Surgical treatment of breast cancer

Once a breast cancer diagnosis is made , the most appropriate and individualized treatment plan must be discussed with the patient. Surgical treatment of breast cancer , along with other oncological treatments (chemotherapy, immunotherapy, hormone therapy, etc.) and radiotherapy, will be the cornerstones of treatment.

In recent decades, surgical treatment has evolved from radical procedures to increasingly conservative ones. It's worth noting that until the 60s, along with the entire mammary gland, the pectoralis major and minor muscles were removed, as well as all the axillary lymph nodes. Today, minimally invasive surgery is preferred whenever possible . In any case, surgery is necessary for all breast cancers.

We will refer to the techniques used in early, localized stages, which involve the breast with the tumor and the armpit on the same side (lymph node surgery). These techniques will depend on the size and location of the tumor, the absence of contraindications, and, of course, the patient's wishes.

Breast surgery

Conservative surgery: It involves the removal of the tumor with a safety margin of healthy tissue. After this type of surgery, complementary radiation therapy to the tumor bed is always necessary. It is currently performed in 60-70% of cases.
radical mastectomy: It is the removal of the entire mammary gland, including the nipple-areola complex. It is performed when conservative surgery is contraindicated, the tumor is multicentric, or radiation therapy is subsequently contraindicated.
Subcutaneous mastectomy: It respects the nipple-areola complex. It is usually indicated in prophylactic or preventative cases, such as in women in whom a genetic disorder is detected.

Surgery on the armpit

This type of surgical treatment for breast cancer has a dual purpose : to determine if the lymph nodes on the same side are affected and, if so, to reduce the likelihood of disease recurrence by removing them.

Detection of the so-called 'sentinel node': It involves injecting a radioactive isotope into the tumor, usually through the lymphatic system, which drains into the lymph nodes in the armpit. The first node(s) in the chain are then identified. During the surgical procedure, these nodes are located with a probe and analyzed immediately (intraoperative biopsy). Depending on what the pathology department reports, the surgeon will decide what steps to take next.
Standard axillary lymphadenectomy: It involves the removal of all the lymph nodes in the anatomical region of the armpit. The number is not a fixed number, as it can vary greatly from woman to woman. It is performed when the sentinel node technique is contraindicated (in cases of inflammatory carcinoma, in locally advanced cases that are large and where we know in advance that some lymph node is already affected, etc.).

There are special cases that will need to be individualized and assessed beforehand ; for example, in the case of carcinomas 'in situ', in so-called multicentric carcinomas (several tumor foci distant from each other in the breast), the existence of scars from previous surgeries, pregnant women…

This procedure is performed less frequently, and the main drawback is that it can cause lymphedema as a long-term side effect . This involves swelling in the arm, sometimes accompanied by infection and pain, due to the accumulation of lymph when its drainage is obstructed. It occurs in 10 to 30% of cases.

Breast reconstruction after surgical treatment for breast cancer

These are different surgical techniques that aim to minimize any negative impact on a woman's body image following breast cancer surgery. They can be performed using the woman's own body tissue (fat, muscle, etc.) or prosthetic material (silicone implants). In some cases, the healthy, contralateral breast is also operated on to achieve the best possible aesthetic result, thus avoiding significant asymmetries.

Immediate reconstruction: It is performed in the same surgical procedure after surgery to treat the problem oncological.
Delayed reconstruction: in a second surgical procedure, after completing treatment with chemotherapy and radiotherapy (if necessary).

The timing and type of surgery will be assessed on a case-by-case basis in consultation with the unit's plastic surgeon. It's essential to consider not only the potential risks and benefits of these techniques but also to be realistic about the long-term prognosis for the disease.

Generally speaking, these techniques do not affect the overall course of the disease, nor will they interfere with ongoing treatments (for example, the need for radiotherapy after reconstruction).

At a psychological level, it seems that the benefit for the women who undergo it is clear, as they do not see a mutilation that hinders their well-being.

In any case, it is a very personal decision that requires thorough prior information.

Article written by Dr. Suárez from the Women's Unit of Ruber International Hospital.

Dr. Mª Esther Suárez Agustín, gynecologist at the Women's Unit

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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Surgical treatment of breast cancer