Oncoplastic Surgery: Reconstruction After a Lumpectomy

Lumpectomy. Photo @ ADAM

Reconstruction is not just for after a mastectomy, a surgical procedure that removes the entire breast; it is also a choice following a lumpectomy, which removes the cancerous lump and a margin of tissue surrounding the lump. Depending on the size of the breast lump being removed, as well as the size of a woman’s breast, a lumpectomy can change the contour of a woman’s breast, and make it significantly different in appearance than her other breast.

Lumpectomy reconstruction to correct defects is called oncoplastic surgery.

Women who choose a lumpectomy over mastectomy as their treatment for early stage breast cancer often do so because they get to keep their breast. They want their breast to look and feel like it did before surgery. What many women do not know, and is not always explained to them prior to surgery, is that a lumpectomy can change how their breast looks.

When the cancerous lump is removed, so is some surrounding tissue. As a result the breast may be smaller and firmer.  

Radiation, which goes hand in hand with lumpectomy as a treatment, can also change the size of a breast by causing some shrinkage. It can also change the feel of the breast.

A recent survey, by the American Society of Plastic Surgery indicated that 46% of women that opted for a lumpectomy were not happy with the cosmetic outcome of this procedure.

Breast reconstruction following a lumpectomy can be performed at the time of the lumpectomy, or after radiation, or even several years later.

Federal law mandates insurance companies cover reconstruction after breast conservation surgery.

Since every lumpectomy defect is unique, the options to reconstruct vary from patient to patient. The main oncoplastic procedures can be summarized as follows:

1. Breast reconstruction. Women who have breasts that are considered moderate to large in size, who are getting a lumpectomy, may do well with an oncoplastic breast reduction.

The plastic surgeon and breast oncologic surgeon will work together to plan how breast tissue will be removed to enable both a lumpectomy and breast reduction. The other breast will then be reduced, at the same time, to match the reconstructed breast.

2. Breast implant. In some women, a saline or silicone breast implant will be placed to restore volume and shape after a lumpectomy.
3. Fat grafting. Fat, harvested by liposuction from a part of the body where it is unwanted, is then grafted by injection to correct a breast contour deformity caused by lumpectomy.

4. Flap procedures. Flap reconstruction may also be suitable to repair lumpectomy defects. The breast deformity’s size and location determines which flap, if any, is a good choice for partial breast reconstruction.

It would be helpful if physicians shared more about what the patient may experience following breast-conserving surgery prior to the patient beginning treatment.

I was not prepared for the marked difference between the size and shape of the treated breast compared to the untreated breast. Immediately after lumpectomy surgery, the difference in both breasts was barely noticeable. Differences in appearance set in following radiation.

As the years went on and the untreated breast aged, the radiated breast didn't, which only added to the marked difference between the two. Had my doctor prepared me for possible cosmetic outcomes, I would have been better prepared to handle my expectations.

Within two years of treatment, I needed to wear a partial prosthesis to look balanced in my clothing.

Had I known about lumpectomy reconstruction, I might have opted to have the untreated breast reduced to match the forever perky look of the treated breast! As it turns out, treatment for my second primary cancer, a bilateral mastectomy, put me in another category altogether.

Jean Campbell is a 2x breast cancer survivor and the former founding director of the American Cancer Society New York City Patient Navigator Program in 14 public and private hospitals.She is executive director of a nonprofit organization providing research and resource information and support to women and men newly diagnosed with breast cancer.

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