Surgery for Breast Cancer: Then & Now

Breast cancer is the most common cancer affecting women worldwide and is known to account for almost 13.5% of all cancer cases in India (GLobocan 2020). With the increasing incidence of this cancer in all parts of the county, it has also been noted that a significant percentage of breast cancer cases affect younger women.

Surgery is the primary management of localised breast cancer aided by systemic therapy (chemotherapy/ hormone/ targeted therapy etc.) and radiation. There have been major advancements in the field of breast surgery in the last few decades. Most of these changes are directed at improving the quality of life of patients while ensuring their safety from the disease.

From an era where mastectomy (removal of the breast) for all ladies who have breast cancer was the norm, we have moved to a time where 50-70% of patients can be offered breast conservation surgery. This means that only the tumour and surrounding area need to be removed while saving the breast. Breast conservation is possible in a majority of early breast cancers and in certain locally advanced situations, too, with the appropriate use of chemotherapy before surgery.

The use of oncoplastic principles to make the breast appear and feel as close to normal as possible after removing the tumour by filling the defect created by the surgical removal of the tumour also has aided our patients and surgeons alike. This mainly entails surgical planning and using nearby fat so that the shape and size of breasts are maintained even after tumour removal.

Whole breast reconstruction, which means creating an artificial breast mound closely resembling a natural breast by using a patient’s own fat or muscle with or without an implant (artificial device), is also being increasingly offered to those women who need to undergo mastectomy for various reasons. This surgery can be done at the time of the cancer surgery. Nipple and skin-sparing mastectomy, i.e. removal of the breast tissue while saving the skin envelope and/or nipple, is also an option for certain women.

Another major change has been the shift from a complete axillary lymph node dissection, i.e. removal of all lymph glands in the armpit of every breast cancer patient, which posed the risk of stiffness and swelling of the arm (lymphedema), to sentinel lymph node biopsy (SLNB) in selected cases. SLNB allows for the removal of a few draining nodes instead of the removal of all by using various dyes (injections) at the time of surgery and, thus, helps reduce the side effects of surgery. Using newer procedures like LYMPHA also seems like an exciting opportunity to reduce the chances of lymphedema by connecting lymphatic vessels to veins at the time of nodal surgery.

All these advancements have helped ensure that women who have developed breast cancer can be cancer free, safe and, at the same, not be left with major changes in their bodies. The journey of a cancer patient is often long and tough, but with the medical and surgical developments in the field of oncology, it is becoming an increasing possibility that most patients have minimum scars and side effects and retain a close to ‘normal’ quality of life and body image after their treatment....