Lumpectomy reconstruction, also known as oncoplastic surgery, is an alternative approach to breast conservation treatment that combines plastic surgery, breast reconstruction and conventional breast cancer surgery. It’s intended to achieve the best possible cosmetic results from a lumpectomy without sacrificing your surgeons’ ability to treat the cancer. Many women who have had oncoplastic surgery report that there’s no sign that they ever had breast cancer surgery — because their breast shape looks similar to or better than before their breast cancer surgery, their breasts look symmetric and the scarring from the surgery is hidden from view.

Besides improved cosmetic results, oncoplastic surgery can also provide the following benefits:

• Widened Surgical Margins — Surgeons normally remove some additional tissue, called a margin, surrounding the tumor itself to help ensure that all the cancer cells have been eliminated. Positive margins (cancer cells found in the edges of the removed tissue) can mean that some cancer still remains near the tumor site. Studies have shown that oncoplastic surgery patients are less likely to have positive margins than patients who had a conventional lumpectomy. Surgeons who perform standard lumpectomies sometimes are reluctant to remove wide margins of tissue around the tumor because that can worsen the cosmetic impact of the procedure. Oncoplastic surgeons are less concerned about taking wide margins because their breast reconstruction methods will effectively fill the space left after removing the tumor.
• Option of Breast Volume Reduction as part of an Oncoplastic Procedure — Patients with macromastia (large breasts causing back, neck or breast pain) can choose to have a breast reduction performed as part of their oncoplastic breast cancer surgery. In addition to the benefit of wider margins, women who have a breast reduction or lift as part of their cancer surgery get the additional benefit of decreased pain related to their large or drooping breasts.

Types of Oncoplastic Surgery

The term “oncoplastic surgery” refers to a range of possible approaches, some involving just the breast operated on for cancer and some involving both breasts. In the most basic form of oncoplastic surgery, a modest amount of tissue will be removed to get clean margins around the cancer and the remaining tissue will be rearranged to make the breast appear as natural as possible. When more extensive tissue arrangement is required, the total procedure may also involve surgery on the opposite, non-cancerous, breast so that both breasts look similar in size and shape. Finally, patients with very large breasts can opt to have a breast reduction performed as part of their oncoplastic surgery. Often, a plastic surgeon will collaborate with the breast surgeon for procedures that include breast reductions or surgery on the opposite breast. 

Marking the Cancer Site

California Pacific Medical Center now utilizes a new device that permanently marks the tumor site and is a valuable aid to oncoplastic surgery in other ways. The device, called BioZorb® (Focal Therapeutics, Inc.), is a three-dimensional surgical implant with titanium clips embedded at various points along the implant’s framework.

BioZorb is sutured directly to the tumor site during breast cancer surgery and has multiple advantages:

• BioZorb’s framework is bioabsorbable, which means that the patient’s body will absorb it over time (a year or more) so it doesn’t need to be surgically removed.
• The device helps fill the space left behind when a tumor is removed and serves as a kind of scaffolding for tissue ingrowth.
• The titanium clips make BioZorb easy to see on standard imaging equipment and the array of clips identify the tumor cavity in three dimensions, a major improvement over other marking methods.
• There is no confusion about where the radiation should be targeted because BioZorb is sutured to the tumor site. This makes it possible to deliver radiation more precisely, which helps protect surrounding healthy tissue and makes a good cosmetic outcome more likely. Recent research confirms that the device makes it possible for patients to receive lower overall volumes of radiation.
• Even after the framework of the device is absorbed, the titanium clips remain behind, marking the site for long-term follow-up on imaging screening such as mammograms or MRI.

These advantages make BioZorb a valuable tool for oncoplastic surgery and can help to prevent the divot-like collapse of tissue that can change a breast’s appearance after a conventional lumpectomy.