Breast Cancer Surgery – Breast-Conserving Surgery, Mastectomy, and Follow-Up Care for Breast Cancer - Everything You Need to Know About Breast Cancer Surgery

Breast cancer surgery is a surgical procedure in which a tumor is removed from the breast to promote the patient’s recovery. It is one of the most important steps in the treatment of breast cancer (mammary carcinoma), a malignant tumor that usually develops in the lobules or milk ducts. In many cases, this surgery is the most effective method for removing the tumor and is an essential part of the overall treatment plan.

Depending on the extent of the disease, the procedure may be performed as a breast-conserving surgery, with the goal of preserving as much healthy breast tissue as possible. During the operation, the tumor tissue is precisely removed to ensure that no malignant cells remain in the surrounding tissue.

If the breast gland is affected, it may be necessary to remove additional lymph nodes to accurately assess the spread of the disease. In many cases, breast-conserving surgery is possible, allowing the shape and function of the breast to be largely preserved. Depending on the tumor’s location, the nipple may also be affected, which in rare cases requires a nipple amputation. Modern surgical techniques place great emphasis on achieving a cosmetically pleasing result to improve the patient’s quality of life.

The decision to perform breast-conserving surgery or a more extensive procedure is made on a case-by-case basis and depends on whether surrounding tissue or additional lymph nodes are affected.

Surgery is performed when a malignant lesion is detected in the breast tissue. Breast cancer primarily affects women, but it can also affect men. The tumor should be removed as early as possible, as it could otherwise grow and spread to other parts of the body (metastasis).

The main goals of the procedure are:

• To remove the tumor to stop the progression of the disease.
• To improve the chances of recovery.
• In some cases: preserving the breast (breast-conserving therapy) and restoring the breast’s appearance through breast reconstruction.

About 13 out of every 100 women will develop breast cancer during their lifetime @ Pixel-Shot /AdobeStock

The procedure for breast cancer surgery depends on various factors, such as tumor size, tumor stage, and the patient’s preferences. There are two main surgical procedures in oncology:

• Breast-conserving surgery (partial resection): In this procedure, only the tumor is removed, while the rest of the breast is preserved. In many cases, radiation therapy is also administered to reduce the risk of recurrence. 75 percent of breast cancer patients receive this treatment.
• Mastectomy (complete removal of the breast): This is chosen when the tumor is too large or when the tumor is present in multiple areas of the breast. After a mastectomy, breast reconstruction may be considered to restore the aesthetic appearance.

Neoadjuvant therapy: Some patients undergo neoadjuvant therapy before surgery. This may include chemotherapy or anti-hormone therapy to shrink the tumor and make the surgery easier.

During surgery, the lymph nodes in the armpit are often removed to determine whether the cancer has spread to the lymphatic system. Today, in most cases, only the so-called “sentinel lymph node” is removed. This is the lymph node closest to the tumor. If it is free of tumor cells, the more distant lymph nodes are also considered normal.

As with any surgery, complications can occur during breast cancer surgery. Possible risks include:

• Wound healing problems
• Postoperative bleeding
• Lymphatic drainage problems (e.g., swelling or lymphedema)
• Infections (rare)

However, modern surgical techniques and careful postoperative care minimize the likelihood of complications.

Scars in the breast area heal better than those on other parts of the body and fade significantly over time @ srisakorn /AdobeStock

After surgery, it is crucial that the patient follow the aftercare recommendations to promote healing and prevent complications. The most important aspects include:

• Radiation therapy: Breast-conserving surgery is often followed by radiation therapy to destroy any remaining tumor cells.
• Lymphatic drainage: If lymph nodes have been removed, lymphatic drainage problems may occur, manifesting as swelling (lymphedema). Manual lymphatic drainage, performed by physical therapists, helps remove excess lymph fluid and reduce swelling.
• Physical Therapy: Physical therapy exercises help restore range of motion in the shoulder and arm area and promote recovery.
• Regular follow-up exams: In the first few years after the procedure, regular follow-up exams are important for detecting recurrences early. These typically take place every three months at first, and then every six months. Your treating gynecologist is the person to contact regarding these appointments.

The prognosis following breast cancer surgery depends on many factors, including the tumor stage, the type of tumor, and the response to treatment. If breast cancer is detected early and the surgery is successful, the chances of a cure are very good. Even in cases of advanced cancer, modern treatment methods such as chemotherapy and radiation therapy can significantly improve the chances of a cure.

Surgery for breast cancer is a central component of treatment, as breast cancer is the most common form of cancer and, at the same time, the most common cancer among women. If breast cancer is suspected, a decision is made together with the treating physician as to whether breast-conserving surgery or a mastectomy is necessary to safely remove the tumor from the breast.

Even before surgery, drug therapy can help shrink the tumor, making breast-conserving surgery possible and allowing the breast to be preserved. During breast cancer surgery, lymph nodes are often removed—sometimes many of them—frequently through an incision in the armpit as part of the axillary surgery.

The goal of the tumor surgery is to ensure that it can be completely removed—and ideally, that the tumor is completely removed—without unnecessarily damaging healthy tissue or removing the breast. The duration of breast cancer surgery depends on the extent of the breast cancer, whether a second surgery will be necessary, and how the surgery is to be performed.

Following surgery, breast reconstruction may be performed, for example, using the patient’s own tissue to surgically balance the breasts and account for any resulting scar. Treatment and follow-up care for breast cancer are based on the individual diagnosis, and managing breast cancer requires long-term medical care.

Specialists in breast cancer come from various medical fields. Typically, they are gynecologists and gynecologic oncologists. They often have additional training in breast reconstruction.

In addition, specialists in plastic surgery and reconstructive and aesthetic surgery are involved. For more information, please visit the informative breast cancer guide from the University Women’s Hospital in Tübingen.