Depending on the histological type and size of the tumor, the patient may have the option for a breast-conserving surgery with good aesthetic results. These types of procedures are called oncoplastic surgeries. In countries where patients regularly come for preventive check-ups, the indication for mastectomy does not exceed 15% of cases. However, it is important for the patient to be thoroughly informed by specialists and actively participate in the decisions regarding the management of the disease (shared decision-making).
Breast-Conserving Procedures:
Lumpectomy: When the ratio of tumor size to breast size allows and is considered oncological appropriate, a simple lumpectomy can be performed. It is crucial that the removal of the tumor is done oncological correctly by a specialized Breast Surgeon, following the surgical margins and techniques predicted by international guidelines.
Segmentectomy – Quadrantectomy: During these procedures, a portion or the entire quadrant of the breast containing the tumor is removed.
Oncoplastic procedures: This is a relatively new term that includes procedures in which a portion of the breast is excised according to the type of tumor, and then the shape of the breast is reconstructed using plastic techniques to achieve symmetry or minimize asymmetry compared to the other breast (tumor-adapted reduction). In some cases, simultaneous reduction or lift surgery may be performed on the other breast to achieve symmetry.
Radical Procedures: There are two types of mastectomies: simple and modified radical mastectomy. The type of surgery depends on the tumor size, involvement, and possible metastases.
During a simple mastectomy, the entire breast tissue, including the nipple-areola complex, is removed.
In a modified radical mastectomy, the entire breast tissue, nipple-areola complex, and axillary lymph nodes are removed.
When is Mastectomy Needed?
One of the first questions patients ask is when mastectomy is needed. It should be emphasized that mastectomy can generally be avoided in 60%-70% of cases. Early diagnosis is crucial in ruling out the need for mastectomy, as there are options such as quadrantectomy and oncoplastic techniques that ensure tumor removal without the need for mastectomy. The indication for mastectomy or breast-conserving surgery should be discussed with the surgeon, and the patient should be fully informed about all other possible options.
Lymph Node Examination and Sentinel Lymph Node
In the case of invasive cancer, surgical lymph node clearance of the axilla is usually performed. The purpose of this clearance is to stage the disease, determine further treatment, and prevent local recurrence in the axillary lymph nodes. Because axillary lymph node clearance is associated with morbidity of the upper limb in some cases, many surgeons prefer to perform a sentinel lymph node examination, where the first lymph node that the cancer cells would go to or have gone to is identified. If this sentinel node is positive, then axillary lymph node clearance is performed. The examination is done after the injection of radiotracers and dye. Sentinel lymph nodes can only be detected in cases of small tumors.
Risks and Complications
Like all surgical procedures, breast surgery carries risks and potential complications. These may include bleeding, infection, seroma formation, hematoma, wound healing problems, lymphedema, changes in breast sensation, and aesthetic issues. However, with proper preoperative evaluation, surgical planning, and postoperative care, these risks can be minimized. It is important to discuss potential risks and complications with your surgeon before undergoing the procedure.
