The surgical treatment of breast cancer has evolved throughout history to reduce the extent of surgery while minimizing physical and psychological harm that may result from it, all without compromising the chances of a cure.
The surgery includes the removal of the breast tumor and, at the same time, examination of the sentinel lymph nodes or their removal. Nowadays, it is usually performed as "breast-conserving surgery" without the need for complete removal. The surgery for removing lymph nodes in the armpit can also be avoided in most cases, reducing the risk of complications.
Mastectomy
Treatment of breast cancer can be accomplished through a mastectomy, which involves the removal of the breast tissue. This procedure typically includes the removal of approximately 95% of the breast tissue, including some skin, with the preservation of the nipple and areola. Generally, the surgery does not involve the removal of chest wall muscles. However, if desired, breast reconstruction can be performed using plastic surgery techniques during or after the mastectomy. In Israel, reconstructive surgeries are considered part of the disease treatment and are funded by health funds.
Skin-Sparing Mastectomy: This procedure is performed through a limited incision around the areola, with immediate breast reconstruction. The nipple and areola are removed and typically reconstructed afterward. This approach allows for a better cosmetic outcome compared to traditional mastectomy. The decision about the extent of surgery is based on oncological considerations.
Nipple-Sparing Mastectomy: In this procedure, the breast is removed while preserving the nipple and areola. Although it offers a preferable cosmetic result, it can lead to debates within the medical community because the nipple and areola are rich in breast tissue. Therefore, it is not the preferred method for preventive surgeries, especially for women at a particularly high risk of developing breast cancer, such as carriers of BRCA mutations.
Breast-Conserving Treatments
Another option for surgical treatment is the removal of the tumor and the surrounding tissue. This treatment is known as breast-conserving treatment or BCT (Breast Conserving Treatment). There are two main techniques for this: "Lumpectomy," which involves removing a lump, and "Quadrantectomy," which involves removing a quarter of the breast tissue. Partial treatment is possible when the tumor is confined to a specific area of the breast and is not widespread or scattered.
The decision to perform partial treatment depends on the appropriate ratio between the size of the lump and the size of the breast. Sometimes, partial removal is possible when a few tumor masses are located in the same quadrant of the breast, but generally, if the tumor is multicentric, a complete removal is necessary. Another factor considered is the presence of "non-invasive" growth (DCIS).
Reconstruction Planning for Breast-Conserving Treatment
When providing treatment to reduce the tumor's size to enable breast-conserving treatment (lumpectomy), the possibility of a rapid response to the treatment must be taken into account. In such cases, there might be difficulties in accurately locating the tumor manually or even through imaging after the treatment's initiation. Therefore, before starting the treatment, metal clips can be placed to mark the tumor's borders, which can help precisely locate the margins for removal.
Reconstructive Oncoplastic Surgeries
In these surgeries, plastic surgery techniques are used to improve the aesthetics of the breast after the tumor's removal. The aesthetic and oncological outcomes achieved are usually better than those of conventional techniques.