Breast Cancer Treatment - Surgery

Surgery is the most effective treatment option ever employed against breast cancer. Halsted's radical mastectomy (RM), which dates from the turn of the century, revolutionized the local control of the disease and demonstrated that a subset of patients could be cured by surgery alone. Halsted viewed breast cancer as a principally local-regional disease that spread in a centripetal fashion.

Fifty years later, Bernard Fisher would hypothesize that breast cancer is primarily a systemic disease and state that the surgeon's knife had little impact upon outcome. Today, we would argue that they are both right and both wrong – breast cancer begins as a local disease and, at some point in its evolution, becomes systemic. Local control cannot cure all patients, but no patients are cured without it. Surgery remains the mainstay of local control at the turn of the millennium, and recent trends towards earlier stage at diagnosis will undoubtedly increase its role.

Many women at high risk for breast cancer consider having their breasts removed (prophylactic mastectomy) to avoid the risk of developing cancer. As with any type of surgery, if you are considering prophylactic mastectomy you should consult with your physicians and surgeon about the risks of the procedure as well as the possible outcomes.

To learn more about reconstructive surgery options and the risks associated with those procedures, you can talk to plastic surgeons, ask to see photographs of breasts after surgery, and perhaps discuss the surgical experience with other women who have chosen prophylactic mastectomy. It is to your benefit to find out everything you can before making a final decision.

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Reconstructive Surgery

The goal of breast reconstruction is to create the most natural looking and feeling breast possible with minimal discomfort. Following mastectomy, women have two options for breast reconstruction, which may be performed at the time of the mastectomy or at a later date. The type of breast reconstruction that is most appropriate for you will depend on your medical situation, overall health, size and shape of your breasts, lifestyle, and goals. Prophylactic mastectomy and reconstructive surgery may or may not be covered by your health insurance

Saline implants. In this option, a plastic surgeon places tissue expanders — hollow, empty balloons — behind the breast muscles and then gradually fills them with saline (salt water). Placement of the tissue expander usually occurs under general anesthesia in an operating room. The surgery takes about one to two hours and may require a brief hospital stay or may be done on an outpatient basis. Sometimes, the procedure may be done at the same time as the mastectomy. Typically, women resume normal activity after three to six weeks. Over the course of two to four months, the expanders are slowly filled with saline to stretch the skin until fully inflated. This process is generally painless, similar to the gradual expansion of the abdomen during pregnancy. In a second operation the actual saline implants are put in place, replacing the tissue expander. The surgery is usually performed under general anesthesia and may require a brief stay or may be done on an outpatient basis.