Therapeutic mammoplasty: am I suitable for the procedure?

Written by: Mr Brendan Smith
Published: | Updated: 08/06/2020
Edited by: Laura Burgess

Therapeutic mammoplasty is a relatively new surgical procedure. The operation removes the breast cancer (therapeutic) and then reshapes the breast by removing its skin and tissue (mammoplasty) to preserve a normal breast shape.

Here, one of our highly-experienced oncoplastic breast surgeons Mr Brendan Smith explains just who is suited to having therapeutic mammoplasty and outlines the advantages versus the disadvantages of the procedure.

Where did the term ‘therapeutic mammoplasty’ originate?

Broken down, the word mammoplasty means breast ('mammo') remodelling or reshaping ('plasty').

Previously, mammoplasty was exclusively used by plastic surgeons who were undertaking cosmetic breast surgery, such as reduction mammoplasty (breast reduction) or augmentation mammoplasty (breast enlargement).

With the integration of breast plastic surgery techniques being incorporated into the training of the modern breast cancer (oncoplastic) surgeons, the skills of both cancer (oncology) surgeon and cosmetic plastic breast surgery are combined.

Therapeutic mammoplasty evolved from this combination of skills and is the term given to operations to remove breast cancers (therapeutic) and internally fill the resulting defect with your own breast tissue, then reshape the breast (mammoplasty).

This is done by removing skin and possibly other breast tissue so that we try and preserve a normal breast shape that will usually be smaller and more uplifted. This technique allows us to remove more breast tissue and usually leaves an acceptable aesthetic outcome compared to a standard lumpectomy.

Who is suitable for therapeutic mammoplasty?

Therapeutic mammoplasty has become the standard of care for breast conservation in the majority of patients. Approximately 70% of our patients are suitable for this procedure. If your surgeon has not offered you this then please ask why.

This operation is usually not suitable to be done after radiotherapy if the initial cosmetic results are poor. The operation is most suitable for women with moderate to larger breasts who have a degree of droop. Modifications of the techniques, however, can sometimes be used for women with smaller breasts.

If there is a significant asymmetry between your breasts afterwards, you may wish for the breast on the other side to be reduced to provide a better match in size and shape. This is known as symmetrisation surgery that can be performed at a later date.

What are the advantages?

The advantages of therapeutic mammoplasty include that:

  • It aims to produce a normal breast shape and is particularly useful for lower breast tumours, which are more likely to develop a deformity if a simple lumpectomy is performed. For women with larger breasts who desire smaller breasts, it is an added benefit.
  • In cases where women have large breasts, reduction in size can make radiotherapy easier.
  • A breast that is internally reconstructed using breast tissue displacement is more natural and stable when compared to total breast reconstruction with an implant or with tissue from elsewhere in the body.
  • Recovery from the operation is also much quicker for most women.

What are the disadvantages?

The disadvantages are:

  • The surgery is more extensive than a simple lumpectomy with more scarring.
  • There are more risks associated with the surgery, including altered nipple sensation or numbness, the potential for nipple (1%) and fat necrosis, and problems with wound healing. These will be discussed in more detail later.
  • A specific cosmetic outcome cannot be guaranteed and there is still a risk you may have a degree of distortion or indentation.

What are the other surgical options for breast cancer treatment?

The other surgical options are:

  • Simple lumpectomy (wide local excision) without reshaping the breast.
  • Mastectomy (remove all of the breast tissue). Please note a mastectomy and reconstruction will usually not produce as good a long term aesthetic result and the best form of reconstruction, is to preserve your breast if possible.
  • Partial breast reconstruction using a perforator flap. This is generally reserved for patients who don’t have enough volume for a therapeutic mammoplasty but due to the position of cancer may have this partial volume replacement option.

If you would like to discuss your surgical options for breast cancer you can book an appointment with Mr Smith via his Top Doctor’s profile here for his expert opinion.

By Mr Brendan Smith


Brendan Smith is a highly trained and dedicated consultant oncoplastic breast surgeon with over 18 years of consultant specialist practiceThis wealth of experience has resulted in leading expertise across the field of oncoplastic breast surgery, such as breast reconstructionbreast cancerbreast reduction, breast augmentationbenign breast diseases and revisional breast surgery.
He has an extremely strong background in teaching and training breast reconstruction techniques to those in training and consultant professionals also. He has been a course director for the level 2 Oncoplastic Breast Reconstruction Surgery course at the Royal College of Surgeons and Association of Breast Surgery of the UK and Ireland Since 2011. He is also joint course director for the Oxford Oncoplastic Breast Surgery Course, teaching on it since its inception in 2013. He is also a faculty member for the Level 1 Oncoplastic Breast Reconstruction Surgery course formally at the Royal College of Surgeons and now the Association of Breast Surgery of the UK and Ireland.

He qualified in 1991 from Charing Cross and Westminster Medical School, completed his college fellowship exams (FRCS Eng) in 1996 and achieved a research fellowship studying the ‘Detection of micrometastases in breast cancer’ gaining a higher Masters of Surgery degree  (MS University of London) in 2003. As a dedicated career breast surgeon from this early stage, he gained his senior surgical training through the University of Oxford Surgical rotation in 1996 completing his FRCS exit examination (Gen Surg) in 2004. During senior surgical training in 2003 he succeeded in gaining his first choice preference of one of the first National UK Oncoplastic fellowships at the Christie and South Manchester University Hospitals.
Throughout his career, he has been dedicated to treating his patients using modern and innovative techniques in oncoplastic breast surgery to try and avoid mastectomy, where possible, including therapeutic mammoplasty, lipofilling (fat transfer), partial breast reconstruction using perforator flap techniques and neoadjuvant systemic treatment when necessary.
 He has extensive experience in breast reconstructive techniques using nipple-sparing or skin-sparing mastectomy, pre pectoral and partial sub pectoral ADM breast reconstruction, and autologous and implant-assisted LD flap reconstruction. He also works with an experienced plastic surgeon for patients having DIEP or free TRAM flap breast reconstruction.
He was appointed as the first Oncoplastic Breast surgeon at the Royal Berkshire Hospital in 2004. He set up the oncoplastic breast unit and has continued to develop it introducing new technology and techniques over the last 18 years. He has trained many other practising oncoplastic consultants over that time many of whom now work in the Oxford surgical deanery.
Furthermore, he continues to contribute to his field in the form of research, currently focusing on extending the surgical research portfolio locally.

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