The aim of breast cancer surgery is to remove the cancer from your breast completely, with clear margins, that is with no cancer cells present at the edge of the removed breast tissue. This can be achieved by removing only a portion of your breast, and the term used for this procedure is “Complete Local Excision” or “Wide Local Excision”. A great proportion of breast cancers can be removed safely this way, without the need to perform a mastectomy. Most women, and surgeons, would prefer breast conserving surgery to mastectomy, if feasible, as it involves less surgical intervention, less risks of complications, better aesthetic result, and improved quality of life.

Usually a Wide Local Excision is followed with a moderate dose of radiation therapy to the breast a few weeks later. The goal of breast cancer surgery is that you remain free of breast cancer – a Wide Local Excision followed by breast radiotherapy gives you as good a chance to achieve this as a mastectomy would do, although with less extensive surgery than if you had mastectomy and with preservation of your remaining natural breast.

Some breast cancers are just a bit too large for a simple Wide Local Excision to result in a normal looking breast after the operation. In this situation some surgeons perform a mastectomy rather than risk cosmetically unacceptable results after a breast conserving operation. An alternative to a mastectomy is sometimes available, and this consists of using oncoplastic techniques of breast conserving surgery.

Oncoplastic Breast Surgery

Oncoplastic breast surgery involves a range of advanced techniques that achieve adequate resection of the cancer while preserving the breast shape. The two main categories of oncoplastic techniques can be described as:

• Volume displacement techniques – Complex internal mobilisations of breast tissue are carried out, in combination with cancer removal, to re-arrange the breast into a normal shape. Mammoplasty techniques and breast reductions are examples of procedures in this category, and often result in somewhat smaller breasts.
• Volume replacement techniques – In yet smaller breasts, when there is insufficient breast volume for a mammoplasty or breast reduction, there are techniques to fill the breast defect after a Wide Local Excision. Local chest wall perforator flaps are the most useful techniques in this category. These consist of islands of skin and fat located just outside the breast, beneath the armpit, which can be mobilised and rotated into the breast to replace the volume excised after a Wide Local Excision. This is routinely done through incisions in the lateral (outer) edge of the breast or at the lower skin fold of the breast, leaving inconspicuous or invisible scars.

Oncoplastic techniques make possible the resection of larger cancers, sometimes in very small breasts, giving the option of breast conserving surgery to many women with cancer who would otherwise have required a mastectomy.