ONCOPLASTY AS THE STANDARD OF CARE IN BREAST CANCER SURGERY

Oncoplasty

Breast cancer is a disease where the cells in the breast grow exponentially. The cancerous cells divide more rapidly than the healthy cells and soon they outgrow the healthy cells. They accumulate to form a lump or mass, which causes problems in the site (location of the cancer). These lumps or tumours can be felt by hand or detected in an X-ray. These cells may even metastasize (spread) through the breast to lymph nodes or other parts of the breast.

Breast cancers often begin in the ducts that carry milk to the nipple and are called ductal cancers. When cancer cells grow outside these ducts into other sites of the breast it is called invasive ductal carcinoma. Then there are the lobular cancers, which start in the glands that produce breast milk. When these cells spread from the lobules to the adjacent breast tissues it is called invasive lobular carcinoma.

Doctors attribute genetics, environmental, hormonal changes and lifestyle as causes of breast cancers. Also, factors such as age, history of breast-related diseases or breast cancer, exposure to radiation in young age, obesity, getting period at young age, conceiving late or no conception at all and postmenopausal hormone therapy add to the probability of developing breast cancer. However, it is not known as to why some people with no risk factors for cancer develop cancer and why those with possibility of developing cancer do not.

Treatment

Once cancer is diagnosed using various techniques such as breast ultrasound, diagnostic mammogram, MRI and biopsy, staging is done. Staging enables assess the spread of cancer to other parts of the breast or the body. The extent of spread of cancer determines the stage of the cancer. The size and location of the tumour, tumour grade and whether certain biomarkers are present also determine the stage. The TNM system, biomarker test and the grading system together help assess the breast cancer stage.

Typically, a breast cancer treatment requires a surgery. However, depending on the stage of cancer, other treatments such as radiation, chemotherapy, hormone therapy, targeted drug therapy, immunotherapy or supportive/palliative care may be administered. Depending on the case, a patient may receive a single treatment or a combination of treatments.

Nowadays, growing awareness and increased funding for treating breast cancer has made its diagnosis easier. There has been an increase in survival rates and related deaths are steadily declining. This is due to factors such as early detection, a customised approach to treatment, and advanced knowledge of the disease. Besides, the advancements in breast cancer surgical procedures are delivering both medical effectiveness and aesthetics to the patients.

‘Oncoplasty’ is one such surgical procedure that has developed, thanks to the efforts by woman advocates and surgeons from all over the world for a more ‘aesthetic cancer cure,’. Over the years, oncoplasty as an acceptable and often recommended surgical procedure has made significant advancements in treating breast cancer. It has come to be accepted as the ‘standard of care’ for breast cancer surgery.

Oncoplasty: A Standard of Care for Breast Cancer Surgery

Oncoplasty surgery (OPS) for breast cancer extirpation has gained prominence in the recent past owing to the increased focus on delivering cosmetic outcomes to women undergoing treatment for breast cancer. OPS evolved as a sophisticated surgical technique combining the latest in plastic surgery techniques with breast surgical oncology. The surgical procedure has been developed to alleviate the shortcomings occurring after the breast-conservation treatment (BCT). Oncoplastic techniques are a hybrid approach and serve as an alternative to mastectomy. It is a multi-disciplinary approach to treat breast cancer that brings together the expertise of the breast surgeon, radiation oncologist and radiologist. Also, the expertise of the plastic surgeon, medical oncologist, genetic counsellor and even the psychologist are sought to help achieve the best outcome.

Oncoplasty acknowledges that the breast is not only a functional organ but has aesthetic importance too, along with bestowing identity on a woman. This technique offers greater choice of operative procedures when it comes to retaining the aesthetics of a woman’s anatomy. It takes into account the patient’s existing anatomy, her own satisfaction with it, estimated degree of cancerous tissue extirpation and also the expertise required to achieve an optimal result. A surgical plan is then suggested after considering the patient’s clinical presentation. It is of crucial importance to plan the procedure to attain the dual goals of cosmesis and surgical oncology. Owing to this high level of precision and holistic approach to treating breast cancer, oncoplasty is now the standard of care in breast cancer surgery.

The surgical effectiveness of an OPS is already well-documented. OPS offer more options for breast conservation surgery, while at the same time resecting the tumour, preserving the normal parenchyma tissue, and uses local or regional tissue for breast reconstruction in a partial mastectomy. An oncoplastic breast reconstruction delivers better aesthetic results and increased patient satisfaction. The same is somewhat low-key in breast-conserving oncologic surgery without reconstruction. The deformities in an OPS to the breast are minimal, while offering oncologic safety.

Some of the advantages of oncoplastic techniques are that it can be administered to a large population of patients and has variety of procedures within it. New techniques in oncoplastic surgery for breast cancer are advised for patients depending on the type of cancer and its spread. Volume displacement techniques make breast conservation surgery more effective, as it enables removal of greater amounts of breast tissue by leveraging plastic surgery. The end result is the retention of the breast size and sometimes an enhanced aesthetic breast form. Especially because the techniques are developed in order to target tumours located in specific quadrants of the breast.

The development of oncoplasty as a surgical procedure is also attributed to the expectation of long-term survival after breast cancer treatment. Not just the medical effectiveness, but the Quality of Life (QoL) and self-esteem of patients who have undergone OPS are also known to have increased. The choice of the surgical procedure considerably impacts the surgical outcomes and the effect it has on the patient. A well-configured surgical procedure with aesthetic implications goes a long way in restoring the confidence and self-esteem of the patient. Precise techniques have been developed to excise the lesions from anywhere in the breast to those located in the upper or lower breast. Interestingly, the definition of ‘oncoplasty’ also goes on to include the correction of breast asymmetry by performing a reduction or reconstruction on the contralateral breast. Such is the focus on attaining complete patient satisfaction without compromising on the oncologic safety, that more surgeons are willing to acquire advanced training to improve aesthetic outcomes of their patients. This considerably reduces the psychological trauma to the patient, thereby improving their QoL. There are published studies documenting the outcomes of these experiments.

Breast cancer treatment in India

Even as India is a low-to-middle-income country, it has some of the best healthcare options. When contemplating breast cancer treatment in India, one can choose from super-speciality hospitals in the metro cities of Delhi and Mumbai. Some hospitals have multi-state presence too. These hospitals are accredited by internationally recognised bodies in the field of healthcare. Hospitals are equipped with world-class infrastructure and offer comprehensive care. Leading cancer specialists treat patients who come from different parts of the world. The treatment for breast cancer in India begins with a medical evaluation, the cost of which starts from USD 500. The treatment starts from USD 2,200. Based on the onco-surgeon’s assessment of the patient’s biopsy and other relevant tests, the onco-surgeon will suggest a suitable surgery. If chemotherapy is required, the same is charged at USD 500-USD 1000/cycle.

Summary

Oncoplasty is a medical boon to women who otherwise may have had to live a low QoL with a standard BCT. There has been growing emphasis on the aesthetic implications of breast cancer surgery. Oncoplasty mitigates the lacunae of the traditional surgical procedures to a considerable extent. Among the emerging and developing countries, India stands out as regards breast cancer treatment, which is both specialised and holistic.

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