Advances in Breast Cancer Surgery Help Survivors Look and Feel Like Themselves Again.

Breast cancer is the most common type of cancer among women across the globe. Nearly one in every eight women will develop breast cancer, and in 2020 alone, more than 2.3 million women were diagnosed with the disease. And while breast cancer treatment is personalized for each unique case, most women undergo surgery as part of treatment, either alone or in combination with other therapies.

Thankfully, advances in breast cancer detection and treatment options are leading to higher survival rates and better quality of life for many women after surgery and treatment. Today, advanced surgical techniques and less-invasive approaches allow us to effectively remove cancerous tissue while preserving the natural appearance of the breast⁠—and mitigating future complications. 

Wireless localizations offer convenience and less discomfort.

Many breast cancer tumors are detected on screening mammography before they are large enough to feel. When a tumor is too small to be felt, surgeons need to be able to locate the tumor to operate on it. Traditionally, this required imaging guidance and placement of a wire to the tumor site, a procedure called wire localization. In the past, women would arrive for their lumpectomy (breast-conserving surgery), and before surgery, a radiologist would use mammogram or ultrasound guidance to place a long wire that would serve as a guide for the surgeon. Then, patients would wait in the preoperative area with a wire sticking out of their breast until surgery. Although effective, the wires were uncomfortable and inconvenient. 

Now, there are several options for women to undergo wireless localizations in the days and weeks before surgery. Alternatives to the wire include magnetic seed (Magseed) technology and implantable reflectors, which surgeons can place in the breast and detect with corresponding handheld devices. Benefits to these wire-free advances include:

• Quicker time to start procedure without a preoperative delay
• There is no wire sticking out of the breast that can get in the way of clothes or activities
• Improved clinical outcomes with decreased rates of reexcision as placement is more precise
  
  

Innovative surgical techniques preserve the natural breast appearance.

Historically, nearly every woman with breast cancer underwent a mastectomy, or surgery to remove the entire affected breast. Now, there are different surgical options and we recommend the right surgery for each individual based on the patient’s body, diagnosis (including location, size, and stage of the tumor), preferences, and goals. Although many women with early-stage cancers are now eligible for a breast-conserving surgery called a lumpectomy (or partial mastectomy), some women still benefit from mastectomy, depending on multiple different factors.

The good news is that advances in technology and surgical techniques are leading to improved aesthetic outcomes following surgery. This is important because undergoing a mastectomy is not just a physical journey–it can be an emotional one as well. By using less-invasive approaches to mastectomy and offering more natural options for reconstruction, women can more easily look and feel like themselves following surgery.

Oncoplastic techniques.

Some women who are candidates for a lumpectomy benefit from a sophisticated approach to maintaining the natural look of the breast, called oncoplastic surgery. These techniques are complex but may result in a more symmetric appearance and smaller scars. 

Nipple-sparing mastectomy.

During a nipple-sparing mastectomy, surgeons leave the nipple and the skin around your breast intact while removing only the breast gland tissue. It’s an advanced approach that can be used for women who have tumors at least two centimeters away from the nipple, although cosmetic outcomes will vary based on your breast size and shape. For this reason, your surgeon may or may not recommend this as an option. 

Nipple-sparing mastectomies preserve the natural appearance of the breast and may also be combined with immediate breast reconstruction. As a result, this approach can help minimize the psychological and emotional impact of a mastectomy. 

Autologous breast reconstruction.

In addition to traditional breast implants, many women are candidates for breast reconstruction using autologous (natural) tissue flaps. It involves rebuilding the breast using tissue from the patient’s body, and flaps can be taken from the abdomen, leg, back, or buttocks, depending on the patient. Flap surgery results last a lifetime, unlike implants which need to be replaced within 10 to 15 years.

In many cases, breast reconstruction can be performed immediately following the mastectomy through direct-to implant reconstruction. We offer this in collaboration with our skilled plastic surgeons who are leaders in natural breast reconstruction. Women benefit from needing only one surgical procedure to restore their desired breast appearance. 

Other advances in breast cancer surgery.

Radiation at the time of surgery.

Many women are eligible for a lumpectomy during which surgeons remove only the cancerous cells and surrounding tissue from the breast. This isn’t a new approach to surgery, but one related innovation is combining it with intraoperative radiation therapy (IORT). For certain women who meet eligibility, IORT can be administered at the time of surgery, delivering targeted radiation directly to the tumor bed to prevent recurrence. The combination of a lumpectomy and IORT has proven to be as effective as mastectomy and offers numerous benefits for patients.

This is important because some women with breast cancer (or a high risk of the disease) consider having a double mastectomy. While a double mastectomy significantly reduces the chances of getting breast cancer again in the future, it doesn’t completely eliminate it. Because we know that clinical outcomes are the same for patients who opt for a lumpectomy with radiation, I often counsel women that they should consider this as an option.

New approaches to managing pain.

One of the biggest fears patients often have is related to pain. In recent years, pain management has advanced as well, and we use nerve blocks to effectively manage pain during and after surgery. This approach to pain prevents nerves from sending pain sensations from the incision site to the brain. They offer several benefits over other forms of pain management, as they’re noninvasive and don’t involve the risks associated with opioids.

Minimizing impact to the lymphatic system.

Lymph nodes help filter and drain toxins from the body. Because they are near the breasts, they’re often the first place cancer can spread. When these lymph nodes are damaged or removed during breast cancer surgery, they can cause secondary lymphedema. Secondary lymphedema results in painful swelling in the arm on the same side of the surgery, and it’s historically been difficult to manage, let alone treat. 

At MedStar Health, our reconstructive surgeons are pioneers in advanced procedures that can be performed during a lumpectomy or mastectomy to help minimize the risk of damage to the lymph nodes, or potentially prevent lymphedema altogether through:

• Lymphatic mapping: We can minimize the effects of surgery on lymph nodes through lymphatic mapping. With this approach, we inject a blue dye into the upper arm to identify which primary nodes are draining to the arm. When we know which lymph nodes are involved in drainage, we can avoid them during surgery and lower the risk of the patient developing lymphedema.
• Lymphedema reconstructive surgery: Our reconstructive surgeons are pioneers in microsurgical techniques that reroute the lymphatic system to help alleviate symptoms of lymphedema or potentially prevent the condition altogether.