New Approach Considers Cosmetic and Emotional Effects Upfront When Planning Breast Cancer Surgery

CINCINNATI—A new approach to breast cancer surgery and reconstruction can improve both medical and cosmetic results for women with breast cancer, according to surgeons at the University of Cincinnati (UC).

This method—known as “oncoplastic surgery”—combines breast cancer surgery (mastectomy or lumpectomy and lymph node evaluation) with reconstructive surgery in one operation. A cancer and plastic surgeon work side-by-side to assess the lymph nodes, remove the cancerous tumor and surrounding tissue, and then immediately reconstruct the disfigured breast using the patient’s own tissue.

UC surgeons Jennifer Manders, MD, and Anureet Bajaj, MD, recently launched the Tristate’s first oncoplastics program at the UC Physicians University Pointe medical campus.

“Having a disfigured breast after surgery and radiation is emotionally difficult,” says Manders, an assistant professor and breast surgeon at UC.  “With the advanced breast-conserving surgical techniques available today, there’s no reason women should have to live with physical disfigurement after breast cancer surgery.”

Oncoplastic surgery is covered by most health insurance providers under the Women’s Health and Cancer Rights Act of 1998, which required that health plans and insurers providing medical coverage for mastectomy also offer coverage for reconstructive breast surgery.

“The combined oncoplastic surgery approach can result in cancer-free and aesthetically pleasing breasts in one procedure,” Manders adds.

Oncoplastic surgery requires the breast cancer surgeon and the plastic surgeon to work closely throughout the patient’s treatment, including during initial consultations and in the operating room, to assess and manage both oncologic and aesthetic aims.

Surgeons map out each patient’s surgery so that the tumor and enough surrounding tissue are removed to eliminate the cancer, while conserving enough tissue to reconstruct the breast. When the cancerous tissue has been removed, the surgeons can manipulate the woman’s remaining tissue—essentially giving the woman a lift—to form symmetrical, cosmetically pleasing breasts.

“Collaborating throughout the entire process allows us to effectively control the cancer surgically, and then immediately reconstruct natural-looking breasts. This may help ease the emotional burden of dealing with breast cancer,” Manders says.

The procedure takes between two and three hours to complete, depending on the extent of the patient’s cancer. Women can usually return to their daily activities and work within a few weeks.

The oncoplastics approach, says Manders, minimizes the time the patient spends traveling for various doctor visits and improves communication among all members of the medical team—which usually includes a breast cancer surgeon, plastic surgeon, medical oncologist and radiation oncologist.

“It’s important for the patient to know her caregivers are working as a team, and oncoplastics lets us make those surgery decisions together—with the patient—from day one,” adds Manders. “By working as a combined team, we can better visualize exactly what needs to happen during surgery to achieve the best medical and cosmetic outcomes for the patient.”

According to the American Society of Plastic Surgeons, more than 69,000 women—nearly 47 percent of them between 35 and 50—choose to have breast reconstruction after mastectomy or lumpectomy. The American Cancer Society estimates that about 212,000 women with be diagnosed with breast cancer in 2006.

The UC oncoplastics team sees patients at University Pointe in West Chester,