Breast-conserving reconstruction · New York and New Jersey
Oncoplastic Breast Surgery
Oncoplastic surgery combines a lumpectomy with plastic surgery in one operation. Your breast surgeon removes the cancer, and Dr. Steven Ovadia reshapes the breast so that you keep your breast and its shape. He is a board certified plastic surgeon with offices in New York City and New Jersey.
Overview
Keeping the breast, and its shape
Many breast cancers can be treated by removing the tumor and keeping the breast. This is called breast-conserving surgery, a lumpectomy, or a partial mastectomy. Most patients have radiation to the breast afterward.
Removing part of a breast can change its shape. Oncoplastic surgery adds plastic surgery to the same operation: after your breast surgeon removes the cancer, Dr. Ovadia reshapes the breast that remains, and the other breast can be matched to it.
The cancer operation is your breast surgeon's. Your breast surgeon and oncologists decide what has to be removed and what treatment follows. Dr. Ovadia's part is the shape of your breasts afterward.
The terms you will hear
Breast-conserving surgery
Also called a lumpectomy or a partial mastectomy
The tumor is removed with a rim of normal breast around it, and the rest of the breast is kept. The three names mean the same operation. Your breast surgeon performs it.
Oncoplastic surgery
The lumpectomy plus the reshaping
Plastic surgery is added to the lumpectomy. The breast that remains is reshaped, usually with the techniques of a breast lift or a breast reduction.
Symmetry surgery
The other breast
The breast that did not have cancer is lifted or reduced so that the two match. It is part of the reconstruction, and it is optional.
Why reshape the breast at the lumpectomy
A lumpectomy can change the shape
The more of the breast that is removed, the more likely it is to look different afterward: a dent, a nipple pulled to one side, or one breast smaller than the other. Radiation can make these changes more noticeable over time.
Room to remove more
When the breast is going to be reshaped, your breast surgeon can remove a wider area around the tumor without the shape of the breast depending on it. For some patients this is what makes it possible to keep the breast.
Reshaped before radiation
A breast that has not had radiation heals more predictably. Reshaping it at the time of the lumpectomy, before radiation, carries fewer healing problems than correcting its shape afterward.
The two sides match
A lumpectomy treats one breast. With oncoplastic surgery the other breast can be lifted or reduced as well, so that you are not left with two different breasts.
A smaller, lifted breast
For patients with large breasts, the operation is also a breast reduction. It can relieve the neck, back, and shoulder symptoms that large breasts cause.
Your own breast
The skin, the nipple, and the breast itself are your own. An implant is usually not part of the plan.
How it works
Two surgeons, one operation
Oncoplastic surgery is done by two surgeons working one after the other. Your breast surgeon treats the cancer, and Dr. Ovadia rebuilds the shape of the breast.
Before surgery
Planned as one operation
Your breast surgeon and Dr. Ovadia plan the surgery together. The lumpectomy is placed within the pattern of a breast lift or a breast reduction, and the pattern is chosen around where the tumor is.
Part 1 · Your breast surgeon
The lumpectomy
Your breast surgeon removes the tumor with a rim of normal breast around it, called the margin. This leaves a space in the breast.
Part 2 · Dr. Ovadia
The reshaping
Under the same anesthesia, Dr. Ovadia moves the remaining breast to fill the space, lifts the nipple to its new position, and closes the incisions. The other breast can be lifted or reduced to match.
The diagram is a general illustration. Where the tumor is, and how much is removed, set the pattern that is used.
What else happens in the operation
The lymph nodes
The lymph nodes under the arm are assessed by your breast surgeon and are typically biopsied at the time of the lumpectomy. This is often done through a separate small incision in the armpit.
Markers for radiation
Small clips are typically left by your breast surgeon where the tumor was. Reshaping moves the breast around, and the clips show your radiation team where the tumor had been. They are tiny and stay in place.
One anesthesia
Both parts are done under general anesthesia, one after the other. There is one operation to recover from before radiation begins.
The pathology report
Everything that is removed is examined by a pathologist, including what is removed from the other breast. The report comes back in the days after surgery.
If more has to be removed
If cancer cells are found at the edge of what was removed, more surgery is needed. Your breast surgeon goes over what that would mean before the first operation. In studies, a second operation for this reason has been needed less often after oncoplastic surgery than after a lumpectomy alone.
Chemotherapy first
Some patients have chemotherapy before surgery. The operation is then planned for after it ends, and your oncologist sets the timing.
Candidates
Who oncoplastic surgery is for
Oncoplastic surgery is for patients who are having a lumpectomy and whose breast would otherwise be left with a change in shape or size. It helps most in these situations.
Larger breasts
With more breast to work with, the lumpectomy can be built into a breast reduction. Both breasts end up smaller, lifted, and matched.
Breasts that have dropped
The pattern of a breast lift gives access to most of the breast, and the reshaping lifts the breast at the same time.
A tumor that is large for the breast
The larger the share of the breast that has to be removed, the more a lumpectomy alone changes its shape, and the more reshaping helps.
A tumor in a difficult spot
A lumpectomy in the lower or inner part of the breast, or under the nipple, is more likely to leave a dent or pull the nipple off center.
Smaller breasts
With a small breast there is less to rearrange. Reshaping is still possible for many patients, and sometimes skin and fat are brought in from beside the breast.
The techniquesAlready had a lumpectomy
A breast that changed shape after a lumpectomy and radiation can often be improved. The options are different once the breast has had radiation.
After a lumpectomyWhether a lumpectomy is right for your cancer is decided with your breast surgeon and oncologists. It depends on the size and number of tumors, the size of your breast, and whether you can have radiation. When a mastectomy is the right operation, Dr. Ovadia performs reconstruction after mastectomy as well.
How the options compare
| Lumpectomy alone | Lumpectomy with oncoplastic reshaping | Mastectomy with reconstruction | |
|---|---|---|---|
| What is removed | The tumor and a rim of normal breast around it | The tumor and a rim around it, often a wider one | The whole breast |
| The breast afterward | Depends on how much is removed. A larger removal can leave a dent or pull the nipple to one side | Reshaped in the same operation, usually smaller and lifted | Rebuilt with an implant or with your own skin and fat |
| Radiation | Needed by most patients | Needed by most patients | Needed by some patients, depending on the cancer |
| The other breast | Usually not operated on | Can be lifted or reduced to match | Can be lifted, reduced, or made larger to match. Some patients have a preventive mastectomy on the other side, and both breasts are then reconstructed in the same way |
| Scars | One scar, over or near where the tumor was | The scars of a breast lift or reduction | The mastectomy scar, and others that depend on the reconstruction |
| Feeling | Your own breast and nipple are kept | Your own breast and nipple are kept | The skin of a reconstructed breast usually has less feeling than before |
For patients who can have either operation, long-term survival is the same with a lumpectomy and radiation as with a mastectomy. Which one is right for you is a decision you make with your breast surgeon.
Techniques
How the breast is reshaped
The technique depends on the size of your breast, how much has to be removed, and where the tumor is. Most oncoplastic surgery uses the techniques of a breast reduction or a breast lift.
Breast reduction technique
Oncoplastic reduction
The lumpectomy becomes part of a breast reduction. The breast is made smaller and lifted, and the space left by the lumpectomy is closed within the reduction. This is the usual approach for larger breasts.
Breast reductionBreast lift technique
Oncoplastic lift
When less has to be removed, or you want to stay close to your size, the remaining breast is rearranged and lifted without a larger reduction. The breast ends up a little smaller, by about the amount that was removed.
Breast liftBringing in skin and fat
A local flap
When a breast is too small to reshape from within, skin and fat from the side of the chest, next to the breast, can be moved in to fill the space. It stays attached to its own blood supply, and it leaves a scar along the side of the chest.
Fat grafting
A later touch-up
Your own fat, taken with liposuction, can fill in a contour that remains once the breast has settled. It is a separate, smaller procedure, done after radiation is finished.
The nipple, the scars, and the other breast
The nipple and areola
The nipple and areola stay attached to the breast and are moved up to a higher position, as in a breast lift. When the tumor is directly under the nipple, the nipple may have to be removed with it. It can be rebuilt later.
The scars
The scars are those of a breast lift or a breast reduction: around the areola, down to the fold, and often along the fold under the breast. They keep fading for a year or more.
The other breast
The other breast is lifted or reduced with the same pattern so that the two match. It can be done in the same operation, or later, once radiation is finished and the treated breast has settled. Dr. Ovadia goes over the timing with you.
Timing
At the lumpectomy, before radiation
The best time to reshape the breast is before it has radiation. For most patients that means the same operation as the lumpectomy.
With the lumpectomy
The same operation
The breast is reshaped right after the tumor is removed, under the same anesthesia. This is how most oncoplastic surgery is done.
Soon after
Before radiation begins
Sometimes the reshaping is done as a second operation, after the pathology report shows that the margins are clear and before radiation starts.
After radiation
Months or years later
A breast can still be improved after a lumpectomy and radiation. Radiation changes how the breast heals, so these operations are planned differently.
If you have just been diagnosed, it helps to meet a plastic surgeon before your lumpectomy, while all of the options are still open. If your surgery is already scheduled, call the office and let us know the date.
If you have already had a lumpectomy
A breast that changed shape after treatment
After lumpectomy and radiation
A dent, a nipple that has shifted, or a difference in size between the two sides can be addressed after treatment is over. A breast that has had radiation heals less predictably, so the plan often relies on:
- Fat grafting, to fill a dent or soften a contour
- Lifting or reducing the other breast to match the treated one
- Reshaping the treated breast, for some patients
- Bringing in skin and fat that has not had radiation, when more is needed
Real results
Oncoplastic breast surgery before and after
These are Dr. Ovadia's own patients. Each had a lumpectomy for breast cancer, with the breast reshaped using breast lift or breast reduction techniques. Each case notes how far out from surgery the "after" photo was taken.
Before-and-after photographs
This section contains before and after photographs of real surgical procedures.
You must be 18 years or older to view this content.
Recovery
What to expect after surgery
The day of surgery
Surgery is done in the hospital under general anesthesia. Some patients go home the same day, and some stay overnight. Dr. Ovadia and your breast surgeon go over this with you before surgery.
Swelling is normal and expected
The breasts are swollen at first, and they sit high and feel firm. Wearing your surgical bra is important: the compression helps prevent and minimize swelling. Over the following weeks the swelling goes down.
Drains
Dr. Ovadia often places drains when a breast reduction technique is used. With a smaller reshaping, closer to a breast lift, they may not be needed. You are taught how to empty them before you go home, and they are removed in the office.
How the incisions heal
The incisions generally heal well. Occasionally, healing is slower at the point under the breast where the incisions meet. This usually heals with simple wound care. Radiation starts once the incisions have healed.
Getting back to exercise
At about 2 weeks, you can generally walk on a treadmill or ride an exercise bike at an easy pace. Running and faster-paced exercise usually come back at 3 to 4 weeks. If lymph nodes were removed, your breast surgeon may give you separate instructions for your arm.
A break from nicotine
Nicotine affects how well the incisions heal. If you smoke or vape, Dr. Ovadia goes over taking a break from nicotine before and after surgery.
Call the office right away if one breast becomes much more swollen, firm, or painful than the other, or if you notice spreading redness, warmth, drainage from an incision, or a fever. These are best taken care of early.
A general timeline
This is a general guide. Everyone heals differently, and cancer treatment can change the timing. During your recovery, Dr. Ovadia will review your timeline with you.
After radiation
Radiation and the years after
The breast keeps changing after surgery, mostly because of radiation. These are the points worth understanding before you start.
What radiation does to the breast
During radiation the skin can redden, darken, or peel, much like a sunburn, and the breast can swell. Most of this settles over 6 to 12 months. Over time the treated breast may become a little smaller and firmer.
If the two sides drift apart
Only one breast has radiation, so a small difference can develop even when the two matched after surgery. If it bothers you, it can be adjusted once the treated breast has settled, with fat grafting or a small procedure on the other breast.
Firm areas
After any breast surgery, an area of fat can heal as a firm lump. This is called fat necrosis, and it is not cancer. Any new lump should still be examined, and sometimes imaging or a biopsy is needed to be sure.
Mammograms
You continue to have mammograms. Reshaping changes how the breast looks on imaging, so tell the imaging center about your surgery. Your breast surgeon and oncologists tell you when your first mammogram after treatment should be.
Feeling in the breast
Early after surgery there may be changes in sensation in the nipple or the skin of the breast. These typically improve over time. Radiation can also change how the skin feels.
Follow-up after cancer
Reshaping the breast does not change your cancer follow-up. Your breast surgeon and oncologists tell you what exams and imaging you need, for both breasts.
Cost and insurance
Insurance coverage
Reshaping the breast as part of cancer surgery is reconstructive surgery, not cosmetic surgery, and it may be covered by insurance. A federal law, the Women's Health and Cancer Rights Act of 1998, requires most health plans that cover mastectomy to also cover reconstruction. New York's insurance law names partial mastectomy, which is another name for a lumpectomy, for the plans it regulates.
What these laws require plans to cover
Federal law after a mastectomy · New York law after a mastectomy or partial mastectomy
- All stages of reconstruction of the breast that was operated on
- Surgery and reconstruction of the other breast to produce a symmetrical appearance
Plans differ in how they apply these rules after a lumpectomy. Your plan's deductibles and coinsurance still apply, every plan has its own process for approval, and coverage is not guaranteed.
If you have questions about possible insurance coverage for surgery, call or email us and we will go over it with you.
Your surgeon
Board certified and double fellowship-trained
Dr. Ovadia is board certified by the American Board of Plastic Surgery. After his plastic surgery training he completed two fellowships: gender-affirming surgery and microsurgery at Johns Hopkins, and craniofacial and pediatric plastic surgery at UT Austin / Dell Children's Hospital.
Breast surgery is a large part of his practice. He uses the same techniques in oncoplastic reconstruction that he uses in breast lifts and breast reductions, and he also performs reconstruction after mastectomy, with implants and with the patient's own tissue. He works alongside breast surgeons and oncologists at hospitals in New Jersey and New York City, and he sees patients in New York City and in Jersey City and Millburn, New Jersey.
Questions
Common questions about oncoplastic surgery
What is oncoplastic breast surgery?
It is a lumpectomy combined with plastic surgery in the same operation. Your breast surgeon removes the cancer with a rim of normal breast around it, and Dr. Ovadia reshapes the breast that remains, usually with the techniques of a breast lift or a breast reduction. The other breast can be lifted or reduced to match.
Is oncoplastic surgery the same as a lumpectomy?
The lumpectomy is the cancer part of the operation, and it is the same. It is also called breast-conserving surgery or a partial mastectomy. Oncoplastic surgery adds the reshaping of the breast to it, under the same anesthesia.
Who does which part of the operation?
Your breast surgeon removes the cancer and assesses the lymph nodes, which are typically biopsied at the same time. Dr. Ovadia reshapes the breast afterward and performs the surgery on the other breast. The two plan the operation together beforehand.
Does reshaping the breast affect how well the cancer is treated?
Studies comparing oncoplastic surgery with a lumpectomy alone have not found a higher rate of the cancer coming back. In those studies, a second operation to remove more around the tumor was needed less often after oncoplastic surgery. What has to be removed is decided by your breast surgeon, and the reshaping is planned around it.
Is a lumpectomy with radiation as effective as a mastectomy?
For patients who can have either operation, long-term survival is the same with a lumpectomy and radiation as with a mastectomy. Whether a lumpectomy is an option for you depends on your cancer, and it is a decision you make with your breast surgeon and oncologists.
Will I still need radiation?
Most patients have radiation to the breast after a lumpectomy, with or without reshaping. Your oncologists decide what treatment you need. Radiation usually starts once the incisions have healed.
Will the reshaping delay my radiation or chemotherapy?
In most cases it does not. Radiation starts once the incisions have healed, which is true after any lumpectomy. An incision that is slow to heal can push the start back, which is one reason Dr. Ovadia goes over nicotine and other things that affect healing before surgery.
Will my breasts be smaller afterward?
Usually, yes. Part of the breast is removed with the tumor, and with a reduction technique more is removed to shape the breast. The other breast is reduced or lifted to match. How much smaller is something you go over with Dr. Ovadia before surgery.
Is the other breast operated on at the same time?
It can be. The other breast is lifted or reduced with the same pattern so that the two match. It can be done in the same operation or later, once radiation is finished and the treated breast has settled. It is optional.
What if the margins are not clear?
If the pathology report shows cancer cells at the edge of what was removed, more surgery is needed. That can mean removing more from the same area or, for some patients, a mastectomy. Reconstruction is still possible in either case. Your breast surgeon goes over this with you before the first operation.
What will the scars look like?
They are the scars of a breast lift or a breast reduction: around the areola, down to the fold, and often along the fold under the breast. When the other breast is matched, it has the same scars. Scars keep fading for a year or more.
Will I lose feeling in my nipple?
The nipple stays attached to the breast in most oncoplastic surgery. Early after surgery there may be changes in sensation in the nipple or the skin, and these typically improve over time. Radiation can also change how the skin feels.
My breasts are small. Can I still have oncoplastic surgery?
Often, yes. With a small breast there is less to rearrange, so the plan is different. The remaining breast can be reshaped for many patients, and sometimes skin and fat are brought in from the side of the chest. Dr. Ovadia goes over what is possible after he examines you and reviews your imaging.
I already had a lumpectomy and radiation, and my breast changed shape. Can it be improved?
Often, yes. A dent, a nipple that has shifted, or a difference in size between the two sides can be addressed after treatment is over. A breast that has had radiation heals less predictably, so the plan often relies on fat grafting, on lifting or reducing the other breast to match, or on bringing in skin and fat that has not had radiation.
Can I still have mammograms after oncoplastic surgery?
Yes. You continue to have mammograms after treatment. Reshaping changes how the breast looks on imaging, so tell the imaging center about your surgery. Your breast surgeon and oncologists set the schedule.
Is oncoplastic surgery covered by insurance?
Reshaping the breast as part of cancer surgery is reconstructive surgery, not cosmetic surgery, and it may be covered, along with surgery on the other breast for symmetry. Federal law requires most health plans that cover mastectomy to cover reconstruction, and New York's insurance law names partial mastectomy specifically. Plans differ in how they apply these rules after a lumpectomy, and your deductibles and coinsurance still apply. If you have questions about possible insurance coverage for surgery, call or email us and we will go over it with you.
Can I have a consultation without coming to the office?
Yes. Phone and video consultations are available, in addition to in-person visits in New York City, Jersey City, and Millburn, New Jersey.
Next step
Start with a consultation
Dr. Ovadia will examine you, go over your options, and explain what he recommends and why. If you have a date for your lumpectomy, or records from surgery you have already had, let us know when you call.
225 Broadway, Suite 3100, New York, NY
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90 Millburn Ave, Suite 206, Millburn, NJ
Phone and video consultations available · info@ovadiaps.com