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Oncoplastic Lumpectomy in Los Angeles
Reviewed by Elizabeth Arena, MD, FACS.
An oncoplastic lumpectomy combines tumor removal with reconstructive techniques during the same operation, reshaping the remaining breast tissue to preserve a natural, balanced appearance. Dr. Elizabeth Arena, a top breast cancer surgeon, offers oncoplastic lumpectomy in Los Angeles for patients who want to conserve their breast while addressing both the cancer and the cosmetic outcome from the beginning.
What is oncoplastic surgery?
The American Society of Breast Surgeons defines oncoplastic surgery as a lumpectomy followed by reshaping of the same breast, with surgery on the other breast for symmetry when it is needed.[1] It is also called oncoplastic lumpectomy or oncoplastic breast-conserving surgery. The lumpectomy removes the tumor and a rim of healthy tissue called a margin. The reshaping then moves nearby breast tissue into the space, or lifts or reduces the breast around it.
In a standard lumpectomy the surgeon stitches the skin closed over the space. If the tumor is large for your breast or sits where a change is easy to see, your breast can heal with a dent, or with your nipple pulled toward the scar. Radiation can deepen the dent over the following months.[2]
Who performs your oncoplastic surgery?
Dr. Arena operates first: she removes the cancer and, for most invasive cancers, the sentinel lymph nodes under your arm. A plastic surgeon then reshapes your breast while you are still under anesthesia.
Dr. Arena works with several plastic surgeons and chooses one for your operation according to how much tissue she expects to remove and whether you want your other breast lifted or reduced. Before surgery, she and the plastic surgeon plan where your incisions will go.
Who is a good candidate for oncoplastic lumpectomy?
You may be a candidate if a standard lumpectomy would leave a visible change in your breast and Dr. Arena can still remove the whole tumor with a clear margin. She measures the tumor on your mammogram and on ultrasound in her office, and compares it with the size of your breast. When those do not show the tumor's full size, she orders an MRI.
Dr. Arena may recommend it if you have:
- A tumor that would leave a dent: one that is large for your breast, or sits high on your chest, in the inner half of your breast or near your nipple. Because the plastic surgeon fills the space, Dr. Arena can remove a larger piece of tissue than in a standard lumpectomy.[2]
- Larger or drooping breasts: Dr. Arena removes the tumor within the tissue taken out in a breast reduction or lift, and after a reduction your breasts are smaller.
- Breasts that were uneven before the cancer: the plastic surgeon can lift or reduce the larger breast during your operation.[2]
- A tumor that shrank with chemotherapy before surgery: you may now be able to have a lumpectomy instead of a mastectomy.[2] A small clip placed at your biopsy shows Dr. Arena where the tumor was.
It is usually not the right operation if you have:
- Inflammatory breast cancer: this type makes the skin of the breast red and swollen. It is treated with chemotherapy, then a mastectomy that removes the whole breast and the lymph nodes under the arm, then radiation.[8]
- Cancer in several areas of your breast (multicentric cancer): Dr. Arena usually recommends a mastectomy. Two or three separate tumors in one breast can sometimes still be removed by lumpectomy followed by radiation.[7]
What happens during oncoplastic surgery?
If the tumor cannot be felt, a radiologist places a small marker in it before your operation. You are then under general anesthesia for all three steps:
-
Removing the cancer
Dr. Arena follows the marker to the tumor, removes it with its margin, and leaves small metal clips in the space. Once the tissue has been moved, your radiation oncologist uses the clips to aim radiation at the tumor site, and radiologists see them on your future mammograms.[2]
-
Checking the lymph nodes
For most invasive cancers, meaning cancers that have grown out of the milk duct or lobule, she removes the sentinel lymph nodes through a separate small incision. These are the first few nodes under your arm that fluid from the tumor drains to.
Which reshaping technique will you have, and where will the scars be?
The technique depends on how much of your breast Dr. Arena removes and where the tumor sits.
| Technique | What the plastic surgeon does | How much of your breast is removed | Where the scars are |
|---|---|---|---|
| Tissue rearrangement (volume displacement) | Moves nearby breast tissue into the space | Under 20% (level 1 in the American Society of Breast Surgeons' system)[1] | Around the edge of the areola, in the fold beneath your breast, or near your armpit[2] |
| Breast lift or reduction (volume displacement) | Lifts or reduces your breast around the space and moves your nipple higher | 20% to 50% (level 2), most often in larger or drooping breasts[1] | Longer scars around the areola and on the lower half of your breast[2] |
| Tissue flap (volume replacement) | Brings tissue from your side or upper back into your breast, still attached to its blood supply | More than your remaining breast tissue can fill, often in smaller breasts[2] | On your side or back as well as your breast[2] |
What is recovery like, and when does radiation start?
Many women go home the same day after tissue rearrangement,[2] and most are back to light activity within days. A flap, or surgery on both breasts, takes longer to recover from.
| When | What happens |
|---|---|
| First few days | Soreness, swelling and bruising in your breast and under your arm |
| About a week after surgery | Dr. Arena reviews your pathology report with you: whether the margins are clear and whether the lymph nodes contain cancer |
| If a margin is not clear | She removes more tissue in a second operation. Occasionally the whole breast has to be removed instead.[2] |
| The following weeks | Radiation starts once your incisions have healed and, if you need it, your medical oncologist has finished your chemotherapy. Dr. Arena sends her operative report and the clip positions to your radiation oncologist. |
| During and after radiation | Radiation can shrink your treated breast by 10% to 20% over the following months, so the plastic surgeon leaves it slightly larger than your other breast at your operation.[2] |
How is oncoplastic lumpectomy different from a standard lumpectomy?
| Standard lumpectomy | Oncoplastic lumpectomy | |
|---|---|---|
| The space left by the tumor | Closed without moving tissue into it | Filled with breast tissue moved from around it, or with a flap |
| How much tissue can be removed | Limited by the dent it would leave | A larger piece, so larger tumors can be removed[2] |
| Cancer at or near the edge of the removed tissue (positive or close margins) | 8.3% of standard lumpectomies at one cancer center, 2007 to 2014 | 5.8% of oncoplastic lumpectomies at the same center; the women were not assigned to either operation at random[3] |
| Scars on the breast | Usually one short incision | Longer scars after a lift or reduction[2] |
Why choose Dr. Arena for oncoplastic surgery in Los Angeles?
- Double board certification: Dr. Arena is double board-certified in general surgery and complex general surgical oncology, and a Fellow of the American College of Surgeons.
- Consultation to follow-up: Dr. Arena sees you at your consultation, performs the cancer part of your operation, and sees you at each follow-up visit.
- Ultrasound in her office: she scans your breast at your consultation, without a separate appointment at an imaging center.
- Mastectomy as well as lumpectomy: if the cancer is too large or too widespread for a lumpectomy, Dr. Arena performs the mastectomy, including nipple-sparing mastectomy.
Double board-certified in general surgery and complex general surgical oncology, Dr. Elizabeth Arena brings advanced cancer expertise to oncoplastic lumpectomy in Los Angeles. She considers the tumor’s size and location alongside the patient’s breast shape, treatment needs and priorities to determine how the cancer can be removed while preserving a natural, balanced appearance. When appropriate, she coordinates tumor removal and breast reshaping in a single operation, prioritizing clear margins while planning thoughtfully for how the patient will look and feel after surgery.
Frequently asked questions
Is oncoplastic surgery as effective as a standard lumpectomy?
A review of 18 studies covering 18,103 women found no significant difference in how often cancer came back after oncoplastic lumpectomy, standard lumpectomy or mastectomy.[4] At one cancer center, survival over a median of 3.4 years was the same after oncoplastic and standard lumpectomy.[3] These studies compared groups of women treated in the usual way; none assigned women to one operation at random.
Does insurance cover oncoplastic surgery?
A federal law, the Women's Health and Cancer Rights Act, requires health plans that cover mastectomy to cover reconstruction and surgery on the other breast for symmetry. The plan's usual deductibles and coinsurance still apply.[5] California law defines a mastectomy as removal of all or part of the breast. That brings lumpectomy within the same rule for health plans regulated by the California Department of Managed Health Care.[6] Employer plans that pay claims from their own funds follow only the federal law.[5] Before surgery, Dr. Arena's office asks your insurer how much it will pay of the plastic surgeon's fee and of the fee for surgery on your other breast.
How is oncoplastic surgery different from a mastectomy?
In oncoplastic surgery Dr. Arena removes only the tumor and a margin, and the plastic surgeon reshapes the breast tissue that is left. In a mastectomy she removes nearly all of the breast tissue, and a plastic surgeon can rebuild the breast with an implant or your own tissue, often in the same operation. A nipple-sparing mastectomy leaves your breast skin and nipple in place.
Will I still have feeling in my breast?
After an oncoplastic lumpectomy most women keep normal feeling in the skin of their breast.[2] Skin near the incisions can be numb, and a lift or reduction that moves your nipple can reduce the feeling in it.
Sources
- Chatterjee A, Gass J, Patel K, et al. A Consensus Definition and Classification System of Oncoplastic Surgery Developed by the American Society of Breast Surgeons. Annals of Surgical Oncology. 2019;26(11):3436-3444. https://pubmed.ncbi.nlm.nih.gov/30977016/
- Breastcancer.org. What Is Oncoplastic Lumpectomy Surgery? Reviewed by Patricia Clark, MD, FACS, and Monique Gary, DO, MSc, FACS. Updated April 17, 2026. https://www.breastcancer.org/treatment/surgery/breast-reconstruction/types/oncoplastic-lumpectomy
- Carter SA, Lyons GR, Kuerer HM, et al. Operative and Oncologic Outcomes in 9861 Patients with Operable Breast Cancer: Single-Institution Analysis of Breast Conservation with Oncoplastic Reconstruction. Annals of Surgical Oncology. 2016;23(10):3190-3198. https://pubmed.ncbi.nlm.nih.gov/27406093/
- Kosasih S, Tayeh S, Mokbel K, Kasem A. Is oncoplastic breast conserving surgery oncologically safe? A meta-analysis of 18,103 patients. American Journal of Surgery. 2020;220(2):385-392. https://pubmed.ncbi.nlm.nih.gov/31926592/
- U.S. Department of Labor. Your Rights After a Mastectomy: Women's Health and Cancer Rights Act of 1998. https://www.dol.gov/agencies/ebsa/about-ebsa/our-activities/resource-center/publications/your-rights-after-a-mastectomy
- California Health and Safety Code § 1367.6. https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?lawCode=HSC§ionNum=1367.6
- Boughey JC, Rosenkranz KM, Ballman KV, et al. Local Recurrence After Breast-Conserving Therapy in Patients With Multiple Ipsilateral Breast Cancer: Results From ACOSOG Z11102 (Alliance). Journal of Clinical Oncology. 2023;41(17):3184-3193. https://pubmed.ncbi.nlm.nih.gov/36977292/
- National Cancer Institute. Treatment for Inflammatory Breast Cancer. https://www.cancer.gov/types/breast/treatment/inflammatory-breast-cancer
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