Breast Reconstruction After Lumpectomy
30 Apr 2016
A lumpectomy involves the removal of just the tumor found in the breast, and some of the non-cancerous tissue surrounding it–not the entire breast as with a mastectomy. This surgical procedure conserves the breast, which is good. Unfortunately, it leaves the breast with a dent, bulge, or imperfection near the surgical site. After a lumpectomy the breast or breasts are likely to be different in size. Sometimes the breasts may seem asymmetrical. Because of this, many women choose breast reconstruction after a lumpectomy.
The Susan G. Komen website assures readers that breast cancer patients who have lumpectomies (along with breast radiation) face the same survival odds as those who have mastectomies. It also reports that oncologists have been encouraging women with early-stage breast cancer to choose a less radical surgery than mastectomy.
A U.S. News & World Report article from 2015 cites an expert panel assembled by the National Cancer Institute in 1990. The panel stated that “lumpectomy with radiation was ‘preferable’ to mastectomy for women with stage 1 or 2 breast cancer.” This information contributed to a reduction in mastectomy rates for those patients. It dropped from 100 percent in the 1980s to less than 40 percent in 2015. Lumpectomies now account for somewhere between 60-70 percent of cancer surgeries.
Plastic surgeons recommend waiting six months to a year after a lumpectomy before having breast reconstruction. That time will allow the breast tissues to heal. It also allows any distortion or asymmetry to stabilize. Studies have shown that after a lumpectomy about 46 percent of women were unhappy with the physical appearance of their breasts.
Immediate Lumpectomy Reconstruction
Oncoplastic surgery combines the latest plastic surgery techniques with breast surgical oncology at the time of the lumpectomy. One of the options offered by oncoplastic surgery for reconstruction is to rearrange some of the remaining tissue in order to realign the nipple and areola. This should restore a natural appearance to the breast shape. The opposing breast will then be modified to create symmetry.
During the lumpectomy, the plastic surgeon will perform what is called a bilateral breast reduction or lift. The surgeon will remove breast tissue from the cancerous breast and modify the normal breast. This procedure is described by John Hopkins Medicine as “an incision around the nipple and areola, a vertical incision from the nipple to the lower fold of the breast, and a horizontal incision in the fold of the breast.”
Unfortunately, There is a possibility of not being able to preserve blood supply to the nipple during surgery using this method, necessitating a free nipple graft. A free nipple graft removes the nipple and replaces it after the breast reduction or lift is complete. However, the free nipple graft can result in nipple numbness and inability to breast-feed, making it a “last resort” procedure.
Breast Reconstruction After Lumpectomy and Radiation
If radiation therapy follows a lumpectomy, the type of reconstruction may be limited. The skin and breast can be affected by the radiation therapy in a negative way. The method of reconstruction will then depend on the condition of the skin.
The effects of radiation can produce some shrinkage of the breast and contribute to some of the breast asymmetry. Radiation causes permanent changes to the normal breast tissue. While radiation does not affect all women the same way, for some women the breast can become hard. The breast feels much tighter, and the skin and tissue underneath are less stretchy. However, a surgeon may be able remove the firmness and scarring and fill the breast with fat injections or tissue taken from other areas of the body.
Another method that may be viable after radiation is a tissue flap. When transplanting healthy, non-irradiated tissue to the breast, the flap behaves more like normal tissues and the health of the surrounding tissues improves quite a bit. Tissue can be taken as a flap from the abdomen, the back, the rear, or even the thigh. It is possible for reconstruction to be made totally of transplanted flap tissues. If there is not enough tissue available, the flap can be used with tissue expanders and implants.
The surgeon could also suggest lipofilling, which uses tissue from other areas of the body to fill the breast or breasts. A large dent would need to be filled by fat removed from the abdomen or back. A treated breast that is much smaller than the other could be made bigger with an implant. The larger breast could be reduced and lifted which would create symmetry.
Again, because each surgical situation is different, there is no typical approach to reconstruction after a lumpectomy or with or without radiation. The surgeon will personalize the surgery based on previous treatments, goals and expected outcome.