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News and Information Archive

Oncoplastic Surgery

31/8/2013

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The combination of cosmetic and oncological treatments gives options to women with breast cancer.
Long established as an approach to breast  cancer surgery in Europe and the US, oncoplastic surgery is making inroads  into the Australian  hospital landscape.The approach sees standard plastic  surgery come together with  breast cancer surgery.The combination of cosmetic and oncological treatments is giving  women more options  for dealing with  the prospect of losing part or both of their breasts. Using an oncoplastics approach, a surgeon might, for example, plan a breast  reduction in such a way so as to remove  the tissue  containing the cancer and do a breast  reduction at the same time. Or, she might take out a cancer and do a breast  lift as part of the same procedure.The long-term result  is a body aesthetic that is pleasing and, for many women, more so than what  they had before. Dr Elisabeth Elder is one of the breast cancer surgeons bringing this approach to Macquarie University Hospital as part of the hospital’s significant new  undertaking: the Macquarie University Cancer Institute.

Picture“For many women who have had breast cancer treatment, how their breasts look may well be a significant factor in their body image – and, hence, their mental wellbeing”
“For many women, if it’s a small cancer needing to be removed with  a prognosis for good results, then just a standard  tissue  removal may suffice,” said Dr Elder.“But, for others, if the cancer is larger  or if they are facing a mastectomy, then we may be able to preserve the breast  better  than we have in the past, when breast  conservation wasn’t a focus. As part of that focus, we can try to reconstruct a breast  to what  a woman would  ideally like.”

While taking  this approach probably involves an extra  and more complicated surgery, there are reasons  to consider it.

“Because  we are getting increasingly better results  from cancer treatments, it makes sense to attend  to the long-term  aesthetic of your body,” explained Dr Elder.“For many women who have had breast  cancer treatment, in a few years  when they are feeling  like life is more normal  again, how their breasts  look may well be a significant factor in their body image  – and, hence, their mental  wellbeing.”

Decision-making

Much goes into deciding if oncoplastic surgery is right for an individual patient. 
Medical  factors such as the volume  of the tumour  in relation to the volume  of the breast  is one. If more than 10 per cent needs  to be resected, then the approach is worth considering. Factors such as overall  health, including surgical risk factors such as smoking and diabetes, also have to be taken  into account. Then, perhaps most importantly, there  is the woman herself. Her own physiological make-up and the surgical requirements of her procedure determine the type of technique best used. For example, if a standard  breast  reduction were being  done, a surgeon could  use an inferior pedicle. But if there  is a tumour  involved, a superior or a lateral  pedicle might be used. Surgeons  also factor in what  a woman wants, in terms of her own body shape and image.

“No woman, no breast  and no tumour  are the same,” explained Dr Elder.“This is very individual, personalised medicine. Besides all the medical issues, we also have to look at what  is important to a woman in terms of her own sense  of herself.”

Dr Elder is heartened by the fact that studies overseas have shown  a positive correlation between five-year post-treatment depression levels  and the resulting breast  aesthetic. Emotional wellbeing is no small factor in a decision to take this approach.

“I spend  a lot of time talking  to my patients about how they want  to approach this, and what  they want  to get out of it,” said Dr Elder.

“The approach is fantastic for some patients, but it’s not for everybody.”

Dr Elder completed her undergraduate degree and postgraduate fellowship training at the University Hospital in Stockholm, Sweden. She received a PhD in tumour oncology from the Karolinska Institute. After working in Australia for several years, she returned to Sweden to learn the latest
techniques in oncoplastics before  taking up a position in the Breast Cancer Institute at Westmead Hospital. Dr Elder holds a senior  lecturer position at The Australian School of Advanced  Medicine and is engaged in a range  of research projects from diagnostics to patient-level outcomes and quality of life.

Dr Elder is part of the Breast Surgeons  of Australia and New Zealand sub-committee on breast  oncoplastics that is driving  the use of these  techniques to become more widespread in Australia and New Zealand.

In addition  to training surgeons, this committee’s work  involves  research on important issues  and assurance of quality control. Professor John Boyages, director of the Macquarie University Cancer  Institute, said that Dr Elder’s presence will be a much-valued contribution to the way  in which the Institute works.


By Dr Andrea Lewis

Private Hospital    A UGU S T  2 0 13
Source 


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