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Breast Cancer Surgery Options

Tuesday, Aug 05, 2014

Donna Angotti, MD, breast surgeon and expert in the treatment of breast cancer answers questions about personalized treatment options for breast cancer.

What are the treatment options for breast cancer?

Breast cancer treatment relies on a three-pronged approach that includes surgery, radiation and medication. Surgery and radiation are typically the first line of attack against breast cancer with the goal of removing the tumor and reducing the risk that it will return. Medication is used to prevent cancerous cells from growing in areas other than the breast.

How is a personalized treatment plan developed?

Thanks to research and the ability to see microscopic characteristics of cancer cells, physicians now have a better understanding of the genetics of breast cancers. Physicians consider many factors when determining a course of treatment for each individual patient, including: the types of cells in the tumor, the size of the tumor, whether or not the cancer has spread to lymph nodes, the presence of hormone and growth receptors, and any errors in the genetic code of the cancer cells. All this information allows physicians to personalize a patient’s treatment to defeat cancer.

What surgical options are available to treat breast cancer?

The surgical options to treat breast cancer include breast conservation, or lumpectomy, and breast removal, or mastectomy. Because most breast cancer tumors are detected at an early stage and are small, most patients are candidates for breast conservation.

Mastectomy is recommended for women:

  • Who have had previous radiation to the affected breast
  • Who have multiple tumors in more than one section of the breast
  • With non-invasive cancer or DCIS that exists over a wide region of the breast
  • Who test positive for certain genetic mutations that they carry as an individual, such as BRCA-1 and BRCA-2 mutations.

Others who may consider mastectomy are patients who have a large tumor compared to the size of the breast, patients with a strong family history of breast cancer, and those who exercise personal choice after they have been informed of their options.

Patients who are good candidates for breast conservation have the same survival rate with a lumpectomy as with a mastectomy. There is a common misconception that a mastectomy is superior to a lumpectomy, but that is not true for patients who are appropriate breast-conserving candidates.

Are there surgical options available that preserve the breast and/or nipple?

There are several types of mastectomy. Traditionally, the nipple and areola were removed as it was believed there would be a higher rate of cancer recurrence if they remained. We have since discovered that the nipple and areola may be saved safely for many patients, and this nipple-sparing mastectomy can be combined with reconstructive surgery to give a superior cosmetic result. This helps the woman feel less of a loss of her physical self and retain positive self-esteem and self-body image.

For patients who are not candidates to save the nipple, there is a skin-sparing mastectomy that only removes the nipple and preserves all of the skin of the breast. With nipple tattooing, the results can be highly pleasing. In conjuction with Doylestown Hospital's plastic surgeons, I am performing skin-sparing and nipple-sparing mastectomies for appropriate candidates. Patient outcomes and satisfaction have been outstanding.

Is radiation necessary after surgery?

The goal of radiation after surgery is to reduce the risk of a local-regional recurrence of the cancer. I recommend that most lumpectomy patients undergo this treatment. Some mastectomy patients who are high risk for recurrence benefit from post-mastectomy radiation.

Is there a chance cancer will return after mastectomy?

Undergoing a mastectomy drastically reduces the chance that breast cancer could recur because almost all of the breast tissue is removed. There is a very small chance that some breast cells could remain on the chest wall and that is why it is important to continue self-exams and see your doctor on a regular basis for clinical exams. Be sure to report any changes to your doctor after treatment; most are the result of the healing process, but it is important to determine what those changes represent, particularly for peace of mind.

It's important that you know all your options for treatment. You are encouraged to ask your physician as many questions as you need to feel comfortable. Doylestown Hospital also has a nurse navigator for breast cancer who can help with your concerns.

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