ADVANCED ONCOPLASTIC BREAST RECONSTRUCTION
Oncoplastic breast surgery emerged in the 1990s as an innovative approach to expand the possibilities of breast-conserving surgery, reducing the rates of mastectomy and additional surgery to remove remaining tumor tissue while avoiding unsightly deformities.
It combines breast cancer surgery with plastic surgery techniques, allowing the removal of the tumor, leaving sufficient healthy tissue around it.
“This approach not only achieves the essential goal of complete tumor removal but also creates a symmetrical breast, preserving its natural shape and function, comparable to the results expected from purely cosmetic breast surgery.”
The surgical plan is defined based on a precise preoperative diagnostic evaluation that considers the size and shape of the breast, the location of the tumor, and the tumor-to-breast volume ratio. The combination of all these factors determines which technique is most appropriate. The treatment decision always results from a multidisciplinary team discussion and shared decision-making with you, the patient. I generally reserve oncoplastic surgery for cases in which the lesion is unicentric and unifocal, meaning it is confined to a single area of the breast. More recently, the concept of extreme oncoplastic surgery has been introduced, expanding the use of oncoplastic techniques to multicentric and multifocal tumors, extensive carcinomas, and locally advanced forms of breast cancer. This procedure must be performed with great caution and reserved only for selected cases, following a thorough multidisciplinary team evaluation.
UNDERSTANDING THE PROCEDURE
Professor Krishna Clough, founder of the international Paris Breast Center – L’Institut du Sein in Paris, where I had the honor of completing my training and specialization in plastic surgery, was a pioneer in developing the concept of oncoplastic surgery.
Today, it stands as one of the most revolutionary approaches in contemporary breast cancer surgery.
According to Professor Clough’s classification, reported in numerous manuals and scientific publications, oncoplastic surgical approaches are divided into:
• Level I oncoplastics: less than 20% of the breast tissue is removed. The tumor is excised without removing skin, and the area is reshaped using internal tissue remodeling techniques, with possible recentralization of the nipple-areola complex.
• Level II oncoplastics: 20 to 50% of the breast tissue needs to be removed. It often involves removing a small amount of skin and reshaping the breast using techniques borrowed from cosmetic breast surgery, such as breast reduction, breast lift, and similar procedures.
“I believe that integrating cancer safety with a beautifully harmonious result is the true essence of oncoplastic surgery".
FOR A MORE CONSCIOUS CHOICE
In patients with pronounced sagging or hypertrophic breasts, this approach often eliminates the need for radical surgery, enabling wider oncologic resection margins, reducing the risk of local recurrence, and consequently decreasing the likelihood of reoperation. Key indications include cases with an unfavorable tumor-to-breast volume ratio, as well as tumors situated in more challenging locations, such as the central quadrant or the lower and medial poles of the breast. Oncoplastic surgery may not be suitable in cases where it is not possible to safely remove the tumor without a total mastectomy, in the presence of microcalcifications that suggest a multicentric or multifocal disease, or in inflammatory breast cancer.
The advent of oncoplastic surgery has allowed many patients to benefit from a multidisciplinary team approach that ensures both the highest level of oncological safety and the most advanced reconstructive surgical techniques, delivering the best aesthetic results with a minimally invasive procedure. By restoring the size, shape, and overall appearance of your breast, oncoplastic breast reconstruction has a significant positive impact on your quality of life, including psychological, social, sexual, emotional, and functional aspects. Even with similar clinical conditions, there is not always a single option, rather a range of options to consider together, weighing benefits and risks and taking your personal expectations into account. Some patients strongly wish to preserve their breast, while others are certain they want a mastectomy, even when the tumor is small. Dr. Elisa Bolletta believes in guiding you with professionalism and empathy so you can make fully informed, confident decisions. Today, surgery involving a sensitive organ like the breast is increasingly patient-centered, considering your most personal and intimate needs. It focuses not only on treating the disease but also on supporting your quality of life and your personal goals. These considerations complement traditional surgical criteria by addressing the personal impact of reconstruction, as highlighted in recent scientific publications. Patient satisfaction is often more closely linked to thorough information and a solid, shared decision-making process than to the aesthetic outcome alone.
Facing a cancer diagnosis can make it difficult to choose your treatment timing, but you can choose to achieve the best possible outcome for yourself in your situation. Sometimes we see patients who, after a breast cancer diagnosis from their specialist, eagerly await a consultation with Dr. Elisa Bolletta, looking for a glimmer of hope and reassurance amidst everything they have just learned. Discussing oncoplastic reconstruction often brings a positive mindset, as preserving the remaining breast and harmonizing it with aesthetic techniques is generally associated with a minimally invasive procedure. It is important, however, to be fully informed about all potential risks and benefits of this type of reconstruction. Recovery is gradual but typically more manageable compared to a mastectomy with breast implant placement. You must allow yourself plenty of rest, especially if you have an active lifestyle and frequently use your arms. You can typically resume daily activities around 15 days after surgery, with more intense activities, including sports, beginning approximately 40 days post-procedure.
Immediately after surgery, swelling and fluid retention will be present but should gradually subside over the next few days. The breast may remain swollen with bruising for at least 15 days following the procedure. It is normal to feel some apprehension when moving and to experience mild soreness in the arm and throughout the treated area. You may gradually resume normal activities around 15 days after surgery to prevent abnormal tissue tightness and postural imbalances. More strenuous activities, including sports, can typically be resumed about 40 days after the procedure. To support a smooth recovery, we use physical therapy protocols designed to ensure full functional recovery and help prevent potential complications.
On the day of your surgery, you will be welcomed into a safe and private setting. After your final consultation with the anesthesiologist and with Dr. Elisa Bolletta, who will make the preoperative markings, you will be escorted to the operating room. The procedure consists of carefully removing the tumor with clear margins, followed by meticulous tissue reshaping to maintain the breast’s natural shape, symmetry, and function. Every step is performed to ensure both oncological safety and the best possible aesthetic outcome.
The duration of the procedure depends on the extent of the resection and the complexity of the reshaping, usually lasting 2-5 hours, with intraoperative assessments factored in. Ample time is devoted to achieving both safety and an aesthetically pleasing outcome.
At Elisà Plastic Surgery, your comfort and peace of mind are our top priorities. One of our main goals is to provide an almost entirely pain-free experience from start to finish. General anesthesia and personalized pain management protocols make the procedure comfortable. After surgery, you may feel mild pain or tightness in the treated areas, which can be easily managed with medication and targeted care. You will also be fitted with a soft, supportive bra, designed to relieve pressure and help you maintain a comfortable posture from the start. In the days following surgery, you may experience mild discomfort or tenderness in the treated area, especially with movement. This is completely normal and can be easily managed with topical treatments and pain medication.
Recovery is gradual. Generally, you can resume light daily activities after a few days, avoiding strain and heavy lifting, while a full return to normal routines usually takes about 4-6 weeks. Dr. Elisa Bolletta will strongly recommend using a supportive bra for 4–6 weeks to properly support your breasts and promote healing. A gradual, targeted approach is key to returning to your routine safely, comfortably, and smoothly.
Rest and self-care are essential. It is important to follow your post-operative instructions carefully, avoid physical strain, and wear the recommended supportive bra to promote safe, balanced healing. After the procedure, a regenerative dressing will also be applied to support tissue healing. Once the wounds are dry, fully healed, and well-closed, the scars can be treated with specialized products containing silicone or exosomes, following the protocol prescribed. Remember that your result will continue to evolve over the following months, gradually taking on a soft, natural appearance.
As with any surgery, there are risks, including bleeding, infection, or changes in sensation. The experience of the team and the careful management of every step of the procedure help minimize these risks.
Oncoplastic surgery is an approach that blends oncological safety with the aesthetic and functional restoration of the breast. It goes beyond simply removing the disease, focusing on restoring harmony and a natural look through a fully personalized plan.
After surgery, you will have scheduled follow-up visits at 1, 3, and 6 months to monitor healing, symmetry, and the overall aesthetic outcome. This attentive, continuous care will guide you through every stage of your recovery. The final visit, 1 year after surgery, allows us to assess the fully matured scar and the settled results, showing their natural, final appearance. Your care will continue beyond this stage, with ongoing support to ensure balanced, long-lasting, and dependable results. Each check-up is designed not only for your safety but also for your peace of mind, providing consistent, personalized, and thoughtful support that is part of the Elisà Plastic Surgery experience.
The team at Elisà Plastic Surgery consists of highly skilled professionals, including Dr. Elisa Bolletta, a plastic surgeon specializing in breast and oncoplastic surgery, an anesthesiologist, and dedicated nursing staff. Together, they manage every step of your pre and post-operative journey, working seamlessly to ensure the highest standards of safety and care.
