Breast cancer treatment usually involves a combination of surgery, radiation therapy, chemotherapy and/or other targeted/drug therapy. The type of surgery (mastectomy vs breast-conserving surgery) depends on several patient-related and tumour-related factors, including the stage, tumour distribution, size and biology, as well as age, general health, and patient’s preference.
Mastectomy is the surgery to remove a breast. This surgery is most often used to treat breast cancer or to help prevent breast cancer in women who have high risk for it, such as those with known genetic mutation. In Simple or Total mastectomy, the breast, along with its nipple and areola, is removed at surgery. The end result is a flat chest, with the area of breast replaced with a long scar across it. Newer techniques allow the mastectomy to be performed with immediate reconstruction, giving patients the best possible outlook.
For treatment of breast cancer, mastectomy may be coupled with the removal of lymph nodes, a procedure known as sentinel lymph node biopsy or axillary clearance.
A) Minimal-scar mastectomy and immediate reconstruction
In minimal-scar mastectomy, as the name implies, the breast is removed via a much smaller-sized incision. Types of minimal scar mastectomy include:
-nipple-sparing mastectomy: the breast tissue is removed while the native skin envelope and the nipple-areola complex are preserved.
-skin-sparing mastectomy: here, the breast tissue is removed, along with the nipple and areola but the skin envelope is maximally preserved.
When is mastectomy preferred?
Usually, mastectomy is advised if a) the tumour is large, b) the tumour involves more than 1 area of the breast, c) when radiation therapy is contraindicated or undesired by the patient, or d) patient’s preference.
B) Breast Conserving Surgery and oncoplastic technique for reshaping
Breast-conserving surgery (BCS) is surgery to remove the part of the breast that has cancer, along with a rim of healthy tissue that surrounds it. The volume of tissue removed depends on various factors. A change in size and shape of the treated breast is expected. Nonetheless, oncoplastic technique can be used to reshape and maximize the outlook of the breast after BCS. After BCS is done, radiation therapy is given to the rest of the breast to lower the risk of recurrence.
When is BCS suitable?
Generally, BCS is an option for some women if her breast cancer is small, is located in 1 area of the breast, and the patient has no contraindication—and agrees—for post mastectomy radiation therapy.