Reconstruction After Lumpectomy: What Partial Reconstruction Involves

A lumpectomy removes the cancer and keeps your breast. But it can also leave a hollow, a flattened area or one breast sitting smaller than the other. Research shows lumpectomy may cause major deformities and asymmetries in about one-third of patients.

If you’re worried about the shape of your breast, partial breast reconstruction is designed to deal with it.

Key Insights

• Partial breast reconstruction reshapes or rebuilds part of the breast after a lumpectomy. It can be done during the cancer operation or months to years later.
• The amount of tissue removed decides the approach. Smaller removals are usually reshaped using the breast’s own tissue. Larger ones may need tissue brought in from nearby.
• A dent in the breast after lumpectomy is commonly treated later with fat grafting, usually after radiotherapy and once the area has healed.
• Surgery on the other breast is sometimes offered for balance, but it isn’t always needed.
• Every case is different, so the right plan comes from a consultation with a specialist breast surgeon.

What Is Partial Breast Reconstruction?

Partial breast reconstruction is a surgical procedure to restore the shape of a breast that has had part of its tissue removed. You’ll often hear it called oncoplastic surgery. That simply means cancer surgery (oncology) combined with plastic surgery techniques, so the cancer is removed and the breast is reshaped in the same procedure.

It’s different from the reconstruction people usually hear about. A mastectomy removes the whole breast, and the breast is rebuilt from scratch. Here, you keep most of your breast, and the surgeon works on the gap. You can read more about lumpectomy surgery and oncoplastic breast surgery.

Timing matters because of radiotherapy. A course of radiotherapy is almost always recommended after breast-conserving surgery. Radiotherapy can change how breast tissue heals and looks, which is why some repairs wait until it’s finished.

Why Does a Dent in the Breast After Lumpectomy Happen?

When a surgeon removes a tumour and a margin of healthy tissue, there’s a space left behind. If a large amount of tissue is taken, the treated breast can be left with a dent and look much smaller than the other.

Two things raise the chance of a poor shape. Tumour position in the breast and large breast size have both been associated with poorer aesthetic outcomes after lumpectomy alone. Scar tissue and radiotherapy then shape the final result over the following months.

That’s why a dent in the breast after lumpectomy can become more noticeable well after surgery, not straight away.

Reconstruction During the Lumpectomy

Your surgeon can reshape the breast at the time the cancer is removed. This is the earlier of the two windows for partial breast reconstruction, and it’s often the best chance to prevent a dent from forming at all.

It’s a clear way to see how the approach changes with the amount of breast removed:

• Level 1 (up to 15% removed): The surgeon moves nearby breast tissue to fill the gap. The breast may end up about one cup size smaller.
• Level 2 (15% to 25% removed): This needs extra surgical training. It can involve moving the nipple and using breast lift or reduction techniques. Fat grafting after radiotherapy, or a tissue flap, may be added.
• Level 3 (25% to 60% removed): Breast reduction techniques reshape the breast, and surgery on the opposite breast is often included for balance.

The more tissue removed, the more reshaping or replacing the breast needs. For a side-by-side look, see oncoplastic vs standard breast-conserving surgery, or browse real oncoplastic surgery results.

Volume Displacement vs Volume Replacement

These two terms come up a lot, so here’s what they mean.

Volume displacement means rearranging the breast’s own tissue. The surgeon shifts it around to fill the space, a bit like closing a gap in a row of books by sliding the others along.

Volume replacement means bringing in new tissue when there isn’t enough breast left to move. This can use spare tissue from the armpit, upper back or area around the breast. A piece of tissue moved with its own blood supply is called a flap. One example is a LICAP flap (lateral intercostal artery perforator flap), which borrows tissue from the side of the chest.

Fixing a Dent Later

Not everyone has partial breast reconstruction at the time of the lumpectomy. Some people only notice the change after radiotherapy, and some surgeons advise waiting before breast reconstruction after lumpectomy begins. These later procedures are usually performed at least 6 months to 1 year after surgery and radiation to allow the body time to heal.

How Fat Grafting Works

Fat grafting is the most common fix for a dent. Fat is taken by liposuction from an area such as the thighs or belly, then injected into the hollow to restore the contour. There’s no large new scar on the breast, which is a real advantage when radiotherapy has made the skin less forgiving.

Because the body can reabsorb some of the transferred fat, a second session may be needed to achieve the shape you’re after. Your surgeon will explain what’s realistic for your breast.

Other later options for repairing a dent in the breast after lumpectomy include a breast implant, a flap, or a lift or reduction. Which one suits you depends on the size of the defect and how your tissue has healed.

What About the Other Breast?

Sometimes the treated breast ends up smaller or sits differently. Your surgeon may offer to adjust the other breast so the two match, using a lift, a reduction, or a similar procedure. This is also called breast asymmetry surgery.

But it isn’t compulsory. A Swedish study of 144 women who had oncoplastic surgery and radiotherapy, with no surgery on the other breast, found that most were satisfied with their breasts. A Breast360 summary of that research reports that only about 11% wanted surgery on the other side. Some women prefer to leave a healthy breast alone, and that’s a valid choice.

Talk to a Breast Surgeon in Sydney

If you’re facing a lumpectomy, or you’re living with a dent or asymmetry afterwards, an early conversation gives you the most options. At BB Clinic, specialist breast and general surgeon Dr Michael Yunaev can assess your breast, explain what partial breast reconstruction could involve for you, and map out the timing around your cancer treatment.

This article is general information and isn’t a substitute for medical advice. Results vary between patients, and all surgery carries risks. You should seek a second opinion and speak with a qualified specialist before making a decision.