Doctors combine breast cancer surgery, cosmetic repair

Surgeons are increasingly offering an added benefit to their breast-cancer patients: removing the tumor and cosmetically repairing the breast at the same time.

Women with breast cancer traditionally would see a cancer surgeon to have the diseased tissue removed and later see a plastic surgeon for reconstruction. Now, more cancer surgeons are getting trained in cosmetic techniques that preserve or restore a breast's shape or appearance. This emerging field of "oncoplastic surgery" could allow a patient to minimize the number of times she must go under the knife.

The shift comes as traditional plastic surgeons turn increasingly to purely cosmetic procedures, which pay more. Indeed, the number of breast-reconstruction surgeries declined 29 percent to 57,100 last year from 2000, a development the American Society of Plastic Surgeons attributes in part to poor insurance reimbursement for these procedures.

Breast cancer strikes one out of eight American women at some time in their lives. Making plans for breast reconstruction at the same time as cancer surgery can speed a woman on the path of psychological, as well as physical, recovery. And by combining procedures to reduce the number of operations, it also reduces the risk of complications from successive surgeries.

The combination of cancer surgery with cosmetic techniques is aimed mainly at women with early-stage cancer getting a lumpectomy, a procedure that removes cancerous tissue but leaves the rest of the breast. Oncoplastic surgery also can sometimes benefit patients who need a mastectomy, or total breast removal, by helping to prepare their bodies for subsequent reconstruction.

"There is a growing awareness that we haven't done as good a job as we should" in offering aesthetic options to breast-cancer patients, says Pat Whitworth, director of the Nashville Breast Center in Nashville, Tenn.

In a typical lumpectomy, also called a partial mastectomy, the surgeon makes an incision, scoops out the cancerous tissue and then closes the opening. That can often leave the breast with a disfiguring dent. In oncoplastic surgery, by contrast, a wedge is removed and tissue under the skin is then pulled together to close the defect. That can leave the breast looking smaller, but otherwise normal. Sometimes an oncoplastic approach may be taken by two surgeons teaming up to do cancer removal and repair in the same operation.

"What we're talking about for the most part is how to do a nice lumpectomy," rather than relying on breast reconstruction that uses artificial implants or tissue transplants, says Benjamin Anderson, director of the University of Washington's

The number of surgeons using oncoplastic techniques is small but growing, says Diana Rowden, a breast-cancer survivor and vice president of health sciences at Susan G. Komen for the Cure, a Dallas-based advocacy group. There is no professional certification for oncoplastic surgeons, so patients should inquire about a practitioner's training and experience.

The American Society of Breast Surgeons since 2005 has sponsored introductory oncoplastic courses at its annual meeting. In December, the American Society of Breast Disease, a group that includes radiologists and oncologists, held its first School for Oncoplastic Surgery in Texas. The three-day course, to be repeated this year, included a session at the cadaver laboratory at Baylor Medical Center at Frisco, where the surgeons got to practice some techniques. Practitioners say they don't make more money from oncoplastic surgery than from regular cancer surgery, and say the attraction is mainly wanting to do a better job for their patients.

Some cancer surgeons say they are seeking oncoplastic training because of a shortage of reconstructive surgeons, a growing problem especially in rural areas and mid-size towns. Plastic surgeons are "bailing out" because "they get paid $1,000 for reconstruction when instead they could do four breast augmentations at $5,000 a pop or more," says Michael Cross, a breast surgeon in Fayetteville, Ark. Reconstructive surgeries also often take more time to perform than purely cosmetic procedures.

Before surgery

Some questions for a cancer surgeon:

• Do you specialize in breast surgery?

• Are you familiar with oncoplastic surgical techniques?

• How do those techniques apply to my case?

• Do you ever do a lumpectomy with a breast reduction at the same time?