Breast conserving surgery and breast reshaping:
Breast-conserving surgery (BCS) is the removal of early-stage breast tumor with adequate margins in patients with suitable tumor/breast volume. Aesthetic concerns should not be ignored while surgical treatment of the tumor is performed. Depending on the localization of the tumor, different cuts (incisions) can be used to remove the tumor. In suitable patients, reduction of the large breast, lifting the sagging breast can be performed or flap surgery may be considered for tumors behind the nipple. During all these procedures, sentinel lymph node biopsy is performed for lymph nodes.
Things to do before deciding on the type of surgery:
A mammographic examination should be performed before BCS, even if a palpable breast lump in self-examination or doctor’s examination suggests cancer, or even if cancer has been diagnosed by biopsy. In this way, other non-palpable cancer foci within the breast can be detected, limited or diffuse microcalcification can be detected. If the histological features of the tumor are not known preoperatively, the surgeon should inform the patient that the surgical treatment option may change according to the pathological examination to be performed during the operation. If the surgeon does not have the opportunity to perform a pathological examination during the operation, the tumor should be removed first and a detailed pathological examination should be performed. Because the most important factor that will determine the type of surgical treatment is the histological features of the tumor.
Patient’s preference:
Considering the characteristics of the disease, the physician should tell the patient about the surgical treatment options (skin-sparing mastectomy + repair, at the time of mastectomy or late breast repair, BCS breast reshaping) and the pros and cons of each surgery to the patient, and the patient should decide for himself which surgery will be performed without being influenced.
Radiotherapy possibilities:
Radiotherapy is required after breast-conserving surgery. Mastectomy is preferred in cases where radiotherapy facilities are not available or conditions are insufficient. A radiotherapy that is not performed in good quality will adversely affect the aesthetic result. Side effects related to radiotherapy are more common in large breasts.
Aesthetic result:
The aim of BCS is to remove cancerous tissue in accordance with oncological principles and to achieve good aesthetic results. The prerequisite here is that the oncological principles are not compromised. Performing two targeted procedures without compromise requires both oncological knowledge and surgical skill. As a result of the evaluations made by the patients and non-team doctors, the aesthetic satisfaction/appreciation/success in BCS is around 75-80%. Although the oncological procedure is complete, if an amorphous, hard and asymmetrical breast remains after BCS, the procedure has not reached its goal.
Plastic surgeons help the oncological surgeon to achieve the best aesthetic result without compromising oncological principles, by transferring their experience and skills from other breast surgeries (breast reduction, augmentation, and lift) to patients who have undergone BCS. BKC and breast remodeling and recently oncoplastic surgery; It produces solutions for the factors that negatively affect the aesthetic result in the BCS procedure, which is performed by adhering to oncological principles.
Factors affecting BKC indications and aesthetic result and solution suggestions of plastic surgery:
Tumor size and tumor size/breast size ratio:
The general acceptance is breast-conserving surgery for single tumors of 3-5 cm. It should not be forgotten that the tumor should be removed together with 1-2 healthy tissues around it. The larger the tumor, the more breast tissue will be removed and the remaining breast will be negatively affected by this procedure. Extensive removal of the tumor in a small or small and drooping breast will inevitably result in deformity and the patient will search for post-treatment aesthetic improvement and will be faced with complex surgical recommendations and risk explanations for these surgeries.
In this group of patients, tissue can be added to reshape the operated breast and provide symmetry after the tumor has been removed, that is, during BCS. Here, it is preferred to use the patient’s own tissues to complete the lost breast tissue. If the breasts are both small and drooping, the breast lift and volume addition procedure is applied to both breasts. For some patients in this group, breast skin-sparing mastectomy and immediate breast repair may be the best alternative.
Location of the tumor:
In general, the results of BCS performed in tumors located behind the nipple or in the lower middle quadrant are less satisfactory. In a normal-sized and/or drooping breast, severe asymmetry will occur if the breast tissue under the nipple or lower quadrant is drained. Especially if the tumor is close to the nipple and the nipple is removed along with the tumor, the problem becomes more serious. Under these conditions, plastic surgery ensures the aesthetic success of the surgery by applying one of the methods used in breast reduction surgeries to both breasts, depending on the location of the tumor.
Condition of the breast:
Small and drooping or normal sized but drooping breasts cause aesthetic problems. For large and/or drooping breasts, especially in the radiotherapy of deeply located tumors, the goal of reaching the desired dose in the tumor bed may increase the side effects of radiotherapy. The condition of the breast is among the most important factors in BCS. Especially in drooping or large and sagging breasts, performing breast reduction/lift operation together with BKC not only guarantees removal of the tumor with a sufficient solid margin, but also ensures a satisfactory aesthetic result.
