MASTECTOMY CAN BE AVOIDED USING NEW ONCOPLASTIC TECHNIQUES

In the 1970s breast conserving surgery radically altered the surgical aspect of breast cancer treatment. A similar feat has been achieved by the latest oncoplastic techniques which are the best alternatives for mastectomy. The complex nature of these processes makes them technologically very demanding but there is increasing data and figures to support their clinical efficacy.

WHAT IS BREAST CONSERVING RECONSTRUCTION?

The latest option for women who would earlier required a mastectomy is breast-conserving reconstruction which saves normal breast tissue to the extent possible and the defect caused by tumour resection is remodelled. The best principles of reconstructive surgery in combination with oncological knowledge are used to provide the patient minimum cosmetic deformities which are quite common in local excisions undertaken for treating breast cancer.

This kind of oncoplastic surgery puts together two quite different aspects of surgery – resection and reconstruction.Breast-conserving reconstruction is extremely useful in patients who are averse to having a mastectomy. Any resection that involves more than 20% of the breast volume decreases the chance of a good cosmetic result, more so when the tumour resection is in the central part of the breast.Breast conserving reconstruction can solve this issue and can be effectively used to reconstruct defects when half, or in some cases even more than half of the breast tissue has to be removed. In some extreme cases of full mastectomyalso good cosmetic outcomes are achievable with reconstruction.

TECHNIQUES OF BREAST CONSERVING RECONSTRUCTION

Mainly there are two types of methods of breast –conserving reconstruction:

•          Volume displacement-The volume displacement techniques comprise of reconstructing the resection defects by pedicles raised within the breast tissue,which are moved into the clefts left by resection. Usually the shape of the breast is not altered here but the net volume of the afflicted breast becomes less than the other one, therefore special mirror-image procedures are carried out to match the appearance of the breasts.These procedures are suitable for women with medium to large breasts where loss of volume from the breast is not an issue and sometimes may even make postoperative radiotherapy easier.

•         Volume replacement – This technique is used in cases where corresponding tissue is imported from somewhere other than the breast itself to fill in the gaps and reconstruct the defects caused by tumour resection.Generally the volume of the breast doesn’t change and may even increase in some cases because of the imported tissue therefore needing no contralateral intervention for restoring symmetry.Patients who have small- to medium-sized breasts or who may not want to lose any volume can opt for these procedures.

ADVANTAGES OF MODERN BREAST CANCER TREATMENTS

The advanced techniques applied in breast cancer treatment make them far superior than traditional treatments in the following ways:

•          These avoid full mastectomy which is a long and painful process with psychological implications as well.

•          These also avoid full reconstruction to a large extent and the use of implants which in turn lead to many complications.

•          These breast-conserving reconstruction techniques preserve a large amount of normal breast tissue which provide normal breast sensation,movement and feeling unlike any implants.

•          The normal breast tissue preserved in these techniques also responds favourably to postoperative radiotherapy when required.

•         The cosmetic outcome of these procedures is aesthetic and almost flawless.

Breast-conserving reconstruction thus is an innovative surgical process in the treatment of early breast cancer and has certainly a few notches ahead of both mastectomy orconventional breast-conserving surgery.