Breast cancer originates when breast cells begin to grow out of control. Most cancers originate in the cells of the breast ducts, whose function is to carry milk to the nipple. The anatomic-pathologic term is infiltrating ductal carcinoma, and it is the most frequent cancer, accounting for 85% of breast cancers.
Approximately 5% of tumors originate in the milk-producing lobules. Known as infiltrating lobular carcinoma. The rest of the tumors originate in other breast tissues. Less frequent are sarcomas, angiosarcomas and lymphomas.
What types of breast cancer surgery are there?
From the time William Halsted performed the first radical mastectomy in 1889 until the 1980s, all women who developed breast cancer underwent mastectomy. Umberto Veronesi in Italy and Bernard Fisher in the United States were pioneers in the development of conservative surgery during the last decades of the 20th century.
Conservative surgery consists of excision of the tumor with a safety margin around it and is always followed by radiotherapy of the breast.
At the end of the 20th century, axillary sentinel node surgery was also developed. This technique replaces axillary lymphadenectomy or complete excision of the axillary nodes.
What is the difference between mastectomy and lumpectomy?
The cure is the same when we perform mastectomy or conservative surgery.
In approximately 20% of cases mastectomy is still necessary. In large tumors with respect to breast volume and in extensive premalignant lesions (ductal carcinoma in situ).
In these cases a conservative mastectomy of the nipple-areola complex is performed today. It is a technique that allows the conservation of the skin of the breast and the nipple-areola complex. It is always accompanied by an immediate reconstruction in the same surgery with prosthesis or expander. This technique allows a safe oncologic surgery and an optimal aesthetic result.
In these cases, the surgeon’s experience is important. Personally, I have been performing it since 2002. It is a technique that was developed at the European Institute of Oncology, where I worked from 2002-2009. It is necessary that the distance from the tumor to the nipple-areola complex be greater than two centimeters.
Is chemotherapy always necessary before surgery?
When deciding the individualized treatment plan for each patient we take into account the following factors: type of tumor, molecular subtype and the presence or absence of lymph node involvement.
The molecular subtype is the most important factor when it comes to medical treatment prior to surgery. We divide tumors into four subtypes:
- Luminal tumors (luminal A and luminal B) are hormone receptor positive tumors.
- Luminal B tumors can be her 2 positive or negative.
- The other two molecular subtypes are hormone receptor negative, and can express Her2 receptor positive or negative.
Triple negative tumors (hormone receptor and Her2 negative) and Her2 positive tumors (Luminal B Her2 positive or hormone receptor negative and Her2 positive) are usually started with medical treatment prior to surgery. If the tumor is larger than 2.5cm and there is lymph node involvement, 6 months of medical treatment is followed by surgery.
Care after breast cancer surgery
- 60% of conservative surgeries are performed on an outpatient basis with the patient being discharged after quadrantectomy and sentinel node biopsy on the same day.
- The remaining 40% of patients require 24 hours of hospitalization.
- Conservative mastectomy of the nipple-areola complex and immediate reconstruction with prosthesis requires 48 hours of hospitalization.
- The drains are removed before discharge so that recovery and return to normal life is practically immediate.
- It is necessary to wear a well-fitting sports bra for 7 days.
- Immediate mobilization of the arm is advised after sentinel node biopsy and lymphadenectomy.
For more information, consult a gynecologist specializing in breast surgery.