Oncoplastic surgery is a word in surgery to describe breast surgery for cancer patients modified to produce an aesthetic result. It is derived from the two fields of surgery which Dr Girardi has the most experience; they are breast oncology (the study of breast cancer) and plastic or cosmetic surgery. Dr Girardi is at the forefront of oncoplastic breast surgery techniques in Sydney which focuses on treating the patient whilst achieving the best cosmetic outcome. This means that the patients Dr Girardi treats feel as normal as possible after treatment.
A wide range of reconstructive and breast conservation options are available after mastectomy and Dr Girardi is happy to discuss these with his patients.
Oncoplastic breast surgery is a rapidly growing field of surgery. It is technically complex and requires more time to carry out than traditional breast surgery. Dr Girardi is a well-trained and highly regarded surgeon in the specialty of breast surgery and has all the skills necessary to offer a wide range of surgical options without any of the normal drawbacks that operations associated with breast oncology had in the past. The size of the tumour in relation to the size of the breast is the most important factor when predicting the potential cosmetic result. The location of the tumour within the breast also plays a vital role in aesthetic outcome. Dr Girardi takes these two factors into account before deciding on how to proceed with your surgery.
Reconstruction following breast-conserving surgery may be carried out using volume replacement or volume displacement techniques
This technique has the potential to eliminate the need for complex reconstructive surgery using autologous grafts or implants. The purpose is to move the remaining tissue to fill the defect resulting from excision of the tumour. Displacement techniques reshape the breast through advancement, rotation or transposition of existing/remaining tissue with and without skin. Potential complications may include seroma and contour irregularities.
This involves making a breast entirely with an implant. The operation usually takes under 2 hours and hospital stay is usually 2-5 days.
Mastectomy and implant reconstruction can be performed in one operation. However sometimes two operations are required; the first to remove the breast and place a tissue expander creating a space for the implant, the second to replace the tissue expander with a permanent implant.
Autologous (patient’s own) tissue is harvested and transferred into the resection defect, replacing the volume of excised tissue. As the volume is restored, contralateral surgery is seldom required to achieve symmetry. Dr Girardi is happy to offer this type of reconstruction at the time of tumour removal or at a later date. A major complication of this surgery can be donor site morbidity, flap necrosis and cosmetic failure.
A common breast reconstruction technique is tissue expansion, which involves expansion of the breast skin and muscle using a temporary tissue expander. This is an inflatable implant designed to stretch the skin and muscle to make room for a future, more permanent implant.
When your mastectomy is done, Dr Girardi will insert a tissue expander beneath your skin and chest muscle. A small valve mechanism is located inside the expander through which salt-water solution is injected gradually to fill the expander over several weeks or months. You may feel a sensation of stretching and pressure in the breast area during this procedure, but most women find it is not too uncomfortable.
This process will usually begin three to four weeks after your mastectomy, once your drains are removed, and will continue until the size is slightly larger than your other breast. After the skin over the breast area has stretched enough, the expander will be removed in a second operation and either flap reconstruction or a permanent implant will be inserted.