The Medical Minute: Combining breast cancer surgery and plastic surgery

HERSHEY, Pa. — By the time Laurie Engle, a 72 year old from New Cumberland, found out she had breast cancer, she was already tired of surgery. After recovery from shoulder surgery delayed her scheduled mammogram, she discovered that she would likely need surgery again — this time for breast cancer.

“When I was finally able to get my mammogram, they didn’t like what they saw. The follow-up ultrasound showed two masses on the right side and one on the left,” Engle said. “At first, I wanted a lumpectomy because I didn’t want another extensive surgery, but I quickly changed my mind and decided to do mastectomies with reconstruction.”

When it was time for surgery, Engle turned to Marnie Kaplan of Penn State Health. Kaplan is a breast surgical oncologist at Penn State Health Medical Group – Noll Drive in Lancaster, where she works alongside her husband, Chance Kaplan, a plastic and reconstructive surgeon. 

October is Breast Cancer Awareness Month, and the Kaplans explained how combining breast cancer surgery with plastic surgery can shorten recovery time and reduce the need for additional procedures. 

Types of breast surgery

Breast surgery can be either cosmetic or medically necessary. Cosmetic surgeries — such as breast reductions, augmentations and lifts – are elective and focus on appearance. Medically necessary breast surgeries, which include lumpectomies and mastectomies, are performed to diagnose or treat conditions like breast cancer.

Chance said that nearly half of his patients see him for cosmetic surgery. During consultations, he talks to them about their cosmetic goals and guides them toward procedures that offer the best outcomes with the lowest surgical risk. Plastic surgery techniques that are used for cosmetic breast surgeries can also be used when treating breast cancer to maintain the shape and symmetry of the breasts.

What is oncoplastic surgery?

The primary goal for oncoplastic surgery is cancer removal, but the secondary goal is making the breast look as natural as possible following breast cancer treatment. 

“Oncoplasty is when we combine breast cancer surgery with the plastic surgery you’ll need to make your remaining breast tissue look the way you want it,” Marnie said. “It’s not just about treating your cancer — it’s about making your breasts look attractive when you’re done.”

Oncoplastic surgery can shorten recovery time by combining two procedures, such as a lumpectomy for breast cancer with breast reduction, so the patient may not need any additional surgeries. 

During oncoplastic surgeries, the two doctors operate side by side, with Marnie focused on removing the cancer, while Chance works to achieve the best cosmetic outcome. 

“After surgical recovery, they can start their radiation treatment or other cancer care,” Marnie explained.

What is breast reconstruction?

When a person has mastectomy, which is the removal of the whole breast, they can choose to have breast reconstruction. This process rebuilds the breast after a mastectomy has been performed. Marnie and Chance start reconstruction during the mastectomy, with Chance placing an initial implant called an expander. The expander saves that space and gradually stretches the tissue. After completing all the cancer treatment, the patient returns for a smaller procedure to place permanent implants that are softer and more comfortable.

“We prefer to start reconstruction during the initial operation whenever possible because the end result looks significantly better,” Chance said. 

Although many patients choose reconstruction when they need a mastectomy, some do not want reconstruction.

“I’ve had many patients who have chosen to ‘go flat’ after mastectomies performed for breast cancer or a gene mutation,” Marnie said. “In these cases, the surgical goal is to make the chest area as flat and smooth as possible.”

Engle will have her surgical follow-up appointment with both doctors in December to discuss her recovery.

“I definitely saw the benefits of combining procedures,” Engle said. “Why recover twice when you can recover once?”

When should you see your doctor about breast cancer symptoms?

The Penn State Health Breast Center recommends that all women get an annual mammogram beginning at age 40. Women should also do a monthly breast self-exam and check for lumps or other changes to the breast or nipple. If you notice symptoms of breast cancer, it’s important to see your primary care provider as soon as possible. Warning signs of breast cancer may include:

• A painless lump
• Swollen lymph nodes
• Pain or heaviness in your breast
• Swelling, redness or thickening of the breast skin
• Changes in your nipple

Your provider may refer you for a mammogram. If breast cancer is detected, they may then refer you to a breast surgeon for additional tests and treatment.

Related content:

• The Medical Minute: Do you know your risks for breast cancer?
• The Medical Minute: Could that breast pain be cancer? When to get a mammogram
• Video: Understanding genetic risks for breast cancer. Penn State Health St. Joseph – Cancer Center

Learn more about breast surgery services at Penn State Health.

Schedule a mammogram near you.

The Medical Minute is a health news feature produced by Penn State Health. Articles feature the expertise of faculty, physicians and staff, and are designed to offer timely, relevant health information of interest to a broad audience.