Advancement in Breast Conserving Surgery Offers Hope to Breast Cancer Patients

Receiving a breast cancer diagnosis is a life-changing event but it is crucial to understand that it does not mean every woman has to lose her breasts.

Breast cancer treatment continues to develop and progress in every aspect, resulting in increased number of survivors. Breast surgical treatment has gradually evolved in the attempt of breast conserving surgery where possible. Offering women with more surgical options, empower them in navigating the challenges of decision making.

Understanding mastectomy

Mastectomy is a procedure where 90-95% of breast is removed. Mastectomy can never be 100% of breast tissue removal due to the anatomy of the breast. Women who undergo mastectomy is usually due to the following reasons: surgeons not able to remove the breast cancer and leave patient with a cosmetically acceptable breast; women choose to have mastectomy; or women have genetic mutation associated with high risk for developing more breast cancers.

Generally, there are three types of mastectomies:

1. Simple mastectomy - The removal of the breast tissue without reconstruction. Patients have the option of using external breast prosthesis in their bra.
   
   
2. Mastectomy with breast implant reconstruction. If is done immediately after mastectomy, skin and maybe the nipple of the breast can be kept and the removed breast tissue space is replaced with breast implant.
   
   
3. Mastectomy with autologous reconstruction means reconstruction using patient’s own tissue usually from the back or tummy tissue.

What is oncoplastic breast surgery?

Traditionally, women with bigger cancers (larger than 4 or 5cm) would be offered mastectomy. Thanks to oncoplastic surgery, breast cancer patients can have more breast conserving surgical options to choose from. Most small breast cancers can be removed with lumpectomy or wide local excision with or without using simple oncoplastic surgical techniques. For bigger cancers, complex oncoplastic surgery or partial breast reconstruction surgery can be offered, giving patients alternatives to mastectomy whenever it is possible.

1. Simple oncoplastic breast surgery is when less than 20% of breast tissue is removed with the cancer.  The removed cancer space is filled with surrounding breast tissue.
   
   
2. Complex oncoplastic breast surgery is when breast cancer is removed and the breast is reduced and uplifted at the same time. Medically, this is known as therapeutic mammoplasty and there are many types of mammoplasties.
   
   
3. Partial breast reconstructions surgery is when the breast cancer is removed and the space is replaced with chest wall tissue from below the armpit or below the breast. These tissues are called chest wall perforator flaps. Partial breast reconstruction with chest wall perforator flap is essentially a technique used by surgeons to give back what is removed.

It is important to be aware that research has shown that breast conversing surgery with radiotherapy is as safe as mastectomy in terms of overall survival. Breast conserving surgery can reduce patients’ physical disfigurement and help patients recover better while reducing the impact of breast cancer surgical treatment on physical, psychosocial, sexual, and mental wellbeing.

All these surgical options need to be carefully assessed by trained Oncoplastic and Reconstructive Breast Surgeons with or without involving Plastic and Reconstructive Breast Surgeons. Surgeons need to empower patients in the process of decision making so that both surgeon and patient can agree on the best possible surgical treatment. 

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