Breast Cancer Surgery | Dr. Mª Esther Suárez Agustín
In this video, Dr. María Esther Suárez Agustín , gynecologist and Head of the Breast Unit at the Women's Unit of Ruber International Hospital, offers a detailed explanation of the surgical options available for patients diagnosed with breast cancer . She also shares how the Women's Unit approaches different cases, tailoring treatment to each patient's individual needs.
“All patients have to undergo surgery”
Currently, all patients diagnosed with breast cancer must undergo surgery. It is crucial to determine the type of surgery required and when, as in many cases it is primary surgery . This means the initial procedure is performed, followed by any additional treatments the patient may need, such as radiotherapy, chemotherapy, or hormone therapy.
In other cases, primary or neoadjuvant systemic therapy is chosen . This means that certain types of tumors require this treatment first before proceeding with surgery to complete the therapeutic process.
Conservative surgery and mastectomy
The choice between breast-conserving surgery and a mastectomy depends on the type of tumor, the patient's clinical characteristics , and the anatomy of the breast. Most patients are candidates for breast-conserving surgery, which involves removing only the area affected by the tumor, ensuring a safe margin. This procedure should then be followed by the necessary cancer treatments.
In other cases, mastectomies will be required. Sometimes this is at the patient's request, but other times it is due to the location of the tumors, or because they are multifocal, meaning there are many areas of pathology in the breast. We must also not forget those patients who carry a mutation and are considered high-risk. In these cases, mastectomies must be performed, almost always followed by immediate breast reconstruction.
Minimally invasive surgery
As the tumors we detect become smaller and pre-surgical treatments are more effective at reducing their size, the use of minimally invasive surgeries has increased . This involves making incisions that are as inconspicuous and aesthetically pleasing as possible. During the procedure, if necessary, we use oncoplastic techniques to optimize the cosmetic results.
Oncoplasty is performed during breast-conserving surgery to minimize adverse aesthetic effects. This involves reshaping breast tissue, removing skin if necessary, and repositioning the nipple area to center it properly. While ensuring oncological safety is the priority, we also pay close attention to aesthetics.
In cases where the lesions are non-palpable or very small, which is fortunately the most common scenario, it is essential to locate the lesion before scheduling surgery . Our radiologists place a small seed, marker, or coil in the area where the lesion is located, or where it was located if it has disappeared after treatment. In the operating room, we locate this lesion using probes or harpoons, depending on the case, and send the sample to the radiologists. They will confirm with an X-ray that the lesion has been completely removed, ensuring that the marker indicating its location has been removed. If the lesions are larger , the pathologists verify that complete removal has been performed.
The importance of doing an armpit study
To properly stage and manage breast cancer, an axillary examination is necessary . Until recently, all axillary lymph nodes were removed, but this is now rarely done. Most of the time, we perform a sentinel lymph node biopsy . This node is the first axillary lymph node to collect all the breast drainage, and therefore, we know whether or not to remove more lymph nodes if it is affected. If it is disease-free, no further removal is necessary.
To locate the sentinel lymph node, we use isotopes, substances that migrate through the lymphatic system via the breast and accumulate in the armpit . So, after we've introduced this isotope into the breast and located the lymph nodes, in the operating room, through a small incision in the armpit, we use a probe to determine how many there will be (one or two) and remove them for analysis by the pathologist.
Safe surgeries
Conservative surgeries are clean, quick procedures with minimal complications . In fact, most patients only require one night of hospitalization and are discharged the following day with instructions for wound care at home.
In cases where mastectomies , reconstructions, or, in rare cases, a complete axillary lymph node dissection are performed, a slightly longer hospital stay is required. This is because drains are usually placed to prevent the accumulation of blood and lymph, and these may remain in place for up to 48 hours. These patients typically stay for two to three nights. Fortunately, complications such as infections, hematomas, and seromas are uncommon.
Very high survival rate
Currently, thanks to very early and accurate diagnoses, as well as a greater understanding of the biology of tumors, which present significant variations in terms of their treatments, we approach each case individually.
By using minimally invasive techniques and complementary therapies, including radiotherapy, hormone therapy, targeted therapies, and immunotherapy, we have multiple options available in collaboration with our multidisciplinary team. This allows us to achieve a high cure rate, prolong disease-free intervals, and attain exceptional survival rates.
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If you found this article interesting and would like to be seen by a specialist in Gynecology and Obstetrics, the Women's Unit at Ruber International Hospital has a specialized department in this area. You can request more information by calling 91 387 51 72/73/74 or schedule an in-person appointment with top specialists.
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