What plastic surgery options are available after a lumpectomy?

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JoshLevineMD (Physician - Surgery - Plastic (Verified) ) - 05 / 24 / 2012

Lumpectomy is the surgical removal of the breast cancer tumor with enough surrounding tissue such that the margins are free of cancer. This is different from a mastectomy, which removes the entire breast. Mastectomy results in the absence of breast, so reconstructive options are designed to replace the entire breast. Lumpectomy may or may not require any reconstruction.

If the tumor is small enough within the breast, removing it may not cause a noticeable defect, and reconstruction is not needed. That is the best-case scenario, and a good argument for lumpectomy, which is also called "breast conservation therapy".

If the tumor is in a place where its removal can be combined with a reduction or lift, this is another option. Of course, this would probably require a similar procedure on the other side for symmetry. These options are in a category knows as "onco-plastic” procedures.
There are also a number of autologous options (using the body's own tissue) for lumpectomy defects that can be done at the time of the lumpectomy or later on. These options include local flap procedures, which borrow tissue from the side (next to the breast), and free flap procedures, which borrow tissue from further away, like the abdomen.
There are good reasons to wait to do the reconstruction for a lumpectomy defect at a later time:

1. You won’t know the extent of the defect at the time of the lumpectomy, especially since radiation will almost certainly be done after surgery. Radiation causes changes to the remaining breast.

2. You will not know for sure that the margins of the lumpectomy are clear (free of cancer) until several days after the lumpectomy

Fat grafting (using your own liposuctioned body fat) can also be done to fill in depressed areas in the breast. The main problem with this technique is that the results are unreliable. There is also concern about whether or not this influences the recurrence rate for developing cancer in the future.
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