Oncoplastic Breast Surgery After Lumpectomy: Techniques, Candidates and Results
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Oncoplastic breast surgery combines two things in one operation: removing the breast cancer and reshaping the breast so it keeps a natural look. The surgeon takes out the tumour with a safe edge of healthy tissue. Then plastic surgery methods are used to fill the gap or reshape the breast. It is done together with a lumpectomy (breast-conserving surgery). For many women it means keeping their breast with a good shape, without weakening the cancer treatment.
Still from the surgical animation explaining oncoplastic breast surgery.
In this article
What is oncoplastic breast surgery?
The word joins “onco” (to do with cancer) and “plastic” (to do with reshaping). That shows the double goal: treat the cancer well and keep a good-looking breast. A lumpectomy removes only the tumour and a small edge of healthy tissue. Most of the breast stays. Combined with radiotherapy, it treats the cancer as well as a mastectomy (removal of the whole breast).
Still, a lumpectomy can change the shape of the breast. How much depends on the size and place of the tumour, and on the size of your breast. Without extra care, some women end up with a dent, a pulled nipple or a clear difference between the two sides. Oncoplastic surgery is designed to prevent this from the start.
The first goal never changes: all the cancer must be removed with a clear edge of healthy tissue. Good oncoplastic methods support this goal. They let the surgeon take a wider edge while still keeping the shape of the breast.
Oncoplastic breast surgery. Surgical animation illustrating the general technique. It does not show complications, provide recovery instructions or predict an individual result. Your own operation may differ.
Who is a candidate for oncoplastic surgery?
Oncoplastic surgery is not needed for every lumpectomy. A small tumour in the upper outer part of a larger breast often leaves little visible change. Oncoplastic methods become useful when the risk of a poor shape is higher. That is the case when:
the tumour is large compared to the size of your breast;
the tumour sits in a difficult place, such as near the nipple, in the lower part or in the inner part of the breast;
you have medium or large breasts, or sagging (ptosis), so a reduction pattern can be used;
you have small breasts and a lot of tissue must be removed, so tissue from nearby is needed to fill the gap;
you would otherwise need a mastectomy because of the size or place of the tumour.
Dense breast tissue and planned radiotherapy also play a role. Radiotherapy can make tissue shrink and feel firmer. Thinking about these later changes helps the surgeon choose the right method now. Your breast surgeon, plastic surgeon and oncologist plan this together with you.
The main oncoplastic techniques
There are two families of oncoplastic techniques. In volume displacement, the surgeon uses your own remaining breast tissue to fill the gap. In volume replacement, tissue from next to the breast is brought in. The choice depends on your breast size, the size of the gap and where the tumour sits.
Volume displacement: reshaping your own breast tissue
These are the most common oncoplastic methods. After the tumour is removed, the surgeon moves and reshapes the remaining breast tissue to close the gap. They work best when there is enough breast tissue left to work with.
Oncoplastic reduction or lift (mastopexy). The tumour is removed as part of a breast-reduction pattern. The surgeon reshapes the remaining tissue into a smaller, lifted breast and moves the nipple to a higher spot. The anchor-shaped (Wise) pattern gives access to tumours almost anywhere in the breast. The vertical (“lollipop”) pattern suits medium reductions. This method suits women with medium to large breasts, and can also improve sagging or a large breast size at the same time.
Batwing technique. The surgeon makes two curved cuts that meet, a little like a bat’s wings, above or around the areola. The tumour is removed and the nearby tissue is moved to fill the gap. This helps avoid the “scooped-out” look and suits tumours in the upper part of the breast.
Round block (periareolar) technique. The cut runs around the edge of the areola (the darker skin around the nipple). The surgeon reaches the tumour through this cut, removes it and gently reshapes the tissue around it. The scar hides well in the colour change of the areola. This method suits smaller reshaping in breasts with mild sagging.
Simple shape-preserving steps are often part of these methods too. The surgeon can lift and shift tissue from fuller areas toward the empty space, or use stitches to gently close the gap so it heals with less of a dent.
Volume replacement: bringing tissue in from nearby
For women with smaller breasts, or when a lot of tissue must be removed, there may not be enough breast tissue left to reshape. The surgeon can then bring in tissue from next to the breast. This keeps the breast at about the same size.
LICAP flap. Skin and fat from the side of the chest wall are turned forward to fill a gap on the outer part of the breast. The scar sits at the side, mostly hidden in the bra line.
AICAP flap. Tissue from the front of the chest wall, just below the breast, is used to fill a gap on the inner or lower part of the breast. The scar lies in or near the fold under the breast.
TDAP flap. Tissue from the upper back is brought forward on its own blood vessels for larger gaps on the outer breast.
Lipofilling (fat grafting). Fat is taken from the belly or thighs and injected into the breast to fill a dent. This is often done later, in one or more small sessions, once the breast has settled after radiotherapy.
Not every lipofilling session gives the volume you hoped for. Read more about failed fat grafting to the breast and what can still be done.
Timing of oncoplastic surgery with radiotherapy
Doing the reshaping straight away, in the same operation as the tumour removal, often gives the best result. The tissue has not yet been changed by radiotherapy, and the natural layers of the breast are still intact.
Some countries, such as the Netherlands, use an in-between option called “delayed-immediate” reshaping. The tumour is removed first. The reshaping follows in the second week, once the lab confirms that all the cancer is gone. This avoids reshaping a breast that later needs a second cancer operation.
Delayed reshaping, months or years later, is chosen when the effect of radiotherapy is not yet clear, or when you need time to think about your options. Most surgeons advise waiting at least 6 to 12 months after radiotherapy before any further reconstruction. Radiotherapy itself is planned as usual after oncoplastic surgery. Follow-up mammograms also still work well.
Scars and results after oncoplastic surgery
Where the scar sits depends on the technique. The surgeon places the cut where it is least visible and still gives good access to the tumour. A cut in the fold under the breast is almost invisible when you stand. A cut along the edge of the areola hides well in the colour change. A reduction pattern leaves an anchor-shaped scar: around the areola, straight down and along the fold.
Scars are red and firm at first. They usually fade a lot during the first year, especially if you protect them from the sun and care for the wound well. The shape of the breast keeps settling for several months. Radiotherapy can make the treated breast a little firmer and smaller over time, so the final result is best judged about a year after treatment.
Most women can go home the same day or after one night. Light daily activities are possible within a few days. Heavy lifting and sport are best avoided for a few weeks. Your team will tell you when radiotherapy can start, usually once the wounds have healed.
Symmetry of the other breast
Cancer surgery itself makes the breasts uneven. After an oncoplastic reduction, the treated breast is often smaller and higher than the other one. An operation on the other breast then gives the best balance. Options include a matching reduction, a lift (mastopexy) or small adjustments with lipofilling.
Both breasts can sometimes be done at once. But when radiotherapy is planned, many surgeons prefer to do the other breast in a later stage. The treated breast can still change during the first year after radiotherapy. Waiting makes it easier to match the two sides well. Read more in our article on breast symmetry surgery after lumpectomy, mastectomy or reconstruction.
Risks of oncoplastic breast surgery
Oncoplastic surgery is safe, but it is a larger operation than a simple lumpectomy. Possible problems include bleeding, infection, slow wound healing and fluid under the skin. Fat inside the breast can sometimes harden into a firm lump (fat necrosis). This is harmless, but it can be felt and may need a check on a scan.
After a reduction pattern, the feeling in the nipple may change, and breastfeeding later may be harder. In a small number of women, the lab finds cancer cells at the edge of the removed tissue. A second operation is then needed. Because the tissue has been moved, the surgeon uses clips placed during the first operation to find the right spot again.
Choosing an oncoplastic method for a better look does not weaken your cancer treatment. Cancer control stays excellent, and the edges are often cleaner because more tissue can be removed.
Frequently asked questions about oncoplastic breast surgery
What is oncoplastic breast surgery?
Oncoplastic breast surgery combines cancer removal with plastic surgery methods in one operation. The tumour is removed with a safe edge of healthy tissue. Then the surgeon reshapes the breast or fills the gap, so the breast keeps a natural look.
What is the difference between a lumpectomy and oncoplastic surgery?
A standard lumpectomy removes the tumour and closes the wound. Oncoplastic surgery adds a reshaping step in the same operation. This helps prevent a dent or an uneven shape, especially when a larger piece of tissue must be removed.
Who is a candidate for oncoplastic breast surgery?
It is often a good option when the tumour is large compared to the breast, or sits in a difficult place, such as near the nipple or the inner breast. Women with medium or large breasts, or with sagging, may benefit from a reduction pattern. Your breast surgeon and plastic surgeon decide together with you.
Is oncoplastic surgery as safe as a standard lumpectomy for cancer control?
Research shows again and again that oncoplastic surgery gives cancer results as good as a standard lumpectomy. The surgeon can often take a wider edge of tissue, so the edges are cleaner. Radiotherapy and follow-up mammograms work as usual.
Do I still need radiotherapy after oncoplastic surgery?
In most cases, yes. Radiotherapy after breast-conserving surgery is part of the cancer treatment, whether or not the breast is reshaped. Oncoplastic surgery does not change the need for radiotherapy or make it harder to plan.
Will my breast look different after oncoplastic lumpectomy?
The breast may become a little smaller or sit a little higher, especially after a reduction pattern. The goal is a natural, even shape without a dent. Radiotherapy can make the breast firmer or slightly smaller over time, so the final result takes about a year to settle.
Will the other breast be operated on too?
Sometimes. When the treated breast becomes smaller or higher, the other breast can be reduced or lifted to match. This can be done at the same time or, more often, in a later stage after radiotherapy. Read more in our article on breast symmetry surgery.
Questions to ask your surgeon
Is oncoplastic surgery a good option for the size and place of my tumour?
Which technique do you advise, and where will my scars be?
Will the reshaping be done in the same operation or in a second step?
How will radiotherapy change the result, and when is the best time to balance the other breast?
What happens if the lab finds cancer cells at the edge?
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Written by Dr. Mahyar Foumani, plastic and reconstructive surgeon specializing in breast reconstruction. Based on the book 'Breast Reconstruction Explained.'
This article is education, not medical advice
This article explains in plain words how breast reconstruction works. It is meant to help you understand what is possible, so that you and your doctor can make a good decision together. It does not replace personal medical advice.
Every situation is different. What is best for you depends on your body, your illness, your treatment and your own wishes. So always follow the advice of your own doctor or care team. Do you have symptoms, or are you unsure about something? Please contact your doctor or GP. In an emergency, call your local emergency number.
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