Body, soul, integrity and femininity are just a few things breast cancer effects in women. Breast cancer patients are encouraged to discuss and receive guidance from the multidisciplinary team, including surgical, oncologic, and plastic surgical consultations as to their various treatment options. The surgical procedures may include breast conserving surgery, mastectomy, and reconstruction when appropriate. Here at Hadassah Medical Center, our prestigious medical professionals provide complete care and guidance throughout the entire process – from diagnosis and throughout the entire treatment, which is personally tailored according to each patient's disease status and wishes.
Surgical intervention for breast cancer patients has evolved over the past few decades. The evolution has led to a more conservative approach: breast conserving surgery (lumpectomy) instead of removal of the entire breast (mastectomy), sentinel lymph node biopsy instead of axillary lymph node dissection and nipple-areola sparing mastectomy. This change in approach became possible thanks to our better understanding of the disease process, early detection, and effective adjuvant therapy, including chemotherapy, radiation therapy, and targeted therapies, such as hormonal and biologic treatments.
A joint discussion between the patient and the medical staff is held, to determine the type of surgical intervention the patient will undergo, based on her general condition, the extent of the tumor, and her personal preferences. Since the prognosis for breast cancer in our era is excellent, especially with early stage tumors, and we expect long term survival, the quality of life after cancer is an important consideration. Therefore, the extent axillary lymph nodes excision is minimized, to prevent long-term functional impairment and lymphedema, and care is being taken to achieve favorable cosmetic outcomes.
Lumpectomy or Breast Conserving Surgery
A lumpectomy is conducted to remove the tumor, along with a surrounding layer of healthy breast tissue. In those cases, post- operative breast irradiation is required in order to decrease the chances of cancer recurrence.
Today, we have the ability to offer breast conserving surgery in situations in which such a procedure would not have been possible in the past. For instance, when there is a large tumor, preoperative treatment (neoadjuvant therapy) may be given, and in certain cases will decrease the size of the lump and allow breast conserving surgery.
In complex situations, in which the tumor occupies a large portion of the breast, the removal of a large amount of breast tissue is needed, and could result in a significant deformity in the shape of the breast. The procedure could be done in conjunction with a plastic surgeon (oncoplastic surgery), utilizing breast reduction techniques, to maintain the breast contour, therefore providing the highest level of cosmetic outcome without compromising oncologic results.
Various options are available to correct deformities after previous breast conserving surgery and radiation. Those include breast reduction techniques, by the use of implants, or transfer tissue from another site. Another option is using the patient's own fat and injecting it to fill defects in the breast.
Mastectomies are performed in any of the following situations: Tumor occupying a large portion of the breast, the failure of breast conserving surgery (residual disease following surgery), multifocal breast cancer, the inability to receive radiation treatment, or at the woman's will.
Breast reconstruction can be performed immediately following a mastectomy. The advantages of immediate breast reconstruction, include having a single operative intervention and anesthesia, as well as the ability to preserve most of the natural skin envelope of the breast (Skin-sparing mastectomy), and in certain cases even the preservation of the nipple and areola.
There are two main options for breast reconstruction after mastectomy:
Both options are equally effective. Factors to perform one procedure over the other include, among others, the patient’s body habitus, past or future oncological treatments, and the patient’s personal preference.
Breast reconstruction with silicone implants can be done either in one stage (if there is enough excess breast skin) or in two stages, which include implementation of tissue expanders, gradual inflation and stretching of the overlying skin, and their replacement with permanent silicone implants once the desired volume has been reached.
TRAM (transverse rectus abdominis muscle) Flap, DIEP (deep inferior epigastric) Flap or Latissimus Dorsi Flap, are various procedures in which muscle and tissue is transferred from the abdomen or back, and are shaped to replace the breast. This procedure is generally performed on patients who have received radiation therapy as part of their treatment.
Preventive mastectomies are provided as well to women with a high risk of developing breast cancer. Those are usually followed with an immediate breast reconstruction.
Our devoted and experienced team works in full cooperation with the radiology, pathology, oncology and plastic surgery departments, to assure that each patients receives the most appropriate and highest level of care she well deserves.
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