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Advances in breast cancer surgery now allow surgeons to remove cancer with minimal trauma to healthy tissue. The result: smaller incisions, faster recovery, and better preservation of body image. Dr Melanie Seah provides insights into precise surgery techniques.

I’VE ALWAYS THOUGHT BREAST CANCER SURGERY MEANS LARGE INCISIONS AND SCARS. HAS THAT REALLY CHANGED?

Yes, breast cancer surgery today is a far cry from before, where large incisions, visible scars, and long recovery times were the norm. New surgical techniques today allow surgeons to remove cancer with millimetre-level accuracy, minimising trauma to healthy tissue. This leads to better clinical outcomes, and greater preservation of body image and emotional wellbeing.

Many incisions for lumpectomies are well hidden along the periareola line (around the areola) or at the lateral or inframammary folds (the side and lower limits of the breast).

Nipple sparing mastectomies have similar incisions and preserve the appearance of the breast while enabling the removal of all the breast tissue.

WHAT ARE SOME OF THESE NEW SURGICAL TECHNIQUES?

Depending on the extent of cancer spread, endoscopic nipple-sparing mastectomy may be possible, where breast cancer tissue is removed while preserving the nipple and surrounding skin, via a small incision using endoscopic instruments.¹ This technique enables a magnified view of the surgical field and the longer instruments that are used help in difficult-to-reach areas of breast dissection.

Oncoplastic breast surgery, which combines cancer resection with plastic surgery techniques to reshape or remodel the breast for an aesthetic outcome, is also fast gaining traction. Techniques such as combining breast cancer removal with a breast-lift procedure, partial breast reconstruction, and fat grafting, can help to reduce deformity and conserve the appearance of the breast.

I’VE KNOWN OLDER BREAST CANCER SURVIVORS WHO HAVE TO LIVE WITH DEFORMED BREASTS POST-SURGERY. IS THIS STILL THE CASE TODAY?

Lesser so. Today’s reconstructive approaches are able to restore the appearance of the breast and help women be more confident in their bodies post-cancer.

In lumpectomies, the gap that is created by tumour removal is filled either by displacing neighbouring breast tissue or shifting folds of tissue from the side of the chest wall (partial breast reconstruction).

When greater volume of tissue is needed for a mastectomy, it is possible to shift an even greater volume of tissue from the abdomen (similar tissue that is removed during a tummy tuck) up to where the breast previously was. This is known as autologous reconstruction where tissue is taken from another part of the body to reconstruct the breast. This offers a more natural look and feel.

Implant-based reconstruction is where silicone implants are placed under the pectoralis muscle and skin flap. This is utilised when ladies do not want to have another site of surgery or in very slim ladies who may not have enough of their own tissue to fill the missing breast volume.

Fat grafting is yet another technique used both to fill and even out the reconstructions further.

As far as possible the reconstructions take place during the same lumpectomy or mastectomy surgery. It is also possible to do it after chemotherapy or radiotherapy is completed.

¹ Wang, Y., Wu, J. X., & Guan, S. (2017). A Technique of Endoscopic Nipple-Sparing Mastectomy for Breast Cancer. JSLS:Journal of the Society of Laparoendoscopic Surgeons, 21(2), e2017.00028. https://doi.org/10.4293/JSLS.2017.00028