Dr. Lashan Peiris, an oncoplastic and reconstructive breast and general surgeon in Edmonton, Alberta, Canada, discusses oncoplastic surgery after a breast cancer diagnosis. He defines the term oncoplastic breast surgery, describes the type of conversation he has with his patients, and who might be a candidate for this type of surgery after a breast cancer diagnosis.
Shared Decision-Making in Oncoplastic Surgery
When a person is diagnosed with breast cancer the healthcare team should work together to coordinate patient care to determine the best long-term survival and quality of life choices in treatment and surgery. Dr. Peiris makes a profound statement, “Gone are the days where we as breast surgeons walk into a room, tell a lady she’s got breast cancer, and walk out five minutes later.” Dr. Peiris continues his discussion by describing the shared decision-making process in breast cancer and breast surgery care.
All aspects of the patient’s life are taken into consideration. Lifestyle, preferences in outcomes, support systems at home, risk factors, genetic predispositions for breast cancer, and talking about complications from surgery and other treatments. Surgeons no longer should tell a lady, “You should have this kind of operation.”
Options for Breast Surgery Based on Studies
Dr. Peiris references two randomized studies using thousands of women and written by notable authors, Dr. Bernard Fisher, and Umberto Veronesi. In 2002 these gentlemen did a twenty year follow up on these studies. The studies looked at two groups with early-stage breast cancer. One group of women had breast conversing surgery with radiation. The other group had a mastectomy.
The study found after twenty years, and perhaps even longer, a person’s survival for breast cancer was equivalent. Dr. Peiris states this is a big take home message for patients. He also points out long term studies show women who have breast conserving surgery rather have increased long term quality of life compared to those who chose mastectomy. He is careful to point out some women are not candidates for breast conserving surgery and it is in their best interest oncologically to have a mastectomy. This is why these studies have become a key component of discussion at consult.
Who is a Candidate for Oncoplastic Breast Surgery?
The breast cancer tumor becomes the focus of conversation. The type of tumor, the volume or size of the tumor and comparing it to the patient’s breast size. A woman with larger breasts is going to notice less any of the incisions and removal of a tumor compared to a woman with much smaller breasts.
Typically, when a woman with smaller breasts is a candidate for a lumpectomy, but the removal of the tumor will lead to asymmetry Dr. Peiris then talks to the patient about oncoplastic surgery. The principals of oncoplastic surgery are born out of the same principals as all cancer surgeries, taking the cancer out and achieving clear margins but marrying that with plastic surgery procedures. The idea is to “fill the hole” that has been left behind by the cancer.
Why Patients Should Consider Oncoplastic Surgery after a Diagnosis
Dr. Peiris goes on to tell us about a quality-of-life study he is doing with women who have had oncoplastic surgery. These are the choices that should be presented to all those newly diagnosed with breast cancer. Mastectomy and breast reconstruction are not the only choices. When surgeons who specialize and train in oncoplastic surgery patients can go on to live long, healthy lives with this option of oncoplastic surgery after a breast cancer diagnosis. Dr. Peiris shares his personal feelings of gratitude about being let into a patient’s life after a diagnosis and “explore what’s important to them.” This is what all patients deserve. Thank you Dr. Peiris! You can listen to our conversation here: