A new surgical option for breast cancer patients combines removal of the cancerous tumor with breast reduction in one surgical procedure, called oncoplastic surgery, with benefits that include improved cosmetic outcome and reduced risk of complications. NewYork-Presbyterian Hospital/Weill Cornell Medical Center has pioneered this treatment option in the New York City area.
The procedure is designed for large-breasted women who have breast cancer and experience back and neck pain associated with their large breasts.
"For these women, the alternative is either mastectomy or lumpectomy, both which may result in a significant breast deformity," says Dr. Mia Talmor, assistant professor of plastic surgery at Weill Medical College of Cornell University and assistant attending surgeon at the Breast Center of the Iris Cantor Women's Health Center at NewYork-Presbyterian/Weill Cornell. "While patients could theoretically have a reduction after lumpectomy and radiation, the surgical complication rate is greatly increased when operating in an irradiated field."
"Because there isn't a concern with preserving breast size, this kind of surgery also gives us greater margins of resection -- the size of the area surrounding the tumor that is excised along with the cancer's core. The greater the margin, the greater the chance we remove any stray cancer cells," says Dr. Alexander Swistel, associate professor of surgery at Weill Medical College of Cornell University and director of the Breast Center of the Iris Cantor Women's Health Center at NewYork-Presbyterian/Weill Cornell.
The three-to-four-hour surgery involves two surgical teams in the OR -- oncology and plastic surgery. After the cancerous tissue is removed, both breasts are reduced.
"After surgery, both breasts will look the same, and look no different from breasts that have been reduced for strictly cosmetic reasons," says Dr. Talmor. Unlike reconstructed breasts, the reduced breasts are fully functional, with sensation and the potential ability to produce milk. The rates of recurrence, survival, and disease-free survival with oncoplastic surgery are all equivalent to those of traditional breast cancer treatment.
Four weeks after surgery, radiation therapy begins. "Radiation therapy for large-breasted women is notoriously difficult, with regular complications including skin breakdown, chronic swelling, and tenderness. Oncoplastic surgery greatly reduces these complications," says Dr. Mary Katherine Hayes, clinical director of the Stich Radiation Center at NewYork-Presbyterian/Weill Cornell and associate professor of clinical oncology at Weill Medical College of Cornell University.