Reconstructive options after partial mastectomy

Understanding your reconstructive options when you are considering or have had a partial mastectomy (or lumpectomy) is important. Partial mastectomy and lumpectomy are considered "breast-sparing surgery" or "breast conservation surgery" because there is an attempt to save as much healthy breast tissue as possible while removing the breast cancer.

These procedures are best for treating early stage (I & II) tumors or smaller tumors. Virtually all patients who have one of these procedures will have radiation therapy. This removal of breast tissue may leave an indentation, such as a large dimple, in your breast. This dimple may not be seen until after your radiation treatment. To prevent these cosmetic changes, a plastic surgeon may be able to "re-arrange" or rotate the tissue that is remaining in your breast at the time of the cancer removal.

Often candidates for this technique are women with larger breasts (C or D cup). These techniques may leave you with a smaller breast or further scars on your breast. These procedures are referred to as oncoplastic surgery. The oncoplastic techniques utilized by your plastic surgeon often employ incision patterns traditionally used in cosmetic procedures such as breast lifts (mastopexy) and breast reduction surgery. If these procedures are performed, a "symmetry" or "balancing" procedure to your other breast not affected by cancer may be necessary to match the reconstructed breast. Your breast may also change (i.e. shrink or tighten) as a result of the radiation therapy.

If you are a woman with a smaller breast and do not have enough breast tissue to "re-arrange" or rotate into the area where the cancer was removed, you may need to recruit tissue from another part of your body to fill in the defect. Most commonly, local tissue under your armpit along your chest wall can be recruited (local tissue flaps) or tissue from your back (latissimus dorsi flap) can be rotated to fill the space where the tumor was removed. These techniques will leave further scarring along your chest under your armpit and on your back.

If reconstruction is not an option at the time of your cancer surgery, or you have already had a partial mastectomy and as a result have an indentation in your breast, delayed reconstructive options as mentioned above may be used. Because radiation my shrink or tighten your skin, local tissue flaps or the latissimus dorsi flap, if used to fill in the indentation, may result in you having a "patch" of skin on your breast in the area of the scar where your partial mastectomy was performed. Often your plastic surgeon will also want to assure that your cancer doctors have cleared you from surgery and you are far enough out from your radiation therapy (usually 6 months to 1 year) that you have healed enough to have another surgery. Reconstructive procedures are often more difficult to perform and have a higher risk for complications after radiation therapy.

A few questions to ask your cancer surgeon and plastic surgeon:

1. Would I be a candidate for reconstruction at the time of my partial mastectomy?
2. What are the options I have for reconstruction based on my tumor size and breast size?
3. What complications are associated with the procedures?
4. How will radiation affect my reconstruction?
5. Will I need something done to my breast that does not have cancer?