, your own tissue is used to reconstruct the resulting defect.

Indications for breast-conserving surgery

Most early-breast cancer patients qualify for breast-conserving surgery. Depending on the unique behaviour (biology) of the cancer, the oncologist will discuss options of chemotherapy before (neo-adjuvant) or after (adjuvant) surgery.

After neo-adjuvant chemotherapy, the tumour may have decreased significantly in size and breast-conserving surgery may now be an option, if it wasn’t possible before the chemotherapy.

Depending on the ratio between the size of the cancer and the size of the breast, the plastic surgeon will be able to discuss the various possibilities after breast-conserving surgery with you.

With very small breasts, the possibilities decrease, but many women with small breasts can receive breast-conserving surgery and still end up with a reasonable cosmetic outcome.

Different partial breast reconstruction techniques

Re-arrangement of the remaining breast tissue is possible due to the predictable and reliable blood supply to the breast.

If, for example, a quarter of the breast in the lower inner quadrant is removed, the remaining breast tissue from the lower-outer quadrant can be transposed into the defect.

Special skin incision designs, like the Wise-pattern, lollipop, peri-areolar or infra-mammary, can be utilised to perform the oncoplastic surgery, without leaving unnecessary scars on the breast.

Plastic surgeons are trained to respect the aesthetic-sensitive areas of the breast and once the skin incisions have healed, these procedures give very similar results to standard cosmetic breast procedures.

In selective cases, tissue from the sides or back of the chest can be utilised to fill the defect, but these options include more surgery time and risk, with additional scarring and pain, and should be discussed in detail before the procedure.

What about the opposite breast?

When the affected breast is reduced in size with removal of the cancer, it’s vital that a symmetrising procedure is offered for the non-affected breast. This is very similar to the cancer procedure, except for the fact that the plastic surgeon can plan the areas where breast tissue should be removed with freedom.

It’s important to ask your plastic surgeon for photo-description to understand what to expect after the surgery and how the scars and expected change in size and shape will look like.

End remarks

You don’t have to be afraid to ask your surgeon for breast-conserving surgery. Very good international studies have proven that breast-conserving surgery with post-op radiotherapy are safe and even have a higher survival rate compared to mastectomy alone. This approach keeps the surgery simple without the added risk of implants or large autologous reconstructions (uses your own skin, fat, or muscle).