BREAST CANCER SURGERY
Breast surgeon DR JENDANA CHANYAPUTHIPONG discusses the key surgical options available to breast cancer patients.
What are the main surgical treatment routes for breast cancer?
Breast cancer surgery generally involves surgery to the breast to remove the cancer, as well as surgery to the axilla, or armpit, to determine if cancer cells have affected the lymph nodes. The two main types of surgery to remove breast cancer include breast conserving surgery (BCS) – where only that part of the breast that houses the cancer, along with some normal surrounding tissues, is removed – and mastectomy, where the whole breast tissue is removed.
What are the pros and cons of BCS?
The appearance of the breast after BCS is often good, especially if the tumour is small (in relation to the patient’s breast size). Unless the tumour is located in the centre of the breast or involving the nipple, the nipple is not removed. Nearby tissues may be used to restore the area of defect for better cosmetic results in certain cases. Normal sensation is expected. Overall, patients with BCS have better self-image without the need for major reconstruction.
BCS carries the small risk of repeated surgeries to obtain a “clear margin”, meaning the absence of tumour cells on all sides of the borders of the tissue removed. Your surgeon will always do his or her best to remove all that is necessary, while being careful not to take too much normal-looking surrounding breast tissue to avoid significant breast deformity after the surgery. However, there are occasions when tumours are found at one or more borders at a microscopic level, making further surgery, including the possibility of mastectomy, necessary to obtain a clear margin.
Additionally, with BCS, radiation therapy is a must. Studies have shown that, for BCS to be “oncologically safe”, radiation therapy after surgery is necessary, as it reduces the risk of the cancer returning and improves survival. This is usually done as a day procedure, five days a week, for six weeks.
What are the advantages and disadvantages of mastectomy?
There are many types of mastectomies and they are performed for different reasons. If mastectomy is performed for early cancers, radiation therapy is not required. Also, reconstruction is possible with mastectomy. If the skin envelope and the nipple are preserved, reconstruction with prosthesis or flaps can make the breast appearance look very natural.
However, sensation is lost in this type of surgery, as the nerve endings to the skin are cut when removing the breast tissue. Life-threatening bleeding can occur, though uncommon, necessitating further surgery.
Do most mastectomy patients opt for reconstructive surgery?
There’s an increasing trend towards reconstruction here in Singapore. From discussing with my plastic surgeon colleagues, it’s estimated that up to 30 percent of mastectomy patients opt for reconstructive surgery nowadays.
The decision for reconstructive surgery is an extremely personal one. Many patients with breast cancer are already overwhelmed with the diagnosis and want to focus on the treatment of cancer itself without the additional burden of cost and/or facing potential complications specific to reconstructive surgery. Some may find that reconstruction is important for the preservation of self- esteem and confidence; others may want reconstruction at a later stage.
Ultimately, the surgical options offered to a patient may be different from another and for different reasons. Each individual is different, her preferences are different, and her breast size, tumour size and characteristics are different. Your surgeon will discuss the best options available for you.
It’s also important to note that often in cases of breast reconstruction, additional surgery is required. It may be a revision procedure, staged procedure to complete the reconstruction process, or another procedure to achieve symmetry, reconstruct the nipple or to tattoo the areola.
Are there any new and exciting technological advancements in the field of breast cancer surgery?
Yes, a huge advance! A new promising technique called cryoablation is being studied in multi-centre clinical trials in the USA and has shown promising results. It involves freezing away the tumour with liquid nitrogen via a thin needle-like device that is inserted through a tiny incision. The whole procedure is completed in less than half an hour; there’s no downtime, and no sedation or hospitalisation involved. Furthermore, researchers believe that the cancer DNA that is released when the cancer cells die sends signals to the body to increase immunity against breast cancer recurrence.