Lumpectomy

Lumpectomy Restoration

Resoration after Lumpectomy is, of course, not ordinarily required. The entire reason for choosing lumpectomy as a treatment is to produce an equivalent chance for cure with a superior cosmetic result. In the past, when lumpectomy threatened to cosmetically cripple the breast, mastectomy would be chosen in preference. Also, since even moderately disfiguring lumpectomies may be aesthetically preferrable to mastectomy, many patient's have been encouraged to accept breasts distorted by larger lumpectomies.

After lumpectomy (and radiation), the patient needs to be followed closely for evidence of disease recurrence in the treated breast. If the disease is not localized, or the breast is difficult to examine clinically or by mammogram, mastectomy will usually be the best choice. For those women who can be followed well, distorting lumpectomies may be reconstructed at the time of the cancer procedure with tissue transfers. (Implant restoration is not preferred in these situations because it can significantly complicate the mammographic followup of the patient's breast). Lumpectomy and reconstruction is a good treatment choice in preference to mastectomy if the cancer resection can spare the nipple/ areolar complex. The natural complex will always be cosmetically superior to one that the plastic surgeon can create later.

Example: Lumpectomy Reconstruction

This patient had a large cancer of her left breast. Although it would require a large resection of breast and skin, her surgeon felt that the nipple and areola could be spared without compromising the tumor procedure. Note the pre-operative breast asymmetry.

The encircled area represents the surgical plan for tumor treatment. Notice that the skin is indented ("retracted") by the underlyning tumor.

Here the lumpectomy is completed.

This is the defect after tumor removal. It can be readily appreciated that simply sewing the wound closed would yield a very unattractive result.

Here the patient is shown after completion of her procedure. A tissue flap was transferred from the abdomen to fill the area left after tumor removal.

Here we see the patient after healing and radiation therapy. Asymmetry is comparable to that seen pre-op. (The mark at the center of her flap is a tattoo used to guide radiation therapy).

2/21/00

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