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Do breast cancer patients have surgical options?
Depending on the size of the tumor and stage of the breast cancer, patients often have surgical options to treat their breast cancer. Each patient’s situation is unique, so doctors and patients have to discuss the options, which include a lumpectomy and full mastectomy. Often, radiation and/or chemotherapy are combined with lumpectomies or mastectomies to be sure all of the cancer cells are removed.
What are benefits of a lumpectomy?
A lumpectomy allows a woman to preserve the natural look of her breast. Considered a partial mastectomy, a lumpectomy removes the breast cancer with a rim of normal breast tissue. Radiation treatment follows to create an equal survival rate when compared to mastectomies. These can be done when the cancer is caught early with a single tumor. Women must also be physically able to handle radiation treatment.
When should a mastectomy be done?
A mastectomy removes more than 95% of breast tissue. This procedure is used when the tumor is too large to preserve the breast or there are a number of tumors present. A mastectomy sometimes eliminates the need for radiation therapy following the surgery. It decreases the local recurrence rate of cancer compared to lumpectomy, but does not affect overall cancer survival in cancers which can also be fully excised by lumpectomy alone. Contralateral prophylactic mastectomy (removal of the opposite unaffected normal breast) has no benefit for overall cancer survival but sometimes is requested by patients for improved symmetry at the time of reconstruction or for risk reduction to help prevent future cancer.
What is oncoplastic surgery?
Oncoplastic surgery uses plastic surgical principles along with cancer surgery to preserve the natural look of the breast. Surgeons, while safely removing the cancer, also keep the cosmetics of the surgery in mind. They take incision locations and how the breast will look post-op into consideration before surgery even begins. Incisions are often hidden in the armpit, in the darker skin of the nipple, or under the breast itself. For women with larger breasts, surgeons sometimes do a breast reduction or breast lift to both breasts during surgery to keep the patient’s look more symmetrical post-op.
How does reconstruction surgery work?
Not all patients choose to have reconstructive surgery. Depending on the patient, reconstructive surgery most often happens at the same time as the mastectomy with improved cosmetic outcomes compared to delayed reconstruction. Plastic surgeons reconstruct the breast with a woman’s own tissue, breast implants, or a combination. Different muscles are used for the surgery, so a patient’s lifestyle should be taken into consideration (athletes for example). Breast implants can be filled with silicone or salt water with minimal risk. Natural tissue often comes from the stomach, combined with a tummy tuck or from the back or rarely from the buttocks. Some of the benefits of reconstructive surgery include the patient feeling more comfortable with how the breast looks after surgery. Today’s plastic surgery procedures continue to improve to help make the breasts feel and look as natural as possible.
Dr. Ashikari is an assistant professor of surgery at New York Medical College. He received his general surgery training at Montefiore Medical Center/Albert Einstein School of Medicine and attended the surgical oncology fellowship at University of Chicago Hospitals. He has published research on the topic of tumor immunology where he developed his clinical interest in melanoma. He also specializes in gastrointestinal tumors, breast cancer, and sarcoma. He has a strong clinical interest in women at high risk for breast cancer and prophylactic nipple-sparing mastectomy.
NewYork Presbyterian/Hudson Valley Hospital
The Ashikari Breast Center
1978 Crompond Road
Cortlandt Manor, NY 10567
914-293-8400
www.nyp.org/hudsonvalley
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Andrew Ashikari, MD