When a woman is diagnosed with breast cancer, a million thoughts run through her head. What type of breast cancer do I have? How quickly is it growing? Has the cancer spread? Will I lose one or both of my breasts? Do I need chemotherapy?
All of this can have a profound impact on the treatment decisions a woman makes – especially in cases where breast surgery may play a pivotal role in their overall treatment plan. In fact, surgery is one of the primary treatments for breast cancer and is used:
- As a diagnostic and treatment tool to determine the cancer’s growth and progression
- To relieve symptoms found in advanced stages
- To cosmetically reconstruct the breast(s) after cancer surgery
- To reduce breast cancer risk for those with higher risk, such as women with an immediate family member who has had breast cancer, or those whose genetic tests indicate a mutation that conveys a high risk of breast cancer
Excluding skin cancers, the World Health Organization reports that breast cancer is the most common form of cancer worldwide. In Texas, over 21,000 women are expected to face a new diagnosis of breast cancer in 2022, according to the American Cancer Society.
What are the goals of breast cancer surgery?
The primary goal of breast cancer surgery is to remove the cancer and obtain staging information, but surgeons also have a goal to understand the patient’s wishes for appearance. Using leading-edge technology and advanced surgical techniques, breast surgeons can often achieve both goals. This individualized, patient-centric approach can lead to a better experience for the patient.
How to decide which breast surgery is right for you
Surgery for breast cancer depends on several factors including the size and location of the tumor(s), stage of cancer, tumor receptors/growth rates, breast shape/size, treatment options, and individual goals and preferences. While surgery will not fully treat metastatic breast cancer, it can be helpful to treat one site with significant symptoms.
Common surgical procedures used to treat breast cancer include breast-conserving surgery and mastectomy.
- Breast-conserving surgery, also referred to as a lumpectomy, quadrantectomy, or partial mastectomy, removes the area of cancerous tissues from the breast without removing the entire breast. This can be combined with advanced techniques called oncoplastic surgery to help keep the breast looking the same after surgery or even allow for symmetry surgery at the same time.
- Mastectomy is the surgical removal of an entire breast. It is usually performed when a patient cannot be treated with lumpectomy or if it a patient’s choice. In some cases, mastectomy will be the most appropriate or only option due to the type of breast cancer, tumor size, location of the tumor in the breast, or previous radiation treatment in the area. Some women may have both breasts removed in what is called a double mastectomy. If the cancer does not involve the nipple, a nipple-sparing mastectomy may be performed. Other options include areola-sparing mastectomy combined with nipple sharing techniques, which are less disfiguring and more individualized, patient-centric procedures.
Additional procedures include sentinel lymph node biopsy, lymph node dissection also known as a lymphadenectomy, and breast reconstruction surgery, which can be part of treatment after breast-conserving surgery or mastectomy.
Is breast reconstruction required after a mastectomy?
The impact of breast cancer and its treatment is an important part of every patient’s cancer experience. The loss of one or both breasts may change a woman’s self-perception or body image. This can be a factor for patients deciding if breast reconstruction surgery is right for them. Some women decide to not proceed with reconstruction.
Many women who have a mastectomy choose to have breast reconstruction to restore the breast’s appearance. This procedure rebuilds the shape and appearance of the breast using saline or silicone implants, or tissue moved from elsewhere in the body. In some cases, after a lumpectomy, reconstructive surgery/oncoplastic techniques can help restore breast symmetry and appearance.
Breast reconstruction can be performed at the same time as a mastectomy (immediate reconstruction), or after the completion of further treatment such as radiation and chemotherapy (delayed reconstruction). The timing of reconstruction depends on the type of breast surgery performed and individual patient factors. Breast reconstruction includes aesthetic flat closure using advanced techniques to achieve a flat chest wall without excess skin if that is what the patient desires.
As each person has a unique set of preferences and concerns related to the physical changes associated with surgery for breast cancer, patients should evaluate which surgical procedures are right for them based on their own priorities and goals and address any questions or concerns with their physician.
For more information on breast cancer and breast surgery, visit Texas Breast Specialists at texasbreastspecialists.com.
This article appeared in the October 2022 print edition of Dallas Medical Journal.