Surgical Management of Breast Cancer
Breast cancer surgery aims to preserve as much of the breast as possible by removing the tumor and a portion of the surrounding tissue. The amount of breast tissue removed along with the tumor varies according to the type of breast cancer surgery used. This is determined by the location of the tumor, the extent of its spread, and your emotional state. Additionally, the surgeon removes a few lymph nodes under the arm to be examined for cancerous cells. This will assist your doctor in planning your post-operative care.
There is a wide range of breast cancer treatments available in India, including chemotherapy, radiotherapy, hormone therapy, immunotherapy, and targeted drug therapy. Regardless of the location or size of the tumor, a series of tests will be performed to diagnose any abnormalities.
The vast majority of breast cancer patients require surgery as part of their treatment. Depending on the circumstances, various types of breast surgery may be performed. Surgery, for example, could be performed on:
- As much of cancer as you can remove (breast-conserving surgery or mastectomy)
- Check to see if the lymph nodes under the arm have been affected by cancer (sentinel lymph node biopsy or axillary lymph node dissection)
- After the malignancy has been removed, restore the breast’s form (breast reconstruction)
- Alleviate the signs of advanced cancer
Breast cancer treatment in India is less expensive when compared to other industrialized nations. The achievement can be attributed in part to oncologists’ knowledge and the cutting-edge medical technology used in Indian hospitals.
Why is Surgery Done?
Breast cancer surgery aims to remove cancerous cells from the breast. Treatment for placing breast implants or reconstructing a breast from the patient’s own tissue (flap surgery) can be done concurrently or afterward for those who want breast reconstruction.
The majority of breast cancer stages are treated with surgery, including:
- High risk of breast cancer: Women with a strong family history of breast cancer, specific noncancerous breast biopsy results, or a gene mutation may opt for a preventive (prophylactic) mastectomy with or without immediate breast reconstruction to reduce their risk of breast cancer.
- Noninvasive or in situ breast cancer: Patients with in situ ductal carcinoma (DCIS) may receive radiation therapy in addition to a lumpectomy, and mastectomy with or without breast reconstruction is also an option.
- Early-stage breast cancer: To treat small breast cancers, a lumpectomy or mastectomy may be combined with radiation therapy, chemotherapy, hormone therapy, or targeted therapy, with or without breast reconstruction.
- Larger breast cancers: While chemotherapy, hormone treatment, or targeted therapy are frequently utilized before surgery to enable a lumpectomy to be conducted, larger cancers might be treated with a mastectomy.
- Locally advanced breast cancers: Large breast cancers or those that have spread to numerous lymph nodes are first treated with chemotherapy, hormone therapy, or targeted therapy to reduce the size of the tumour and increase the likelihood that surgery will be effective. Radiation therapy may be used to treat certain cancers after a lumpectomy or mastectomy.
- Metastatic breast cancer: A mastectomy is a treatment option for breast cancer that has metastasized to other regions of the body.
- Recurrent Breast Cancer: Breast cancer that recurs after being treated once can be removed with further surgery.
Surgical Treatment of Breast Cancer
There are two primary surgical procedures used to remove breast cancer:
- Breast-conserving surgery (BCS), also known as a lumpectomy, partial mastectomy, segmental mastectomy, or quadrantectomy, is used to remove the cancerous portion of the breast. The goal of this procedure is to remove the cancer as well as some healthy tissue around it. The amount of breast tissue that must be removed is determined by the size and location of the tumour, as well as other factors.
- An entire breast, all of its breast tissue, and perhaps nearby tissues are removed during a mastectomy. Different types of mastectomy exist. A double mastectomy, in which both breasts are removed, is an option for some women.
What should I choose: Breast-Conserving Surgery or Mastectomy?
The majority of cancer patients in the early stages can choose between BCS and mastectomy. The main advantage of BCS is that a woman can keep most of her breast because only the cancerous tissue is removed, even though she will still need radiation. Mastectomy patients are less likely to receive chemotherapy for early-stage cancers.
Depending on the type of breast cancer, the size of the tumor, previous radiation therapy, and other factors, a mastectomy may be a better and safer option for many women. Many women may be concerned about the possibility of cancer returning after a less invasive procedure. Studies from the last 20 years show that having BCS with radiation has a survival rate comparable to having a mastectomy.
Removing nearby lymph nodes surgically
One or more of these lymph nodes will be removed and examined in the lab to determine whether breast cancer has spread to the axillary lymph nodes. This is a crucial factor in determining the stage of the malignancy. It is possible to remove lymph nodes either as part of breast cancer surgery or in a separate procedure.
There are two primary approaches to lymph node removal surgery:
- Sentinel lymph node biopsy (SLNB): During this technique, the surgeon just removes the lymph nodes beneath the arm where cancer may initially spread. Only one or a few lymph nodes are removed, which reduces the possibility of surgical side effects including lymphedema, or arm swelling.
- Axillary lymph node dissection (ALND): It involves the removal of several axillary lymph nodes by the surgeon (usually less than 20). Although ALND is rarely utilized, in some circumstances it can still be the optimum method of lymph node removal.
Following Surgery, Breast Reconstruction
Many women who have breast cancer surgery have the option of breast reconstruction. The patient wishes to have the breast mound restored in order to restore the appearance of the breast following a mastectomy. In certain breast-conserving procedures, a woman may consider having fat grafted into the damaged breast to remove any dimples that remain visible after the procedure. A woman can choose breast reconstruction based on her medical condition and personal preferences. The patient can choose between immediate (during surgery) or delayed reconstruction (after surgery) (delayed reconstruction).
Breast reconstruction surgery can be performed concurrently or after a mastectomy. This procedure is performed by a plastic surgeon who specialises in reconstruction surgery. The surgeon creates a breast-like form by using an implant or tissue from another part of the body to replace the missing breast. In addition, the surgeon could add an areola-like tattoo to the nipple outline (the dark region around the nipple).
There are two primary procedures for breast reconstruction
- Breast implant: Breast reconstruction using implants is carried out in a series of steps, including:
- The surgery, also known as tissue expansion, begins with the plastic surgeon inserting a balloon expander under the chest muscle.
- To stretch the chest muscle and the skin above it, saline is administered to the expander over the course of several weeks or months. An implant pocket is made during this stage.
- The surgeon removes the expander and places an implant in the pocket after it is the right size (filled with saline or silicone gel). A new breast-like form is produced as a result.
- Even though it seems to be a breast, the mastectomy caused nerves to be severed, so you won’t feel it the same way you did previously. Breast implants are not intended to be permanent. If you decide to get an implant, you may need additional surgery in the future to either remove or repair it. Breast hardening, discomfort, and infection are all potential complications of implants. An implant can break, shift, or change position. These issues may arise immediately following the procedure or later.
Tissue flap: A reconstructive plastic surgeon with specialized training performs this procedure. He fashions a new breast-like shape out of muscle, fat, and skin removed from other parts of the body in tissue flap surgery (often the abdomen or back). This new breast shape should be permanent. Women who smoke, are severely underweight or obese, or have other serious health conditions are not candidates for tissue flap surgery. This procedure can sometimes take longer to recover from than one involving breast implants. Other issues such as infection, poor wound healing, and discomfort may be present.
The size of the mastectomy or breast-conserving surgery should be discussed with the surgeon and the plastic surgeon before surgery. Even if you decide later to have reconstructive surgery, it will give the surgical team time to create the most appropriate treatment plan and recovery schedule for you.