New trends in breast cancer surgery: evolution from aggressive and mutilating treatment to conservative approach
Breast cancer is currently the most common cancer among women worldwide. Surgery is usually the first line of attack against breast cancer.
Today, the aesthetic satisfaction of breast cancer patients coupled with oncological safety is the goal of the modern breast surgeon. The present article will highlight the new surgical treatment options, which are more and more effective and respectful of breast cancer patients.
Breast cancer surgery is not the radically deforming surgery that you may have seen on your grandmother’s day.
People with breast cancer have the opportunity to choose between total removal of a breast (mastectomy) and breast-conserving surgery (lumpectomy). BCS is a less radical cancer surgery than mastectomy. It is an operation to remove cancer and some normal tissue around it, as opposed to the entire breast. A special technique called Frozen section/Cryosection is utilized to perform rapid microscopic analysis and confirm that cancer has been removed completely. For most women, BCS has a good cosmetic result. In rare cases when a larger area of tissue needs to be removed, BCS can cause the breast to look smaller or distorted. The special type of reconstruction called Oncoplasty is performed to at the same time prevent distortion and to match both the breasts.
The main advantage of BCS is that it can preserve much of the appearance and sensation of your breast. It is a less invasive surgery, so your recovery time is shorter and easier than with mastectomy.
They are likely to have 5 weeks of radiation therapy, 5 days per week, after surgery to make sure the cancer is gone. Studies have shown that women with early-stage breast cancer who have BCS followed by radiation, live just as long as women who have a mastectomy.
Staging of the axilla has also gradually evolved toward less aggressive approaches with the adoption of sentinel node biopsy (SLNB).
Patients with early breast cancer qualify for the less invasive sentinel lymph node dissection. SLNB is an alternative to traditional axillary lymph node dissection, and it can spare the patients of more invasive surgery and side effects. Strategic removal of just one or a few key underarm nodes can accurately assess overall lymph node status, again with help of Frozen section analysis. Complete axillary node surgery can lead to uncomfortable side effects, including lingering discomfort, numbness, and swelling called lymphedema. Usually, this happens in only 15-25% of cases.
Prophylactic mastectomy is a preventive removal of the breast to lower the risk of breast cancer in high-risk people. Reconstruction can take place at the same time as surgery, or months to years later. Some women decide not to have reconstruction and opt for a prosthesis instead.
The surgical treatment of breast cancer has undergone continuous and profound changes over the last decade. Today, as a result of the complex and coordinated medical treatment of breast malignancies the long-term survival rate reaches 80% with modern breast surgery playing a prominent role in the multidisciplinary treatment of breast tumors.
Dr. Ashwin KR
Department of Surgical Oncology
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