Oncoplastic surgery, the importance of linking the two disciplines

In Spain every year 26,000 new cases of breast cancer are diagnosed. Catalonia is the territory with the most diagnoses, 84 cases per 100,000 inhabitants, compared to 50 per 100,000 on average in the rest of the regions. With a survival rate higher than 80%, one of the biggest challenges in breast cancer is breast reconstruction. We speak with the doctors of the Oncoplastic and Aesthetic Surgery Unit that explain what this discipline consists of.

Doctor Joan María Viñals, who are you? What is the Oncoplastic and Aesthetic Surgery Unit?

The Oncoplastic and Aesthetic Surgery Unit is a plastic surgeons company founded 20 years ago by Dr. Josep Maria Serra Payró and me. Dr. Amadora Rubia Martos, a specialist in plastic surgery, has also worked with us for 15 years.

Where they are located?

We are currently in the Mútua de Terrassa Hospital (Àptima), in the Sant Josep Clinic (Altahia) in Manresa, in the Diagonal Clinic in Esplugues de Llobregat and in Tarragona, in the Sant Joan de Reus Hospital.

Doctor Serra, what does "oncoplastic" mean?

It is a term created in the field of breast surgery that involves applying the reconstructive resources of plastic surgery to oncological surgery. This discipline allows a more radical surgery in the margins of tumor resection and, at the same time, preserve the shape of the breast and even improve it.

Improve it?

Yes, for example, in oncological breast reductions. It's the same as aesthetic breast reduction but removing cancer. When we have to perform a radical mastectomy - complete removal of the breast - with microsurgical techniques we can transplant skin and fat from the lower abdomen and reconstruct the breast in the same operation. Without prosthesis or other materials that can pose a problem when performing the other necessary treatments such as radiotherapy. Only with skin and own fat of the patient.

But do you also perform a mastectomy?

DS: Yes, of course. We are oncological surgeons and we assume the surgical treatment of cancer.

Dr. Viñals, in what sense is oncoplastic surgery adapted to cancer treatments?

Oncoplastic surgery is especially indicated for the treatment of cancer. By being able to transplant the desired tissue, the tumor and the affected area can be better removed.

Reconstructing the breast with living tissues and well vascularized allows to achieve a good and rapid healing of the operated area, and avoid complications and delays in recovery.

It facilitates oncological treatments such as radiotherapy or chemotherapy, since these can be applied at the month of the operation and at the dose and intensity that are convenient, without having to stop the treatment due to wound infections or other complications.

It also facilitates surgery when there has been RDT and QMT before the intervention. This affects the tissues that are left with healing problems. Providing healthy tissues is crucial for healing.

With the oncoplastic reconstructions we also want to achieve the best aesthetic and functional result for the patient; In breast cancer it is easy to understand, we improve the appearance of the breast on all occasions and we get that no woman without breast leaves the operating room.

Do you work with other specialists?

Always. Medical oncologists and radiotherapists are our road companions, pathologists and radiologists too. We never face an oncological intervention without a meeting and the agreement of all of them.

In what other areas is oncoplastic surgery important?

In head and neck surgery is very important. Without proper reconstruction, some tumors can not be removed. Nowadays, with the techniques of own tissue transplantation, we can reconstruct facial bones thanks also to the new computer programs that allow us to be more precise. Also, we can reconstruct soft facial parts such as the tongue or esophagus.

Esophagus?

Yes, with the small intestine. Even in certain cases with part of the stomach and omentum. It is a method in which we have a lot of experience and that allows us to save very serious situations. For example, when the pharynx is open in the neck with a serious bacterial contamination of the vascular structures of the neck, which can easily produce a fatal hemorrhage. With reconstruction we can quickly cure these cases.

How can you get to this situation?

In general, they are patients who have undergone radiotherapy and chemotherapy for cancer of the larynx or pharynx, but the tumor has reproduced and they have been operated on again. The tissues have lost the ability to heal, they open up and contamination of the mouth and pharynx infects everything.

In what other areas can oncoplastic surgery play an important role?

In soft tissue tumors, sarcomas. They are tumors that are located in any part of the body but especially in the extremities.

In these cases oncoplastic is crucial to be able to do a good surgery, really radical, maintain the limb and avoid amputations at all costs.

Outside of oncology, do you have applications?

Yes, especially in the reconstruction of the lower limb in open fractures, such as those produced in motorcycle accidents. Also in all cases of skin cancer and in any tumor that affects soft tissues, regardless of their origin.

And the aesthetic part, Dra. Blonde?

We are plastic surgeons, aesthetic interventions are the operations that give us the most work and there are many patients interested in them.

Is aesthetics very different from all of the above?

Not at all, the surgical techniques are very similar and most are the same. The difference is that oncoplasty is aimed at patients with a neoplastic disease and, aesthetics, patients who want to improve a state that seems normal to them, due to aging or because the shape of some parts of the body does not they like. For example, too big or too small or fallen breasts, too big a nose, aged eyelids, etc.. The correction of this aesthetic pathology provides a satisfaction, an increase in self-esteem and also the state of health of the person.