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April 2, 2007
Emory surgeons lead in innovative breast cancer surgery

by vincent dollard and lance skelly

Surgeons at Emory are leaders in an innovative breast-conserving surgery for breast cancer patients. Called oncoplastic breast-conserving surgery, it combines breast cancer surgery and breast reconstructive surgery during the same operation.

Working together, a breast cancer surgeon and plastic surgeon remove the cancerous tumor, immediately reconstruct the defect, and reshape the breast using the patient’s own tissue.

Emory surgeons Toncred Marya Styblo and Albert Losken are among a select group of surgeons performing this procedure, which was developed primarily in Europe and is gaining popularity in the U.S. Styblo notes that she has been performing this type of surgery for nearly 15 years, but with recent advances in breast-conserving surgery, radiation therapy and reconstructive options the technique is feasible for more women.

“This is a multi-disciplinary procedure that enables us to obtain generous tumor-free margins, which is an important indicator of success in breast cancer surgery, and to reconstruct the breast immediately,” said Styblo. “Oncoplastic breast-conserving surgery will allow more women to have breast-conserving surgery rather than a mastectomy.”

While a lumpectomy or breast-conserving surgery may result in an undesirable cosmetic result, oncoplastic surgery enables the surgeon to remove more tissue and ensure clear margins, while minimizing the potential for a breast deformity. Not every patient can have breast conservation, but oncoplastic breast-conserving surgery will enable patients to save their breasts and avoid mastectomy whenever possible.

Losken notes that this approach combines the two disciplines and is beneficial for numerous reasons.

“Breast cancer surgeons are typically faced with two conflicting issues,” said Losken. “Their primary goal is to remove as much tissue as possible for effective cancer control, while at the same time trying to preserve breast tissue to prevent a poor aesthetic outcome. By working together as a team, we are able to address these issues simultaneously maximizing both the cancer and cosmetic outcomes.”

There are generally two kinds of breast-conserving surgeries. A lumpectomy, popular in the U.S., involves the removal of the cancerous tumor and some surrounding tissue. A quadrantectomy, which is more popular in Europe, involves a larger section of tissue from the breast.

“Whether the defect is small or large,” said Losken, “the oncoplastic approach allows for preservation of breast shape through breast tissue rearrangement or local flap replacement plastic surgery procedures. Surgery on the opposite breast, such as a lift or a reduction will often improve results and maintain symmetry.”

Styblo explains that communication with the patient is always a key.

“I discuss surgical options at length with any patient who is considering this option,” said Styblo. “Most women are candidates, however, a small percentage of women are not good candidates for breast- conserving surgery in the first place — this can be determined when I meet with the patient. Some of my patients find out that they don’t need a mastectomy after all.”

While this technique combines the talents and resources of two primary specialties, a host of other members forming a full medical team are involved. In addition to breast cancer and plastic surgeons, the Emory oncoplastic breast-conserving surgical team includes a radiologist, pathologist and imaging specialists. A genetic counselor may also be involved as well as a medical oncologist if chemotherapy is necessary.

In a 2005 study published in the Annals of Surgical Oncology, surgeons from the European Institute of Oncology in Milan, Italy, concluded that “oncoplastic surgery adds to the oncological safety of breast-conserving treatment because a larger volume of breast tissue can be excised and a wider negative margin can be obtained. It is especially indicated for large tumors, for which standard breast-conserving treatment may have a high probability of leaving positive margins.”

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