"The rigour of the gesture — at the service of the beauty of the result."
Oncoplastic surgery combines the oncological rigour of lumpectomy with the aesthetic finesse of plastic surgery. Remove the tumour with clear margins, preserve the shape and symmetry of the breast.
Remove the tumour, preserve the breast. This is the principle of conservative treatment — possible in the majority of small to moderate-sized breast cancers.
A lumpectomy removes the tumour with a safety margin of healthy tissue around it — this is the essential condition to limit the risk of local recurrence. The procedure is performed under general anaesthesia, lasts one to two hours, and is most often carried out as day surgery — you go home the same day.
In most cases, a simple scar is sufficient — either over the tumour or periareolar — without the need for oncoplastic surgery. This is the most common situation, and the aesthetic result is usually very satisfactory when the amount of tissue removed remains moderate relative to breast volume.
When reshaping is needed — oncoplastic surgery. When the amount of tissue removed is significant relative to breast volume, letting the cavity fill on its own would risk deforming the breast or creating marked asymmetry. In this case, the remaining glandular tissue is reshaped at the end of the procedure to restore a harmonious shape to the breast — this is called oncoplastic surgery. Oncoplastic surgery consists of applying techniques from aesthetic surgery to the treatment of breast cancer. Several techniques exist depending on tumour location and breast morphology: Round Block (incision around the areola), medial or lateral radial mammoplasty, inverted-T for larger breasts, local perforator flap when the defect is difficult to fill otherwise, or Batwing mammoplasty for central tumours. There is no standard incision — the technique is chosen on a case-by-case basis.
Who is it for? Oncoplastic surgery is offered whenever a glandular reshaping procedure can improve the aesthetic result without compromising oncological quality. It is particularly indicated when the ratio between breast volume and tumour size leads to significant tissue loss, in cases of delicate localisation (lower quadrants, tumours close to the areola, central retro-areolar tumours, tumours in the décolleté or inner quadrants), or in cases of marked hypertrophy or ptosis — the inverted-T then allows combining the oncological procedure with breast reduction and lifting, an indication often appreciated by patients with pre-existing functional discomfort. The limitations of oncoplastic surgery are very large tumours in small breasts, extensive multifocal tumours, and contraindications to radiotherapy — in these situations, mastectomy with possible immediate reconstruction is generally preferable. The decision is discussed in consultation and at the multidisciplinary team meeting.
After conservative treatment, radiotherapy is usually offered to reduce the risk of local recurrence. The modalities are discussed with the radiotherapy team, usually 2 to 3 months after surgery, over 1, 3 or 5 weeks.
If margins prove insufficient on the final pathology report, a re-excision is organised. This result is communicated at the 15-day consultation, which also marks the reading of the final pathology report.
Click on a technique to discover its indication, procedure and practical details.
More and more breast cancers are diagnosed at an early stage, before a tumour is palpable. For these lesions invisible on examination but visible on imaging, preoperative localisation is essential to guide surgery with millimetre precision. Several techniques exist: hookwire, Magseed (magnetic seed), Sirius Localizer (radio-opaque clip).
Announcement of investigation results, clinical examination, presentation of possible surgical techniques with anatomical model, joint choice of technique. Reflection time guaranteed.
Validation of the treatment plan at the multidisciplinary team meeting (medical oncologist, radiotherapist, pathologist, surgeon). Anaesthetic consultation at least 48h before the procedure.
If non-palpable lesion: radiological localisation. Standing surgical marking by the surgeon (essential step for inverted-T mammoplasty). Tracer injection for the sentinel node. Operating theatre.
General anaesthesia. Tumorectomie avec marges de sécurité, prélèvement du sentinel node si indiqué, remodelage glandulaire selon la technique choisie, symétrisation controlatérale si prévue. Pansement modelant. Clinique Hartmann ou Hôpital Américain.
Examination of scars. Reading of the final pathology report (histological type, grade, margins, lymph nodes). Presentation of the complementary treatment plan validated at MDT: radiotherapy, chemotherapy, hormone therapy as appropriate.
In the vast majority of cases, the post-operative course is simple and minimally painful. Moderate tension-type pain, relieved by simple analgesics (paracetamol ± anti-inflammatories), may persist for a few days. A compression bra-shaped dressing is applied and kept on for 24 to 48 hours.
Sutures are usually absorbable — no need to remove them. A nurse contacts the patient the day after surgery to check for any complications. A support bra is recommended for 1 month.
Bruising is common and disappears within a few weeks. If a blue dye injection was used for the sentinel node, the skin may remain coloured for several months — this is harmless.
Baths and sports activities are contraindicated for 1 month. All daily activities are permitted. Adjuvant radiotherapy will usually begin 2 to 3 months after surgery, over 1, 3 or 5 weeks depending on the protocol.
Oncoplastic surgery remains a surgical procedure and carries a low but real risk of complications. True complications are rare following oncoplastic surgery performed according to the rules. Here are the main ones:
30 to 40 minutes for most techniques (Round Block, Batwing, radial mammoplasty, local perforator flap), sauf le T inversé qui dure de 40 minutes à 1h10 depending on the breast et the volume to remove. General anaesthesia in all cases. Excluding the procedure on le sentinel node ou le any axillary clearance.
Oui, le plus souvent. Round Block, Batwing et radial mammoplasty sont quasi systématiquement en ambulatoire — sortie le jour même. T inversé avec symétrisation et flap perforant peuvent nécessiter 1 to 2 nights.
Yes, systematically. Whenever there is breast-conserving treatment, adjuvant radiotherapy is delivered afterwards. It usually starts 2 to 3 months after surgery, over 1, 3 or 5 weeks depending on the protocol. The modalities are discussed with the radiotherapy team.
It depends on the technique. Round Block: single periareolar scar, almost invisible with time. Inverted-T: 3 scars (periareolar + vertical + inframammary fold). Radial mammoplasty: lateral radial scar. Perforator flap: extended scar. Batwing: horizontal V-shaped scar.
Contralateral symmetrisation is offered in the same operative session mainly for the inverted-T and the Round Block, which modify the shape and volume of the operated breast. For the other techniques (radial mammoplasty, local perforator flap, Batwing), it is not usually required initially — a touch-up can be offered later if needed (at least 1 year after radiotherapy).
If the final pathology report (result at 15 days) shows insufficient margins, a re-excision is organised. This procedure is usually simpler — either a new lumpectomy, or, more rarely, a mastectomy depending on the residual extent.
Yes, and it is even common. Preoperative chemotherapy can shrink the tumour and allow breast-conserving treatment that was initially not feasible. Oncoplastic surgery is then discussed based on treatment response and residual tumour size.
Breastfeeding remains possible after oncoplastic surgery, especially if the surgery was conservative and limited. It may be reduced or impossible on the operated side depending on the technique (inverted-T, perforator flap). Subsequent radiotherapy significantly reduces breastfeeding capacity on the irradiated side. Discuss this with your surgeon if you have pregnancy plans.
A consultation to discuss your case, understand the options available to you, or a second surgical opinion — do not hesitate to book an appointment.