Oncoplastic surgery (removing breast cancer while also re-configuring the breast tissue with techniques usually practiced by plastic surgeons to try and ensure optimal cosmetic outcome and symmetry) started in the 1980s but really took off in the 90s/2000s. In the United States, we often have a clear divide between the surgeon who is removing the cancer (aka- the mastectomy surgeon or Breast Surgery specialist), and a plastic surgeon who is responsible for the “beauty” and appearance. Especially in the United Kingdom, they had combined programs where doctors did shorter courses of training, but learned only about Breast Surgery and the plastic surgery techniques for the breast. In the United States, we don’t have as many of these combined programs, but they are growing. For the most part, doctors trained in on plastic techniques, either are typically breast surgical specialists who take additional courses and practice more complicated techniques to put Breast issue back together after cancer is removed, or alternatively, a mastectomy surgeon and a plastic surgeon will work together for these results. For instance, I sometimes perform of Goldilocks mastectomy by myself, but sometimes I will work with our plastic surgeons, and I will perform the mastectomy portion and they will reconfigure the breast so that it looks like a breast reduction has been performed, even though it’s actually a mastectomy. And that way we work together.
Similarly if a patient Wants to keep their breast tissue, but has a fairly large area of cancer that would otherwise create asymmetry or significant changes, I will remove the cancer with a lumpectomy type technique, and the plastic surgeon will come in and perform essentially a breast reduction, reconstruction pattern on both sides to make things match.
Some doctors have additional training where they do all of this themselves, without assistance from a plastic surgeon.
A formal mastectomy with full reconstruction with either implants or autologous tissue (meaning your own tissue from your own body - either from your back, upper buttock area, or stomach area/abdomen) is typically formally performed by a plastic surgeon in the United States, but other countries do have breast surgeons that will do all of it as one person.
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