Oncoplastic and reconstructive breast surgery

What oncoplastic surgery actually means

A cancer operation removes tissue. Where that tissue came from, and what is done with the space it leaves, determines what the breast looks like afterwards.

Oncoplastic surgery plans both at once. The cancer is removed with a clear margin, and the remaining breast tissue is rearranged in the same operation so the result is as even as the anatomy allows. For some women it also makes breast conservation possible where a standard excision would have left too large a defect, meaning the alternative was a mastectomy.

The word describes an approach rather than a single operation. What it involves in practice ranges from a modest rearrangement of tissue to a formal reduction technique applied to both sides for symmetry.

Reconstruction after mastectomy

Reconstruction rebuilds the shape of a breast after mastectomy, using an implant, the body's own tissue, or a combination of the two.

Immediate reconstruction is started at the same time as the mastectomy. Delayed reconstruction is done later, once other treatment is complete. Which is appropriate depends on the cancer, on whether radiotherapy is planned, on general health and on smoking, and on what a woman wants, in that order, because the first three can rule options out.

Reconstruction is a choice, not an obligation. Some women decide against it and are entirely settled in that decision. The role of the conversation is to make sure the decision is informed, not to steer it.

Minimally invasive and robotic approaches

Some breast operations can now be done through smaller and better-hidden incisions than were previously possible, including with robotic assistance. The aim is the same cancer operation through a smaller and less visible access.

These approaches are not suitable for everyone, availability varies between hospitals, and the long-term evidence base is still developing compared with established open techniques. Where they are appropriate they should be offered as an option with that uncertainty stated, which is Dr. Mansukhani's own view and is identified here as an opinion rather than as settled evidence.

She trained in robotic surgical skills at Orsi Academy in Belgium in July 2026, and in robotic breast oncoplastic surgery at IERBS in Taiwan in August 2026.

The cost side of the ledger

Oncoplastic and reconstructive operations are larger than a simple excision. They take longer, they involve more incisions, and they carry more that can go wrong.

Recognised risks include bleeding and infection, delayed wound healing, partial or complete loss of tissue that has been moved, loss of an implant, fat necrosis producing firm lumps within the breast, asymmetry between the two sides, altered or lost sensation, and the need for a further operation to revise the result. Where radiotherapy follows, it can change the appearance and feel of a reconstructed breast over time.

A result that looks good at six weeks can change at a year. Anyone discussing these operations should be told that before deciding, not afterwards.

How the decision gets made

Oncology comes first. No reconstructive plan is worth a compromised cancer operation, and where the two conflict the cancer operation wins.

Beyond that, the decision takes in the size and position of the cancer, breast size and shape, whether radiotherapy is planned, general health, and how much surgery a person is willing to undergo for a given gain in appearance. That last point is personal, and two people can weigh it very differently without either being wrong.