A breast-conserving surgery (BCS) such as lumpectomy removes the cancer and tissue surrounding the tumour, but not the entire breast. With data showing equivalent survival results between BCS and mastectomy, more women with early stage breast cancers are choosing this option in order to preserve their breasts. Achieving complete cancer removal with clear margins is key to this surgery.
Patients taking this option should have tumours that are small in relation to the entire breast size, so that a good breast shape and size can be preserved. Radiotherapy is likely required after BCS. Precise localisation of the tumour during this surgery minimises the amount of breast tissue that needs to be removed. If the tumour cannot be felt but is detected on mammogram and ultrasound, a radioisotope marker or thin wire may be inserted prior to surgery to mark and locate the area to be removed.
Breast oncoplastic surgery
Breast oncoplastic surgery combines the techniques of oncologic surgery (to remove the cancer) with plastic surgical techniques to restore the aesthetics of the breast. The use of these techniques in BCS allows removal of larger tumours while achieving better breast cosmesis and symmetry.
These techniques include the use of well-placed incisions and reshaping the remaining breast tissue after tumour removal, to minimise scarring and deformities. Breast and nipple symmetry may be restored by doing a simultaneous breast reduction or breast lift. With these myriad of techniques, good oncological clearance is achieved without the need for mastectomy.
The choice of technique used is different for each patient, and is tailored depending on the tumour size and location, the size and shape of the breasts.
Partial breast reconstruction
Partial breast reconstruction is a tool for women with larger tumour to breast ratio, where the remaining breast tissue may not be adequate and deformity may result after tumour clearance. In such cases, adjacent tissue from below the breasts or the chest wall may be mobilised to restore the volume of the breast. These tissue flaps survive on blood vessels that are branches from chest wall vessels and are named perforator flaps.
Another form of partial breast reconstruction is the omental flap reconstruction. The omental flap is intra-abdominal fatty tissue that is attached to the stomach and spleen. This tissue is mobilised by minimally invasive abdominal surgery and brought out to fill in the defect in the breast. The omental flap usually has more volume and may be used in patients with larger tumour to breast size ratios.
A mastectomy is usually recommended if the size of the cancer is too large or if the cancer involves multiple locations within the breast. Although most do not require radiotherapy after the surgery, radiation treatment may still be advised after surgery if your tumour is >5cm or if your lymph nodes are affected by cancer.
A simple mastectomy involves removing the entire breast and most of the overlying skin.
If you opt for an immediate breast reconstruction, the overlying skin is preserved as much as possible for a more natural appearance. This is termed skin-sparing mastectomy. If the nipple is also preserved, it is a nipple-sparing mastectomy. This skin preservation is possible only when the tumour is not too close to the skin and nipple.