What is Oncoplastic Breast Surgery?

Shannon N. Tierney, MD, MS, FACS
Fellowship-trained Breast Surgeon

Any diagnosis of cancer can be frightening. A diagnosis of breast cancer involves a unique worry – what will this treatment do to my body? What will I look like afterward? It can be scary enough to make patients hesitate before getting their breast lumps checked. Over the decades, specialized breast cancer surgery has evolved tremendously. Surgery no longer needs to leave patients disfigured. Patients who might have been given only one option in the past now have multiple options.

My fellowship at Memorial Sloan-Kettering Cancer Center taught me advanced oncoplastic techniques designed to improve cosmetic outcomes after breast surgery, while also improving cancer outcomes. Often, patients must travel for these surgeries, but I am thrilled to be able to offer them here in the valley, ensuring patients can get the care they deserve here at home. As the only breast surgeon in Virginia west of Charlottesville that is fellowship trained, I am experienced in balancing skillful removal of tumors with the best cosmetic outcome, helping my patients maintain their self-confidence and body image.

What is oncoplastic?
Oncoplastic surgery uses principles from plastic surgery to repair and improve on the postoperative appearance of the breast and chest. These include patients getting breast conservation (“lumpectomies”) and mastectomies. The goals of oncoplastic include minimal scarring and normal breast shape. Nearly all my patients will benefit from invisible scars. I am Hidden Scar™ certified and my patients can expect the least noticeable scars possible.

Breast conservation offers several benefits, including shorter surgical recoveries and the same or better survival outcomes. From a cancer standpoint, it is uncommon for a patient not to qualify for breast conservation. However, many patients historically were not offered lumpectomies, because their breast size was small, or the tumor was large. Their surgeons anticipated ugly outcomes and would only offer mastectomy. With careful preoperative planning with Augusta Health radiologists, I can map out the extent of the cancer and use tissue transfers, a rearranging technique, to fill in the missing tissue. For patients with large breasts, this can even be done as part of a breast reduction and lift – sometimes with a better appearance after surgery.

Patients undergoing mastectomies can benefit as well.
Nipple-sparing mastectomies preserve the patient’s own nipple, which will always have the most natural appearance. When performed using the most exacting standards, there is very little difference in the risk of recurrence. My approach involves an incision hidden under the breast. Patients who choose not to get a formal reconstruction but want to avoid wearing a breast prosthesis can choose for a compromise surgery, nicknamed the Goldilocks technique, which uses the breast skin as a local flap reconstruction. Having refined these techniques, I can perform this surgery without needing a plastic surgeon, saving patients time and money. For patients who want to go flat after mastectomy, I can offer an “aesthetic flat” approach. This eliminates the extra bulges of skin under the arm or at the middle of the chest that is sometimes seen with traditional mastectomy closures. Not only is the overall appearance better, but it is also easier to wear prosthetics without skin irritation.

These techniques benefit not only our cancer patients but the many people in our community with benign breast disease.
Using minimally invasive approaches to address breast infections, chronic breast disease, and high-risk lesions, we can ensure that treatment can be personalized. Our team is at the forefront of advances in breast care and our patients can feel secure that their care will encompass the latest recommendations, with constant refinement.

The best cancer care addresses the whole person – aiming for the best cures with the least side effects.
I believe that every patient deserves that kind of care, not just those in big cities or near university medical centers. At Augusta Health, your care team is comprised of experts in breast cancer, with additional skills and training that aren’t commonly found in a community hospital. Our patient-centered approach means you will get the best possible cancer treatment combined with the support of a small team that will know you and your goals.