Mastoplasty in breast cancer

What is mastoplasty?

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As the word implies, it is the regeneration of the breast with the use of reduction and lifting techniques of the breasts. Mastoplasty is traditionally used for large breasts (macromastia) in which the main volume has shifted from the upper part to the lower pole of the breast. Also, the nipple is at a lower point than normal (drooping), from a few to several centimetres. It is now quite common for women with macromastia to resort to cosmetic surgery seeking younger breasts (smaller and more erect). For many women, macromastia is also a functional problem because it causes pain in the neck and shoulders and makes it difficult for them to carry out many daily activities.

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What is the role of mastopexy in breast cancer?

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Breast cancer is the most common malignancy in women. One in 8 women will get it at some point in her life. The main treatment is removal of the tumour, either by segmentectomy or mastectomy. In the past, the majority of women underwent mastectomy. But, even women who kept their breast, ended up being dissatisfied with the aesthetic result. This was because breast surgeons had no training in plastic surgery, resulting in no immediate reconstruction of the deficit at the time of oncological surgery. This reconstruction is very difficult to occur in the second year, that is, after the administration of radiation. This problem is solved by modern oncoplastic surgery, which "marries" the safe removal of the tumour with an excellent aesthetic result.

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A modern breast surgeon now has the ability to perform large resections (tumors over 5 cm or multiple tumors) and at the same time reconstruct the breast. In this way, an unnecessary mastectomy is avoided. In essence, the woman's own breast is used and reconstructed without the use of foreign implants. This procedure is called therapeutic mastopexy (therapeutic mammaplasty). The same plastic surgery can be performed on the other - non-affected - breast to achieve symmetry. As you can see from the photos below (from real patients), the breasts are slightly smaller in size after cancer removal, are lifted (naturally, without the use of silicone implants) and have more projection. These are the aesthetic features that a woman would want, regardless of whether she had breast cancer.

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What are the different mastoplasty techniques?

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The differences in the techniques lie in the placement of the incisions (short vs long scars), the reduction that can be achieved and the upward displacement of the nipple. The choice of technique depends on the type of tumour (size, location) and the type of breast of each woman (size, shape, droop). The oncoplastic surgeon must be trained in the use of all possible breast reduction/reconstruction techniques. The most appropriate technique is chosen for each individual woman, which will safely remove the tumor and provide a perfect aesthetic result.

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Can the technique be applied to very small breasts?

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Mastoplasty is ideal for medium to very large breasts, which show some degree of droop (C cup size and above). For very small breasts, which do not show any droop (A/B cup breasts), the surgeon must choose a different method of reconstruction.

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How long is the hospital stay in the clinic?

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Even in cases where both breasts are corrected at the same time, patients stay in the clinic for only one night.

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Is there any pain after the operation?

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Pain is tolerable. Usually, patients only need paracetamol for a few days after surgery.

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What are the advantages of the method? 

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• Superior aesthetic effect.
• Avoiding mastectomy.
• Removing cancer with wider margins. This means less chance of the cancer recurring in the same spot.
• Elimination of the symptoms of macromastia. 
• Better distribution of radiotherapy. Giving radiation to a large breast causes many problems.

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Inference

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Nowadays, breast cancer treatment ensures long-term survival. We have the knowledge and the weapons to deal effectively with this malignancy. Until recently, at the end of treatment, women were left with an unpleasant aesthetic result, with an amputated breast and an ugly scar, which was a constant reminder that they had once had cancer. The modern oncoplastic surgeon has a duty, beyond removing the tumour, to keep a breast that is acceptable to the woman or even create an even better one, thus improving her body image. An improved body image also leads to a better quality of life.

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Wise pattern mastoplasty (result 2 months later)

50 year old woman with multifocal breast cancer 

Dimitrios Kokkonis

Breast Oncoplastic Surgeon

MD, MSc (Onco-Aesthetic Breast Surgery)

Associate of the Clinic "Agios Loukas"

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