Breast Care A-Z · Concept · ONCOPLASTIC

Oncoplastic surgery

also: oncoplastic breast surgery, therapeutic mammoplasty, oncoplastic lumpectomy, oncoplastic breast cancer surgery · pronounced on-koh-PLAS-tik

Oncoplastic surgery combines removing a breast cancer with plastic-surgery techniques that reshape the breast in the same operation, for a better cosmetic result. You may have been told it — sometimes called therapeutic mammoplasty — is one of your options, or be reading about what an oncoplastic breast surgeon does.

Quick answers

Is oncoplastic surgery the same as therapeutic mammoplasty?

Therapeutic mammoplasty is one specific operation within oncoplastic surgery — the breast-reduction-style operation used for larger cancers in larger breasts. Oncoplastic surgery is the broader concept that includes therapeutic mammoplasty, oncoplastic lumpectomy, and mastectomy with immediate reconstruction.

Will I get a better cosmetic result than a standard lumpectomy?

Often yes — particularly for larger cancers, where standard lumpectomy can leave a visible defect. For very small cancers in a larger breast, the cosmetic difference between oncoplastic and standard lumpectomy is small, but the principle of careful incision planning still applies.

Does oncoplastic surgery affect my survival from cancer?

No — survival depends on the cancer's biology and on whether the cancer is fully removed (with clear margins). Oncoplastic surgery does not compromise either of those, and it sometimes allows more generous margins than a simple lumpectomy would have. The cosmetic side is an addition to good cancer surgery, not a substitute for it.

Oncoplastic Breast Surgery -- Breastory Encyclopaedia Plate LXVII Oncoplastic breast surgery: volume displacement vs volume replacement, Level I and II techniques, therapeutic mammoplasty, and contralateral symmetrisation. SURGERY · OPERATIVE PROCEDURES PLATE LXVII oncoplastic breast surgery volume displacement · volume replacement · therapeutic mammoplasty integration of cancer excision with plastic surgical reshaping to achieve clear margins and preserve breast appearance FIG 01 — Volume displacement (left) vs volume replacement (right): before and after VOLUME DISPLACEMENT Before tumour lower pole tissue After tissue rotated Contralateral symmetrising reduction (dashed) VOLUME REPLACEMENT Before tumour LD flap territory After LD mini-flap tunnel i — tumour excision cavity (defect) ii — volume displacement (local tissue rearrangement / rotation) iii — volume replacement (LD mini-flap or lipofilling) iv — therapeutic mammoplasty (reduction + tumour excision combined) v — contralateral symmetrisation (reduction or mastopexy) Level I vs Level II oncoplastics Level I: Simple mobilisation Technique: No formal plastic technique Surgeon: Any trained breast surgeon Level II: Formal plastic technique Examples: Rotation, reduction, flap Requires: Oncoplastic fellowship training Candidate selection >20% breast volume excision Expected large-volume defect Ptotic / large breast Reduction mammoplasty approach Central / subareolar tumour Central excision + reshaping FIG 02 — Standard WLE vs oncoplastic WLE: comparative outcomes Parameter Standard WLE Oncoplastic WLE Technique Simple excision Reshaping + excision Margin status ~20% re-excision Lower re-excision rate Volume excised <20% (standard) 20–50% safely Cosmesis Deformity if large excision Superior outcome Symmetry Contralateral not addressed Symmetrisation planned Operating time Shorter Longer Training required Breast surgery Oncoplastic fellowship Radiotherapy After, as per standard After, as per standard Reconstruction May need later Avoids further reconstruction Patient satisfaction Good Higher for large-volume excisions FIG 03 — Oncoplastic techniques: description and indication Technique Description Best for Batwing excision Superior arc excision + central reshaping Central / upper tumours Round block (donut) Periareolar excision + purse-string Periareolar tumours Hemi-batwing Unilateral arc excision Upper inner / outer tumours Wise pattern reduction Inverted-T mammoplasty + excision Large ptotic breast Vertical scar mammoplasty J-scar reduction + excision Medium-sized breast LD mini-flap Small latissimus flap to fill Lateral / posterior tumours Lipofilling Fat grafting to defect Any site (small defects) Level I mobilisation Undermining + advancement Small defects Contralateral symmetrisation Reduction or mastopexy Matched symmetry FIG 04 — Oncoplastic surgical pathway 1 Tumour location + breast volume assessed 2 Expected volume excision calculated 3 Oncoplastic technique selected (Level I or II) 4 Pre-op marking (tumour + reshaping plan) 5 Oncoplastic WLE ± symmetrisation 6 Adjuvant radiotherapy (standard) FIG 05 — Oncoplastic technique gallery Batwing / hemi-batwing Wise-pattern reduction Vertical scar mammoplasty LD mini-flap Volume displacement (rotation) Lipofilling (fat grafting) FIG 06 — Key statistics Re-excision rate 5–10% vs ~20% with standard WLE [1] Superior cosmesis in >80% patients [2] ~15–20% of all breast conservation is oncoplastic [3] Oncoplastic approach allows wider resection margins [4] FIG 07 — References References 1. Clough KB et al. Oncoplastic techniques. Ann Surg 2010;252:946 2. Patani N et al. Oncoplastic breast conservation. Surg Oncol 2010 3. NHS England. Oncoplastic breast surgery training 2023 4. Association of Breast Surgery. ABS oncoplastic guidelines 2020 5. NICE NG101. Early breast cancer 2023 Clinically authored by Dr Fiona Tsang-Wright , FRCS (Gen Surg) GMC 4549831 · ORCID 0000-0003-4801-026X
Visual Reference · Oncoplastic surgery
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Definition
Oncoplastic surgery is an approach to breast cancer surgery that combines complete removal of the cancer with cosmetic-surgery techniques to preserve or improve the shape of the breast, planned together as a single operation rather than as two separate problems.

Common questions The questions patients ask first

Is oncoplastic surgery the same as therapeutic mammoplasty?
Therapeutic mammoplasty is one specific operation within oncoplastic surgery — the breast-reduction-style operation used for larger cancers in larger breasts. Oncoplastic surgery is the broader concept that includes therapeutic mammoplasty, oncoplastic lumpectomy, and mastectomy with immediate reconstruction.
Will I get a better cosmetic result than a standard lumpectomy?
Often yes — particularly for larger cancers, where standard lumpectomy can leave a visible defect. For very small cancers in a larger breast, the cosmetic difference between oncoplastic and standard lumpectomy is small, but the principle of careful incision planning still applies.
Does oncoplastic surgery affect my survival from cancer?
No — survival depends on the cancer's biology and on whether the cancer is fully removed (with clear margins). Published meta-analyses show oncoplastic BCS achieves wider margins and lower re-excision rates than standard BCS without compromising oncological outcomes3. The cosmetic side is an addition to good cancer surgery, not a substitute for it.
Can my insurance cover an oncoplastic operation?
Yes — UK private medical insurers cover oncoplastic surgery as part of breast cancer treatment, including the contralateral symmetrising procedure that often accompanies therapeutic mammoplasty. Pre-authorisation depends on the procedure code and indication. See [fees and insurance](/fees-insurance/).

Oncoplastic surgery is an approach to breast cancer surgery that combines complete removal of the cancer with cosmetic-surgery techniques to preserve or improve the shape of the breast, planned together as a single operation rather than as two separate problems.

The principle is straightforward: rather than removing the cancer first and dealing with the cosmetic consequences afterwards, an oncoplastic operation plans both at the start. It often allows more breast tissue to be removed than a simple lumpectomy, with a better cosmetic result, and is a defining capability of modern specialist breast practice.

Orientation Why you might be reading about this

You may have been told that oncoplastic surgery — sometimes called therapeutic mammoplasty — is one of the options in your treatment plan, or you are reading about what an oncoplastic breast surgeon does. The term itself is technical and the labels can be confusing (oncoplastic, therapeutic mammoplasty, oncoplastic lumpectomy — these overlap). This page explains the concept, what it means in practice, and how it sits alongside the simpler operations.

Related terms: Lumpectomy · Mastectomy · DIEP flap · Breast cancer surgery

The principle The core principle

Cancer surgery and cosmetic surgery used to be considered as two separate disciplines: a general surgeon would remove the cancer, and a plastic surgeon (where reconstruction was wanted) would address the cosmetic side later. Oncoplastic surgery brings both into a single operation, performed by a surgeon trained in both — an oncoplastic breast surgeon.

The benefit is twofold:

  1. Better cancer surgery — knowing that the breast will be reshaped, the surgeon can take more generous margins of healthy tissue around the cancer, reducing the chance of needing a second operation for involved margins3.
  2. Better cosmetic outcome — the breast is reshaped using techniques borrowed from cosmetic breast reduction and lift surgery, leaving a result that is often better than a simple lumpectomy would have given, and sometimes better than the patient’s pre-operative shape.

In modern UK breast practice, oncoplastic capability is an expected standard for any specialist breast surgeon, not a niche specialism1. Most breast cancer surgery in private practice is now oncoplastic in approach, even when the operation itself is a small lumpectomy.

Oncoplastic breast-conserving surgery is often described as volume displacement (parenchymal rearrangement or mammoplasty techniques that reshape remaining breast tissue) or volume replacement (local or regional flaps such as LICAP or TDAP when the tumour:breast ratio is high). Replacement avoids mastectomy in selected small-breasted patients.

In practice What oncoplastic surgery looks like in practice

The label oncoplastic covers a spectrum of breast-conserving and mastectomy-with-reconstruction operations2. For oncoplastic breast-conserving surgery (OBCS), the UK Clough classification (ABS-BAPRAS 2021) describes:

Oncoplastic lumpectomy (Clough Level I)

Resection of less than about 20% of breast volume with local tissue rearrangement or minor mastopexy. Most lumpectomies done by an oncoplastic surgeon involve at least this level of cosmetic planning — the incision is placed in a natural skin line, the cavity is closed in layers, and the breast is reshaped on closure.

Therapeutic mammoplasty (Clough Level II)

For larger cancers (roughly 20{nd}50% of breast volume), therapeutic mammoplasty uses reduction-pattern reshaping to remove the cancer with a wide margin and restore contour. Contralateral symmetrisation may be done at the same sitting or deferred until margins and adjuvant therapy are settled.

Volume replacement and mastectomy with reconstruction

Where more than about half the breast volume would need to be removed, local perforator flaps (volume replacement) may be offered instead of mastectomy. When mastectomy is needed, oncoplastic principles still apply: skin-sparing or nipple-sparing technique and immediate reconstruction (implant-based or autologous) at the same operation4. See reconstruction.

The role What “an oncoplastic breast surgeon” means

The term refers to a surgeon trained in both:

  • Oncological surgery — removing the cancer with appropriate margins and managing the lymph nodes.
  • Plastic and reconstructive techniques — reshaping the breast, planning incision patterns, and (for some surgeons, in conjunction with a plastic-surgery colleague) immediate reconstruction including microsurgical autologous flaps.

In the UK, the formal qualification is FRCS (General Surgery) with a sub-specialty interest in breast surgery, supplemented by oncoplastic fellowship training1. Surgeons who can offer the full range of techniques on this page — from oncoplastic lumpectomy to therapeutic mammoplasty to immediate reconstruction — are usually referred to as oncoplastic and reconstructive breast surgeons.

Where it fits Where reconstruction sits in the picture

For patients having mastectomy, the reconstructive part of the oncoplastic operation includes both the mastectomy itself (skin-sparing or nipple-sparing) and the choice of implant, autologous tissue, or aesthetic flat closure. Microsurgical autologous reconstructions — DIEP flap, PAP, and others — are usually performed jointly with a plastic-surgery colleague trained in microsurgery. The breast surgeon performs the mastectomy and prepares the chest; the plastic-surgery colleague performs the flap transfer and microsurgical anastomosis. This is part of standard oncoplastic practice in larger units.

At consultation What to discuss with your surgeon

If you are deciding between surgeons or weighing up your treatment options:

  • Is this surgeon trained in oncoplastic techniques as well as cancer surgery, or do they refer the cosmetic / reconstructive aspect to a separate surgeon?
  • What is the expected cosmetic outcome of the operation being proposed, and can you see photographs of the range of results?
  • For mastectomy with reconstruction, is the reconstruction done at the same operation, and is the plastic-surgery colleague (where one is involved) part of the team from the first consultation rather than a downstream referral?

Resources Further reading

Sources & guidance

Every figure on this page is anchored to a published source. Tap a number in the text or below to jump to the reference.

  1. guidance Association of Breast Surgery / British Association of Plastic, Reconstructive and Aesthetic Surgeons. Oncoplastic Breast Reconstruction: Guidelines for Best Practice. London: ABS / BAPRAS. 2021 https://associationofbreastsurgery.org.uk/professionals/information-hub/guidelines/2021/oncoplastic-breast-reconstruction-guidelines-for-best-practice Cited for: UK best-practice standards and credentialing expectations for oncoplastic and reconstructive breast surgery.
  2. cohort Clough KB, Kaufman GJ, Nos C, Buccimazza I, Sarfati IM. Improving breast cancer surgery: a classification and quantification of surgical techniques for breast-conserving therapy. Annals of Surgical Oncology. 2010 ;17(5):1375–1391 doi:10.1245/s10434-009-0792-y Cited for: Level 1 / Level 2 oncoplastic classification for breast-conserving surgery; framework adopted internationally.
  3. meta analysis Losken A, Dugal CS, Styblo TM, Carlson GW. A meta-analysis comparing breast conservation therapy alone to the oncoplastic technique. Annals of Plastic Surgery. 2014 ;72(2):145–149 doi:10.1097/SAP.0b013e3182605598 Cited for: Oncoplastic BCS achieves wider margins and lower re-excision rates than standard BCS, with comparable oncological outcomes.
  4. guideline National Institute for Health and Care Excellence (NICE). Early and locally advanced breast cancer: diagnosis and management (NG101). London: NICE. 2018 ;Last updated 2024 https://www.nice.org.uk/guidance/ng101 Cited for: UK standard for offering breast conservation, mastectomy with reconstruction, and immediate vs delayed reconstruction discussion.