When performing oncoplastic breast reconstruction, Dr. Chang does not strive to just restore your breast appearance but actually enhance and improve upon your pre-cancer breast shape, size, and position. 

Oncoplastic breast reconstruction is a specialized surgical approach that combines principles of cancer surgery with advanced plastic surgical techniques to restore the breast's appearance after a partial mastectomy. The goal is to ensure a balance between effective cancer treatment and a natural, aesthetically pleasing breast appearance. This advanced approach focuses on preserving the natural look of the breast by using tissue rearrangement from the same breast, or nearby tissues, rather than relying on donor sites from more distant parts of the body.

Overview & Why Choose Dr. Chang

Oncoplastic Breast Reconstruction

  • Patients Undergoing Partial Mastectomy – Oncoplastic breast reconstruction techniques are only options for patients undergoing partial mastectomy (lumpectomy). Patients interested in breast reconstruction after mastectomy require either implants or larger-volume autologous tissue from distant donor sites.

  • Patients with Large Breasts Who Wish to Be Smaller – Patients who have larger breasts and wish to be smaller are excellent candidates for a oncoplastic breast reduction and a symmetrizing reduction mammaplasty.

  • Patients Who Wish to Maintain Their Breast Size – Patients who are generally happy with their current breast size and want to minimize additional surgery are candidates for volume displacement and replacement techniques to restore the breast volume lost from cancer removal.

  • Healthy Patients – Healthy, non-smoking patients without major medical conditions that would make surgery or general anesthesia unsafe are candidates for this surgery. Conditions that pre-dispose to increased complications such as diabetes, vascular disease, autoimmune conditions, immunodeficiencies, etc. are still candidates for surgery but require additional pre-operative counseling and optimization.

  • Realistic Expectations – Dr. Chang views surgery as a partnership between the patient and him. It is important trust and confidence go both ways. Together, we will discuss your goals and if we can reasonably achieve those goals based on your anatomy.


Who Is a Candidate?

  • Medical Evaluation – Dr. Chang will review your medical conditions, medications, prior surgeries, and personal and family history of breast diseases, masses, and cancers. Some patients may be referred to their primary care doctor or a specialist to ensure you are medically optimized for a safe surgery under general anesthesia and post-operative recovery.

  • Breast Examination – Dr. Chang will perform a physical examination of your breasts. This will include measurements of the size, location, and symmetry of the breasts and nipple-areolar complexes. Dr. Chang will assess the skin quality, the weight/volume of excess breast tissue relative to your desired size, and the positions of the nipple areolar complexes to help determine the best surgical approach.

  • Clinical Photographs – Clinical photographs from multiple views will be taken of your breasts. These photos are used to plan for your individualized surgery and compare before and after surgery. No photographs will be published online without your written consent.



Pre-Operative

  • Oncoplastic Reduction – Oncoplastic reduction reconstructs the breast by reducing the overall size while appropriately addressing the defect left by the partial mastectomy. In some cases, the tissue removed by the cancer resection would have been removed in a normal breast reduction, and the case is treated almost exactly like a breast reduction. Dr. Chang aesthetically contours the breast mound and envelope and repositions the nipple-areola complex. In most cases, however, the tissue removed by the cancer resection would result in a contour irregularity if just a breast reduction was performed. In these cases, some of the remaining breast tissue is strategically rearranged to fill in the defect from the cancer resection, and some of the remaining breast tissue is reduced to achieve you desired size. A symmetrizing breast reduction is performed on the non-cancer side (in unilateral cases).

  • Local Tissue Rearrangement – Patients with larger breasts and smaller tumor-to-breast ratios and who want to stay roughly the same size are good candidates for oncoplastic reconstruction with local tissue rearrangement. With this technique, Dr. Chang strategically dissects, rearranges, and sutures your remaining breast tissue to reconstruct the defect left by the partial mastectomy and aesthetically contour the breast. Sometimes, this procedure is performed through the incision used to perform the partial mastectomy. Other times, additional incisions are made if you wish to refine the skin envelope of the breast to address problems such as nipple-areola complex ptosis or loose/excess breast skin. In these cases, a symmetrizing mastopexy is performed on the non-cancer side (in unilateral cases).

  • Local Perforator Flaps – Patients with relatively smaller breasts or larger tumor-to-breast ratios who want to stay the same size need the breast volume removed by the partial mastectomy replaced. The most common method is with one of several different perforator flaps. A perforator is a blood vessel that travels through a structure like muscle or fascia to supply an area of skin and fat. Known perforators on the side of your chest wall (lateral intercostal perforator flap and lateral thoracic perforator flap) or your back (thoracodorsal perforator flap) are used to design a flap (skin, fat, and its blood supply) that will replace the lost breast volume. Dr. Chang uses advanced microsurgical techniques to dissect these flaps in order to maintain their blood supply for survival. These procedures do involve additional incisions, separate from the breast. The incisions are strategically placed to be mostly hidden by your bra-line. After restoring the lost volume with the perforator flap, the overlying skin may be tailored to produce a more aesthetically-pleasing breast, if that is in-line with your goals. In those cases, a symmetrizing mastopexy is performed on the non-cancer side (in unilateral cases).





What Techniques Does Dr. Chang Use?

  • Dressings and Incision Care – Your incisions will be dressed with surgical bandage strips and/or surgical skin glue. You will be wearing a comfortable surgical bra stuffed with gauze pads. The bra should be snug but not overly tight. You should try to wear the surgical bra as much as possible but may remove to shower and to wash the bra. You may or may not have surgical drains depending on your medical conditions, amount of breast tissue resect, and Dr. Chang’s clinical judgment. They will be removed at your first post-operative visit. You may shower the day after surgery but cannot bathe or swim until instructed to do so.

  • Pain Management and Medications – Local anesthetic (numbing medication) will be injected at your surgical sites to minimize your immediate post-operative pain. You should take acetaminophen and an NSAID around-the-clock, according to instruction, for the first 72 hours and then as-needed thereafter. You can purchase these over-the-counter. You will be given a small number of low-dose narcotic pain medications for breakthrough pain only for the first 72 hours.

  • Recovery Period – You are expected to go home the same day of surgery and should be ambulating without restriction the same day of surgery. Depending on your occupation, you may return to work as early as the following week, though most return between 2-4 weeks. You may resume light cardio exercises at 2 weeks after surgery. You should not lift anything heavier than 5 pounds or extend your arms extensively over your head for the first 2-4 weeks after surgery. You may resume all physical activities at 4-6 weeks after surgery. You should expect some drainage from the incisions and mild bruising around the incisions. You will be swollen, and it can take up to 3-6 months for the swelling to reside. Your incisions will take 2-4 weeks to completely heal, but the final scar will take 6-12 months to mature. Scar care will be discussed at your 1 month post-operative appointment.

  • Follow-Up Visits – If you have any urgent concerns, you may call the office at any time. Otherwise, expect follow-up visits at 1 week, 1 month, 3 months, 6 months, and 1 year.





Post-Operative

  • Asymmetry – No one’s breasts are perfectly symmetric. While the goal is near-perfect symmetry, there may be some asymmetries in breast size or position, nipple-areola complex size or position, and scars. Achieving symmetry with oncoplastic reconstruction is significantly more challenging that for other breast procedures, like breast reductions, mastopexies, and breast augmentations. The breast diagnosed with cancer is treated with radiation therapy following the partial mastectomy. The radiation causes variable changes to the breast skin and breast tissue that are hard to predict. The net effect is the radiation makes the breast smaller and tighter. Some patients may prefer the contour of this breast because it often appears perkier as the radiation counteracts the age- or pregnancy-induced skin laxity. Unfortunately, it is almost impossible to match that effect on the non-cancer side. In some cases, Dr. Chang will leave the breast with cancer slightly larger, wider, and more ptotic immediately after your oncoplastic reconstruction in an effort to have a more symmetric appearance following radiation therapy.

  • Need for Further Oncologic Surgery and Reconstruction – In rare cases, the final pathology demonstrates residual cancer in the breast or a more severe and dangerous type of cancer. Both cases would require another oncologic surgery to appropriately treat your cancer. Such instances may be managed with a revision of the oncoplastic reconstruction. In other cases, the better oncologic option may be to convert to a mastectomy and then discuss options for breast reconstruction after mastectomy.

  • Fat Necrosis – If a section of breast tissue is too badly traumatized or loses too much of its blood supply, it forms a hardened scar. While not dangerous or cancer-predisposing, fat necrosis can be painful and uncomfortable. If large and bothersome enough, the fat necrosis must be removed surgically.

  • Partial or Complete Nipple-Areolar Complex Loss – If the blood supply to the nipple-areolar complex is compromised, it may result in partial or complete nipple-areolar complex loss. The risk is higher in patients with very large and/or ptotic breasts who require a large reduction and/or significant upward movement of the nipple-areolar complex. The risk is also higher in patients with tumors behind the nipple-areolar complex, as removal of the tumor decreases the deeper blood supply to the nipple-areola complex. If decreased viability is noticed in the operating room, the nipple-areolar complex may be removed and then sutured back on to survive as a graft. In cases where the tumor is too close to the nipple-areola complex, the nipple-areola complex will be removed.

  • Unmet Expectations – Despite thorough pre-operative planning and discussions, you still may not be fully happy with your aesthetic results.

  • Poor Scarring – Everyone scars differently. The final scar takes 6-12 months to mature. In rare cases, hypertrophic scars or keloids may form and may require secondary revision.

  • Wound Healing Issues – There may be small areas where the incisions do not fully heal. In these cases, the wounds will be allowed to heal on their own with dressing changes. Severe cases may require a secondary revision procedure.

  • Infection – Infections are managed with antibiotics. In severe cases, you may need an additional procedure.

  • Bleeding – Significant bleeding after surgery may require an urgent return to the operating room. Smaller collections of blood may be treated conservatively or managed with a small procedure in the office or the operative room.

  • Seroma – Fluid collections may develop in the breast. Small ones will be absorbed by the body, but larger ones will need to be aspirated in the clinic.

  • Changes in Sensation – Temporary changes in breast and nipple-areola complex sensation are expected. Permanent changes may also occur, both decreased and increased sensation.

  • Need for Revision Surgery – For any number of reasons, revision breast reconstruction may be needed to properly achieve your functional and aesthetic goals.


Risks of Oncoplastic Breast Reconstruction

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