Understanding oncoplastic and reconstructive breast surgery

Written by: Miss Fiona MacNeill
Edited by: Kate Forristal

In her latest online article, Miss Fiona MacNeill gives us her insights into oncoplastic and reconstructive breast surgery. She talks about what it is, the procedure, how long the procedure takes, recovery and success stories.

What is oncoplastic and reconstructive breast surgery?

Oncoplastic breast surgery combines cancer treatment with cosmetic improvements. The term "onco" refers to cancer, and "plastic" refers to appearance. This approach merges the best methods from cancer and cosmetic surgeries. It ensures that women getting breast cancer surgery can keep a good-looking breast. In the past, this option was limited, which sometimes left women with misshapen breasts after cancer treatment. This was hard for survivors, as they had to live with the change. Today, many breast surgeons are trained in both types of surgery, allowing them to offer oncoplastic breast surgery.


Reconstructive surgery is a bit different. It's usually for cases where a whole breast is removed. Oncoplastic surgery focuses on reshaping and keeping part of the breast's appearance intact. Reconstructive surgery is more about situations where the whole breast is removed and needs replacement. This can involve using implants or a person's own tissue, like from the tummy or back. Both are reconstructive surgeries, but oncoplastic surgery deals with part of the breast, while reconstructive surgery involves replacing the whole breast.



Does the procedure reduce the original breast volume? Can the aesthetics of the breast significantly change?

What can be done depends on various factors. Sometimes, a woman might want to reduce her breast size as part of the procedure, which could mean operating on both breasts. This depends on the cancer treatment needed and the woman's preferences. During the consultation, the oncoplastic surgeon should talk to the woman about what she wants from the breast surgery. Much of the conversation is about what she likes, especially when it comes to replacing the breasts. She can choose to match her other natural breast or change the size and shape of both. This talk is usually quite detailed when we're discussing it with patients.



How long does the procedure take?

Breast surgeries vary in length, ranging from around 30 minutes for shorter procedures to potentially 8 to 10 hours for more complex reconstruction surgeries. Major reconstructions often involve both a breast surgeon and a plastic surgeon working together. For instance, in procedures like DIEP flap reconstruction, where abdominal tissue replaces the breast, connecting blood vessels can take up to 10 hours for bilateral surgeries (both breasts).


It's important to note that during longer surgeries, breaks are taken. The surgical team doesn't work continuously throughout. A team of surgeons is involved, with the lead consultant handling the intricate parts and then taking breaks while others manage fewer complex aspects. Throughout the surgery, the patient's well-being is closely monitored by the anaesthetic and theatre team. This team ensures the patient's safety, especially their breathing and overall condition.


An operating theatre includes more people than many might expect, all dedicated to the patient's care. The surgical team, including consultants and younger surgeons, collaborates with the anaesthetic and theatre team, which includes nurse specialists and theatre nurses. This setup reflects the comprehensive and cooperative nature of surgical procedures.



What is involved in recovery from oncoplastic and reconstructive breast surgery?

As we mentioned before when we talked about recovering from breast surgery, oncoplastic or reconstructive procedures are a bit more involved. So, the recovery time might be a bit longer. This is because these surgeries are often longer and could cause more bleeding and more scars. If there's more blood loss, you might feel tired for a longer time as your body heals. Also, having more scars could mean slower wound healing and a higher chance of infection.


Generally, for most women who have a straightforward oncoplastic surgery, they can usually start doing regular things like going out, visiting the hospital, having coffee with friends, and maybe even driving again after about two weeks.



Can you recall a success story of one of your patients who has undergone this type of surgery?

Breast cancer is tough on anyone, just like any cancer diagnosis. But modern breast surgery can help people look and feel whole again. This matters because how we see ourselves matters to all of us. It's not about being vain; it's about how we feel about our bodies. It doesn't matter where you're from or your background – how you feel about your body is important. Oncoplastic and reconstructive surgeries aren't done for others; they're done for the person having the surgery. It's about how you feel about yourself, and that's not being vain. I'm really passionate about this because it's crucial for people to feel good about themselves, without feeling like cancer surgery changed how they look in a negative way.


My job, and the job of other cancer surgeons, is to help patients see a future beyond cancer and get back to a normal life. This is where the success stories come in. I meet women a couple of years after their surgeries, during their recovery time. The emotional recovery from this type of diagnosis and surgery can take years, much longer than the physical healing. We, as healthcare professionals, usually focus on the physical recovery, but we're now getting better at addressing emotional and psychological recovery, which often happens quietly, at home. Society is improving at talking about emotional and mental well-being.


One story that always sticks with me is about an older woman with very large breasts. Her breasts had caused her trouble and embarrassment her whole life. As part of her breast cancer surgery, I suggested reducing their size to make her more comfortable. She had to wear specially made bras due to the weight of her breasts, which caused dents in her shoulders. After removing her cancer and a lot of tissue from both breasts, her life changed dramatically. She came back to my clinic a few weeks later, happy and laughing, because she had bought a regular bra for the first time in her life. This surgery transformed her life in a big way, showing how impactful quality breast surgery like oncoplastic procedures can be.


Another touching example is a woman who valued her breasts for nourishing six children. Although they didn't fit society's beauty standards, she wanted them to stay the same. Working with plastic surgeons, we replaced her affected breast to match the other one perfectly. This allowed her to move forward confidently. These stories show the heart of successful breast surgery – collaborating with each woman to fulfil her unique needs and wishes. Everyone has different desires, and it's important for women to openly share what they want so that we can work together to create success stories for each of them.


Miss Fiona MacNeill is a distinguished consultant oncoplastic breast surgeon with over 40 years of experience. You can schedule an appointment with Miss MacNeill on her Top Doctors profile.

By Miss Fiona MacNeill

Miss Fiona MacNeill is a highly achieved and pioneering consultant oncoplastic breast surgeon in the London area where she practises at her private clinic and with the NHS. Originally specialising in general surgery, Miss MacNeill is now a specialist in all things related to the breasts, breast surgery, and breast cancer. Some of her top focuses are rapid access and diagnosis of breast problems, oncoplastic breast surgery (including reshaping and remodelling), breast reconstruction, risk reducing breast surgery, and second opinions.

Qualifying in 1983 from St Bartholemew's Hospital and receiving awards in her education, Miss MacNeill was later appointed as a consultant in 1996 with the Colchester NHS. Here she established a considerably successful breast unit, which she led until moving to The Royal Marsden NHS in 2006. Since then, Miss MacNeill has continued being a groundbreaker by practising novel drugs and treatments, leading prominent associations of breast surgery, and working with the best of partnering departments to provide the highest quality care and results for her patients.

Miss MacNeill is still involved in local and national research trials, striving to achieve the optimum results for patients. She also continues to lecture world-wide, training physicians and surgeons on delivering modern breast cancer care by the evolving role of breast surgery in the treatment of breast cancer, as well as the importance of working with a multidisciplinary team and having a treatment plan. Miss MacNeill is an advisor to multiple Department of Health committees and is a steady member of various associations and societies; one of these is the Association of Breast Surgery, where Miss MacNeill sits as the chairman of the education and training committee.

Furthermore, Miss MacNeill is the National Clinical Lead for the Getting It Right First Time (GIRFT) Programme, which is a standard setting and quality improvement programme for the NHS. Previously, she was the Breast Tutor at the Royal College of Surgeons of England to educate the future generations of breast surgeons by establishing the UK sentinel lymph node training programme and oncoplastic surgery portfolio. This was the first General Medical Council recognised curriculum for breast surgery training.

Miss MacNeill presently practises at the private London Breast Clinic and the Royal Marsden NHS.

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