Oncoplastic Surgery, What Is This?

Dr. Harness:

Oncoplastic surgery is a term that was coined in Europe before here in the United States. Onco means cancer, plastic–plastic surgery. It’s a mindset about really being focused on the cosmetic outcome of patients, which I think there’s been too little of, historically, by general surgeons and even regular, full-time breast surgeons.

The definition includes the reshaping of the breast after a lumpectomy so there’s more of a normal shape and contour of the breast. There is a reduction in volume but hopefully the shape and contour is still maintained. And the term also includes what we do with reconstruction after a mastectomy. That can mean rotating tissue from the abdominal wall up to the breast, from the back to the breast. It could include tissue expanders. It can include permanent implants, but it really is a mindset.

Dr. Jay Harness discusses if mammograms are dangerous.

Dr. Harness:

It is a good question, “Are mammograms dangerous?” The answer is no. The amount of radiation therapy for doing four views, two on each side of the breast, that a woman would receive is frankly less than if she flew across country on a flight today. Do we avoid mammograms in younger women? Yes, we do. We would certainly avoid them completely in developing breasts in teenagers and what have you, but women should not think of them as being dangerous.

One of the potential advantages of digital mammography is that the amount of radiation is slightly lower, but we also need slightly less compression. One of the things that keeps women from getting mammograms is the fear of compression. Particularly women who have had breast augmentation and breast implants put in, they are really scared that somehow the compression will rupture their implant, and I suppose that is possible, and there are reported cases of that happening, but with a little less compression with the digital mammograms, I am having patients tell me now that they are really more comfortable when the digital mammograms are done. Also, the technologist is reading the films right there on the screen in the room and does have to run off to a film processor, and so it's a much more sort of efficient system, and then jokingly I always remind my patients that mammograms were clearly developed by a man.

How long will it take to heal after a mastectomy?

Dr. Harness:

One of the classic things that I say is, I do the surgery: you do the healing. So healing times are variable. The typical bruising usually clears up within a week, sometimes ten days. That’s presuming or assuming there isn’t a blood clot sitting underneath the skin which may prolong that bruising process. But the typical bruising from let’s say, putting just the local anesthetic in, that usually clears up in about a week or so.

Dr. Harness discusses if oncoplastic surgery is painful.

Dr. Harness:

The pain following oncoplastic surgery, if you are doing just reshaping of the breast, is no more painful than a typical lumpectomy. If you put a tissue expander in, there’s probably a little bit more discomfort because of lifting the muscle off the chest wall. So that’s going to be a little more uncomfortable.

If the oncoplastic surgery involves rotating a flap from the belly or the back, there’s no question that that’s major surgery. You have got more incisions that are going to be more painful. I’d like to hope that the surgeons – breast, general, plastic surgeons – are using local anesthesia at the site of all of their incisions to help with the post-operative pain.

Finding an experienced surgeon to perform your double

Dr. Harness:

A woman needs with a double mastectomy, in my view, an experience breast surgeon. In larger urban or metropolitan areas, that’s often easier because there are more and more surgeons who greater than 50 percent of their practice is breast. If on the other hand, the patient is living in an area where the surgeon’s percentage of doing breast surgery is 15, 20 or 25 percent, I would ask that surgeon if they are member of the American Society of Breast Surgeons.

We have 2500 members around the United States. We have well over a thousand of our members attend our annual meeting, and we always talk about the latest and greatest techniques at those annual meetings. But she needs somebody who is experienced, if at all possible.

Family history? When girls should be tested for breast cancer.

Dr. Harness:

First of all, young women in their teen years need to be working with genetic counselors when it comes to any recommendations for gene testing, for a BRCA-1 or 2 or some of the other really unusual genes. So the correct answer is they need to be working with a certified genetic counselor who can help guide them.

In general, we do not do testing on teenagers, and in general, that testing waits until someone is in their 20s. Are there circumstances where you might do it earlier? Sure, but my advice on this one would be that they are in the hands of competent, certified genetic counselors who can give good advice.

What a woman's breast should look like after oncoplastic surgery.

Dr. Harness:

I hope a woman’s breast looks great following oncoplastic surgery. That’s the idea to be focused on, cosmetic outcome. As far as recovery from that kind of surgery, it depends on the extent of the oncoplastic surgery. In general, we are talking about a few weeks, maybe on up to four to six weeks, if we are rotating tissue in from either the back or from the belly.