How do you want your breasts to look after cancer surgery?

It used to be taboo to worry about cosmetic results following breast cancer surgery. Surgeons and patients were focused on one result – removing all of the cancer. How a woman’s breasts looked after surgery was not important.

Fortunately, times have changed, and so have medical advancements. Dedicated breast surgeons and reconstructive surgeons can accomplish both – remove the cancer and restore a woman’s breasts to a cosmetically natural look!

During The Breast of Everything podcast, Eric Brown, MD, Comprehensive Breast Care surgeon, and William Stefani, MD, plastic surgeon, talked about breast reconstructive surgery advancements and what women can expect today.

As surgeons, we ask our patients what is important to them. What do they want their breasts to look like after surgery and treatment? We know their cancer will be treated effectively, but we also want them to have the best cosmetic results. Most women have their whole life ahead of them, and they want to feel good and look good.

This is when oncoplastic surgery merges with breast surgery to achieve the results women are hoping for. The two surgeons have a meeting of the minds prior to the woman’s surgery to determine the best course of treatment for the patient and map out a plan for the best breast conservation possible with the most cosmetically natural looking breasts.

During surgery, the breast surgeon takes out as much breast tissue as possible so the pathologist can have a large specimen. The oncoplastic surgeon sculpts and shapes the remaining tissue of the breast and performs a breast reduction (if needed) and a breast lift. During this one operation, the plastic surgeon also looks at the healthy breast to see if it has any pre-cancerous cells.

Patients report they love the results and love that they only need a single surgery in most cases! That is why it is so important to have dedicated surgeons with specialized training to conduct the surgery. National data shows that if the surgery is conducted by a dedicated breast surgeon, the need for a second surgery is only 15 percent; when an oncoplastic surgeon is involved, the number drops to less than 5 percent.

Dr. Stefani points out that radiation will affect the size of the breast. Radiation doesn’t discriminate, he reports. The breast will shrink over time as a result of radiation, so the surgeon will reduce the size of the healthy breast to match the size of the lumpectomized breast. Patients should also know that, in order to achieve the best cosmetic outcome, traditional radiation will be recommended. This means about 30 to 35 treatments in lower doses over a longer period of time.

One of the most significant issues breast surgeons face is obtaining clear margins. A clear, negative, or clean margin means there are no cancer cells at the outer edge of the tissue that was removed. A positive margin means that cancer cells come right out to the edge of the removed tissue. During a lumpectomy, your surgeon’s goal is to take out all the breast cancer plus a rim of normal tissue around it to make sure all of the cancer has been removed.

 If women without breast cancer want voluntary breast reduction, Dr. Stefani notes the three risk factors involved: smoking, diabetes and a high BMI. In the majority of cases, he will not conduct elective breast reduction surgery on these high-risk patients.

During the podcast, Dr. Brown and Dr. Stefani also discussed fat grafting (also sometimes called lipo-filling). The plastic surgeon uses liposuction to harvest fat as a measure to keep as much of the collagen content as possible, which helps restore the breast’s shape and suppleness, helps improve blood supply and helps with wound healing.