Oncoplastic Surgery

Oncoplastic surgery is a surgical method that combines the removal of the tumor with safe margins and aesthetic approaches in the treatment of breast cancer. It both increases the effectiveness of cancer treatment and contributes to the preservation of breast form.

This surgical method is planned according to the size and location of the tumor. If necessary, aesthetic corrections can also be performed on the other breast to achieve symmetry. Thus, both oncological success and aesthetic satisfaction are ensured.

Oncoplastic surgery expands the boundaries of breast-conserving surgery, making it possible to preserve the breast in more patients. This has a positive impact on psychological well-being and quality of life.

Radiological evaluation and multidisciplinary planning are required before surgery. With appropriate patient selection, the risk of complications is low, and the recovery process is generally fast. Oncoplastic surgery is an important part of modern breast cancer treatment.

You can contact Prof. Dr. Ebru Soy, one of the doctors performing Oncoplastic Surgery in Ankara, to get information about Oncoplastic Surgery prices, the process, and the hospital where Oncoplastic Surgery is performed.

What Is Oncoplastic Surgery?

Oncoplastic surgery is a surgical approach that considers aesthetic outcomes along with tumor removal in the treatment of breast cancer. This method aims to aesthetically reconstruct the shape of the breast while maintaining oncological safety. It is generally applied together with breast-conserving surgery and ensures both the removal of the tumor and the preservation of the patient’s body image. It is a modern technique that combines aesthetic surgery principles with oncological surgery.

How Is Oncoplastic Surgery Performed?

Oncoplastic surgery represents a revolutionary perspective in breast cancer treatment. In its simplest form, we can define this method as blending cancer surgery with aesthetic surgery techniques in the same operation. In classical breast-conserving surgeries, after the tumor is removed, a cavity forms in the breast, which over time may cause depressions, deformities, or displacement of the nipple. In oncoplastic surgery, our goal is to remove the tumor widely without ever compromising oncological principles—that is, leaving no disease behind—while reshaping the breast in the same session.

This approach is generally referred to in medical literature as the “third way.” At one end is mastectomy, where the entire breast is removed; at the other end are standard tumor removal surgeries that may sometimes lead to poor cosmetic results. Oncoplastic surgery serves as a bridge between these two, both preserving the breast and improving its aesthetic appearance. When the tumor tissue is removed during surgery, the resulting cavity is filled by repositioning the breast’s own tissues or, if necessary, by transferring tissue from another part of the body. Thus, when the patient wakes up from surgery, instead of a deficiency or depression in the breast, she awakens with a breast that has been reshaped and improved in form.

How Does Oncoplastic Surgery Affect the Patient’s Psychology?

The breast is a very important part of female identity and body image. During the treatment process, not only physical recovery but also emotional recovery is of great importance. Asymmetry or deformities that occur after surgeries performed with classical methods can be a constant reminder of the disease for patients. The difficulties experienced every time they look in the mirror or choose clothing may harm their adaptation to social life and their self-confidence.

The greatest strength of the oncoplastic surgery approach emerges precisely in this psychosocial area. When our patients see after surgery that their breasts are still in place and sometimes even firmer and more shaped than before, overcoming the trauma of cancer becomes much easier. Research and our clinical observations clearly show that good aesthetic outcomes increase patients’ motivation to hold on to life. This method not only preserves an organ but also protects a woman’s body image, self-esteem, and overall quality of life.

Which Patients Are Suitable for Oncoplastic Surgery?

As with any medical intervention, correct patient selection is of vital importance for oncoplastic surgery. In general, many patients diagnosed with breast cancer and in whom the tumor is expected to be removed with clean margins are candidates for this method. These techniques are particularly employed in cases where the tumor is large relative to breast size or when a significant cavity is anticipated after tumor removal.

In addition, in patients with large or sagging breasts, the possibility of performing breast reduction and lifting procedures together with cancer surgery provides a significant advantage. However, due to medical rules, there are some situations in which this surgery is not appropriate:

The conditions that may prevent the application of this surgery are as follows:

• Multicentric tumors
• Inflammatory breast cancer
• Widespread microcalcifications
• Unclear surgical margins
• Early pregnancy

These criteria are carefully evaluated to guarantee patient safety and treatment success.

Why Is Preoperative Planning Important in Oncoplastic Surgery?

The key to a successful outcome lies in detailed planning carried out in the outpatient clinic long before entering the operating room. While examining the patient in a standing position, the surgeon analyzes the natural posture of the breast, the degree of sagging, and the location of the tumor. This stage resembles the detailed plans drawn by an architect before starting construction. The distances of the tumor to the nipple, the inframammary fold, and the armpit are calculated millimetrically.

During this planning process, breast size and tissue quality are also decisive factors. If the patient’s breast tissue has sufficient volume, the method we call “volume displacement,” which involves filling the cavity using the breast’s own tissue, is preferred. However, if the breast is small or there has been tissue loss due to previous surgeries, “volume replacement,” that is, bringing tissue from outside, is considered. Additionally, whether the patient will receive chemotherapy before surgery is determined at this stage; because a tumor that shrinks with drug therapy may completely change the surgical plan and allow for a more conservative approach.

How Is Oncoplastic Surgery Performed with the Tissue Shifting Method?

One of the most commonly used techniques in oncoplastic surgery is based on the principle of repositioning the breast’s own tissue. We can liken this method to rearranging furniture in a room to make it appear more spacious and organized. If the area of the tumor to be removed constitutes less than one-fifth of the total breast volume, simple shifting of the surrounding tissues may be sufficient. However, in cases of larger tissue loss, that is, when a significant portion of the breast must be removed, we benefit from breast reduction techniques of plastic surgery.

In these advanced techniques, special incision patterns are used according to the location of the tumor. For example, a different approach is followed if the tumor is in the lower part of the breast, and a different one if it is in the upper or lateral part. While removing the tumor tissue together with a wide safety margin, the surgeon releases the remaining healthy breast tissue and readapts it to fill the cavity. During this process, the nipple is also moved to its ideal position.

Some of the specific technique names used during this procedure are:

• Batwing mastopexy
• Donut mastopexy
• J-Plasty
• L-Plasty
• Wise Pattern technique
• Rotation flaps

Each of these techniques is designed so that the scar is minimally visible and the breast achieves its most natural shape.

What Are Oncoplastic Surgery and Volume Replacement Methods?

In some cases, the breast’s own tissue is not sufficient to fill the cavity remaining after tumor removal. Especially in patients with small breasts or when a very wide area must be removed, external support is required to preserve the shape of the breast. At this point, “volume replacement” techniques come into play. This method involves transferring tissue segments (flaps), nourished by their own blood vessels, from areas such as the back or lateral chest wall to the breast:

In the past, muscle tissue was also removed during these procedures, which could lead to functional loss in the patient. However, in today’s modern surgery, “muscle-sparing” methods are at the forefront. In this technique, which we call the perforator flap, only skin and subcutaneous fat tissue are prepared on a thin vascular pedicle without touching the muscles and are transferred through a tunnel opened to the cavity in the breast.

The techniques frequently used in this field are as follows:

• LICAP flap
• TDAP flap
• AICAP flap
• TE flap

Thanks to these methods, the cavity in the breast is naturally filled with the patient’s own tissue, and no loss of muscle strength occurs in the area from which the tissue is taken.

Is Oncoplastic Surgery Oncologically Safe?

The most justified and common question from our patients is whether aesthetic concerns take precedence over cancer treatment. Oncoplastic surgery is actually a method that increases cancer safety. In classical surgery, due to concerns about deforming the shape of the breast, surgeons may sometimes have to remove a narrower margin of tissue around the tumor. However, in oncoplastic surgery, since we will reshape the breast, we do not experience concerns about tissue loss.

This freedom allows the surgeon to remove a much wider and safer margin of healthy tissue around the tumor. Wide margins minimize the risk of leaving cancer cells behind. Long-term scientific studies show that the rate of achieving “clean margins” is higher in patients who undergo oncoplastic surgery. In addition, it has been proven that the risk of local recurrence and overall survival rates in these patients are equivalent to those of surgeries in which the entire breast is removed. Therefore, this method is not compromising safety for aesthetics; on the contrary, it reinforces safety by performing a more extensive clearance.

What Is the Recovery Process and Possible Problems After Oncoplastic Surgery?

Like any surgical intervention, oncoplastic surgery has its own recovery process and risks. These surgeries are more comprehensive than standard mass removal; larger tissue areas are mobilized and more sutures are placed. Therefore, the recovery process may require a little more care.

The most common conditions we encounter after surgery are generally related to wound healing. At points where tissue circulation is delicate, especially in patients who smoke or have diabetes, delays in healing may occur. Sometimes small openings at the suture lines or hardening in the fatty tissue may be observed. However, the vast majority of these problems can be resolved with simple dressings and medical follow-up and do not require reoperation.

The possible complications our patients should be aware of are as follows:

• Wound site infection
• Opening at the suture line
• Fat necrosis
• Hematoma
• Change in nipple sensation
• Breast asymmetry

Your surgeon will take the necessary precautions to minimize these risks and will closely monitor you throughout the process. In addition, for shape changes that may occur in the breast over the long term due to the effects of radiotherapy, results can be perfected with minor touch-up procedures such as fat injection in the later period.

Who Provides Support in This Process and Who Makes Up the Team?

Oncoplastic breast surgery is not a one-person show but a major team effort. The success of this process depends on the harmonious work of different specialties. Although we, as General Surgeons, are the captains of the process, every decision is discussed in a multidisciplinary council.

The indispensable members of this team are as follows:

• General surgeon specialized in breast surgery
• Plastic and reconstructive surgeon
• Medical oncologist
• Radiation oncologist
• Radiologist
• Pathologist

Each of these specialists evaluates the patient’s condition from their own perspective. For example, the radiation oncologist contributes to the surgical plan by predicting how postoperative radiotherapy will affect the shape of the breast. The medical oncologist adjusts the timing of drug therapy. This coordination ensures not only that the patient is cured of cancer but also that, when the treatment is completed, she feels good when she looks in the mirror and confidently continues her life where she left off. Oncoplastic surgery is no longer a luxury in breast cancer treatment but a standard approach that our patients deserve.

Frequently Asked Questions

In which tumor types is oncoplastic surgery preferred?

Oncoplastic surgery is generally applied in early-stage breast cancers. It is especially preferred in cases where the tumor must be completely removed but preserving the aesthetic integrity of the breast is also important.

Is radiotherapy needed after oncoplastic surgery?

Yes. Since oncoplastic surgery is part of breast-conserving surgery, radiotherapy is required in most patients for the treatment of the remaining breast tissue.

How is breast symmetry achieved after oncoplastic surgery?

The surgeon attempts to achieve symmetry by reshaping the remaining breast tissue after tumor removal. When necessary, reduction, lifting, or reshaping procedures can be applied to the opposite breast.

How does oncoplastic surgery differ from aesthetic breast surgery?

Oncoplastic surgery uses aesthetic methods, but the primary aim is the removal of cancerous tissue with oncological safety. While aesthetic surgeries are performed for cosmetic purposes, oncoplastic surgery aims to preserve aesthetics while treating cancer.

What is the recovery process like after oncoplastic surgery?

Recovery generally takes 2–4 weeks. Pain, swelling, and bruising decrease within a few days. The use of a special surgical bra and restriction of physical activity are recommended.

Can reoperation be required after oncoplastic surgery?

Yes. If the tumor margins are not clean according to the pathology result, additional surgery may be required. In addition, secondary interventions for symmetry correction or reconstruction purposes may be performed.

Who is not suitable for oncoplastic surgery?

It may not be suitable for those with very small breast size, multiple tumor foci, or advanced-stage breast cancer. Each patient should be evaluated individually.

Does loss of sensation occur in the breast after oncoplastic surgery?

Temporary or rarely permanent loss of sensation may occur due to the involvement of nerves during surgery. In most patients, sensation largely returns over time.

Will there be deterioration in breast appearance after oncoplastic surgery?

With appropriate surgical technique, aesthetic results are generally successful. However, depending on the healing process, radiotherapy, and individual factors, mild asymmetry or scar formation may occur.

Is psychological support recommended after oncoplastic surgery?

Yes. Body image may be affected during the breast cancer treatment process. Psychological counseling and support groups contribute positively to the recovery process.