Breast surgery

Breast cancer surgery

Breast cancer surgery is an essential component in the treatment of breast cancer. It can be done alone or in conjunction with other approaches, such as chemotherapy, hormone therapy, targeted therapy, and radiation therapy.

h2-Types of breast cancer surgery

Surgeries for breast cancer include various procedures, with mastectomy being one of the main ones. It involves the complete removal of the breast and, when necessary, other parts of tissue around it (in the so-called safety margin). There are several types of mastectomy:

There are several types of mastectomy:

• Simple mastectomy: The complete removal of the breast, including the nipple, areola, and skin.
• Skin-sparing mastectomy: Only the breast tissue, nipple, and areola are removed, while most of the breast skin is preserved. Silicone implants or tissue from other parts of the body are used to reconstruct the breast. This approach, preferred by many women, has the advantage of less scarring and a more natural-looking reconstructed breast. However, skin-sparing mastectomy may not be suitable for larger tumors or those close to the skin surface.
• Skin and nipple-sparing mastectomy: This is an option for women with a small, early-stage tumor near the outer part of the breast, without signs of disease in the skin or near the nipple. The breast tissue is removed, but the breast skin and nipple are preserved. Reconstruction of the breast is done immediately afterward.

In some cases, the surgeon may remove the breast tissue beneath the nipple and areola to check for cancer cells. If the presence of neoplasia is confirmed, the nipple will also be removed. This type of surgery has limitations: in some women, the nipple does not have a good blood supply, so it may sometimes shrink, become deformed, or have reduced or lost sensitivity because the nerves are severed. In terms of aesthetic appearance, this surgery produces better results in women with small to medium-sized breasts.

• Modified radical mastectomy: the mastectomy technique is combined with the removal of the axillary lymph nodes;
• Radical mastectomy: the entire breast, axillary lymph nodes, and the pectoral muscles (chest wall) behind the mammary gland are removed. Currently, this surgery is rarely performed and is more reserved for large tumors that are invading the pectoral muscles; and
• Double or bilateral mastectomy: when mastectomy is performed on both breasts. Women at high risk of developing cancer in the other breast or those with a BRCA gene mutation are usually undergo this surgery.

Breast-conserving surgery

Another possibility in the treatment of breast cancer is breast-conserving surgery, also called lumpectomy, quadrantectomy, partial mastectomy, or segmental mastectomy. It is a surgery in which only the portion of the breast containing the cancer is removed.

The goal is to remove the cancer and part of the surrounding tissue, and the amount of breast tissue that will be removed depends mainly on the location and size of the tumor. It is currently the most performed surgery.

An approach for some types of breast cancer is surgery to remove the axillary lymph nodes (nodes present in the armpit), the two main types of which are:

• Sentinel lymph node biopsy – a procedure in which the surgeon removes only the lymph nodes located in the armpits, as this is the most likely place for breast cancer to spread. The removal of only one or a few lymph nodes reduces the risk of adverse effects of surgery, such as lymphedema (swelling of the arm where the procedure was performed); and
• Axillary lymph node dissection: a procedure in which a larger number of lymph nodes (about 10 to 15) are removed.

Breast reconstruction surgery

Breast reconstruction surgery after mastectomy allows women who have undergone surgery to treat breast cancer to opt for restoration of the breast’s appearance. Although each case should be analyzed individually, most patients who undergo mastectomy can undergo immediate reconstruction (in the same surgery) or delayed reconstruction.

The main types of reconstructive surgery are:

• Silicone implants;
• Fat grafting from the patient’s own body;
• Breast reduction;
• Breast lift or mastopexy, which repositions the nipple and breast tissue, removing excess skin;
• Scar correction; and
• Use of skin flaps and tissue from another region for breast reconstruction.

In addition to its curative nature for cancer treatment, surgery can also be performed to prevent it from occurring in the future: this is preventive surgery.

Some women with a family history of the disease (in close relatives), confirmed mutated BRCA genes (diagnosed by genetic testing), who received radiation therapy in the chest region before age 30, or who had a previous cancer in one of the breasts undergo tests that assess their risk of developing the disease. The doctor will analyze each case to decide if preventive mastectomy is indicated.

Possible adverse effects of surgery

Surgery for breast cancer is a safe surgical procedure, but it carries a small risk of complications, common to all surgeries. The main complications that may occur are:

• Bleeding;
• Infection;
• Seroma (accumulation of fluid at the surgical site);
• Pain;
• Permanent scar;
• Alteration or loss of sensitivity in the chest and breasts;
• Difficulty in healing; and
• Swelling in the arm (lymphedema).