Therapeutic mammaplasty: An expert's guide

Therapeutic mammaplasty is an innovative oncoplastic breast procedure that can treat breast cancer while also retaining the shape of the breast. In her latest online article, renowned oncoplastic breast surgeon Ms Gael MacLean offers her expert insight into this procedure, including who is a suitable candidate, the benefits and the risks.

What is therapeutic mammoplasty, and how does it differ from traditional breast cancer surgery?

Therapeutic mammoplasty uses breast reduction techniques to remove cancer from the breast. This technique maintains the shape of the breast, although it may be smaller than the original breast. This allows larger cancers to be removed, which traditionally may have required a mastectomy. By reshaping the breast and removing the cancer at the same time, it gives a better cosmetic outcome without compromising the cancer treatment.

Who is a suitable candidate for therapeutic mammoplasty?

Deciding if someone would benefit from a therapeutic mammoplasty is very dependent on the size of the patient's breast compared to the size of the cancer. So, with a large breast and a small cancer, the patient may well be better treated with simple surgery. If they have a small breast with a larger cancer, they may be a good candidate for therapeutic mammoplasty.

What are the potential advantages and benefits of therapeutic mammoplasty?

The main advantage of therapeutic mammoplasty over mastectomy is that the patient retains a breast. This does need to be combined with radiotherapy afterwards.  For many patients, retaining a breast, even if it's slightly smaller, is much more acceptable than losing a breast.

What are the common techniques used in therapeutic mammoplasty, and how do they help achieve both oncological and aesthetic outcomes?

The main techniques used in therapeutic mammoplasty are based on breast reduction techniques. One of the main differences between the different techniques is where the scar will be on the breast after the procedure. It is best to discuss the different techniques with your oncoplastic breast surgeon, who will help you decide what the best option is for you.

In therapeutic mammoplasty, the nipple position is usually moved, and it's very important to ensure the blood supply to the nipple is maintained. That is also taken into consideration in deciding which therapeutic mammoplasty is most suitable for individual patients based on their preference and also on the breast size and the location of the cancer.

This type of surgery comes under the heading of oncoplastic breast surgery. No patient and no surgeon want to have a great cosmetic result at the end of the operation, but for cancer to remain in the breast. This is why oncological surgery must be done first, and then the cosmetic aspect is taken care of.

Sometimes if the cancer is not completely removed, the patient may have to come back for further surgery.

Are there any potential risks or complications associated with therapeutic mammoplasty?

All surgery has risks and complications, and those specific to this type of surgery can be that the blood supply to the nipple can be compromised. The sensation to the nipple is changed; in 99% of patients, it's decreased, whereas in 1% of patients the sensation increases.

Due to the nature of where breast tissue is mobilised during this operation, there is also the potential for something called fat necrosis, which is when the blood supply to the fat in the breast has been compromised, and there's bruising of the fat. In the years following the operation, this can start to feel like a lump. Patients need to be vigilant, as all patients should be, about changes to the breast. We can see patients again for reassurance if a lump appears in the breast.

Ms Gael Maclean is a leading consultant oncoplastic breast surgeon based in Oxford. If you would like to book a consultation with Ms MacLean, you can do so today via her Top Doctors profile.