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Is Mastectomy (removal of breast/s) Necessary in Breast Cancer Surgery?

There are a lot of myths, misconceptions and doubts related to the treatment of breast surgery.

As leading breast cancer specialists, we often encounter such questions from our patients or their relatives.

“Do we have to do mastectomy? Is there not any other way?”

To address these question, we finally decided to come up with a detailed answer.

Breast-Conserving Therapy is the procedure to preserve the breast during breast cancer treatment.

This therapy is classified into two parts:

• Breast-Conserving Surgery :

In this surgery, we remove the part of the breast where the tumour is present.

We keep a sufficient margin while removing the tumour, along with the auxiliary nodes. This is known as wide local excision.

• Radiotherapy :

The radiotherapy follows the breast-conserving surgery

The decision to remove the breast or not is taken only after a consultation between the patient, their relative and the surgeon.

It’s mandatory to take a mammography test, tissue examination and clinical examination before making any decision.

There are two aspects to the Breast Conserving Therapy :

• Psychological Part :

In many cases, it’s possible to save the breast.

But the patient wants to get the entire breast removed due to the fear of cancer returning after some years.

In such cases, we do not perform conservative surgery without the approval of the patient.

• Technical Part :

There are 2 types of contraindications that might prevent breast-conserving surgery.

Testing

Let’s talk about Absolute Contra-indications first.

 If the patient has inflammatory breast cancer, breast-conserving surgery is not possible. The reason is this form of cancer is very aggressive.

Moreover, if the patient is pregnant, we cannot provide radiation therapy after the surgery. So in such cases, the entire breast has to be removed.

Additionally, if the patient has received radiation treatment in the breast region in the past for any ailment, we do not perform breast-conserving surgery.

If, during the surgery, we identify that the margin is being diagnosed positive with cancer after multiple attempts, we shift to the mastectomy and remove the entire breast.

Now let’s talk about Relative Contra-indications.

These contradictions are relative, i.e. if they are present, breast-conserving surgery is possible in some patients, while it is not possible in some other patients.

In some patients, cancer is present in the multi-focal form, i.e. there are more than two tumours in the same quadrant.

In this case, it is possible in some patients to perform Quadrantectomy to conserve the breast. Similarly, in some patients, it is present in the multi-centric form.

In this situation, breast-conserving surgery is possible in some cases, while it is not possible in other cases.

In the case of Brca-positive cancer (Genetic cancer), we perform risk reduction surgery.

In this case, we not only remove the breast that has a cancerous tumour, but we remove the opposite breast, too, to reduce the possibility of cancer in the future.

But some patients want to conserve both breasts. In such cases, we may recommend breast-conserving surgery.

Another factor that plays a crucial role in opting for breast-conserving surgery is the availability of radiation.

There are certain regions in our country where even today, radiation facilities are not available.

In such areas, it’s not possible to perform breast-conserving surgery as it’s a combination of surgery and radiation.

Breast Tumour  Ratio is another major factor that decides whether a patient can undergo breast-conserving surgery or not.

It’s a ratio of the breast’s size to the size of the tumour. If this ratio is favourable, only then can we perform breast-conserving surgery.

For e.g.,
If the size of the tumour is 5 cm and the size of the breast is 30, then breast-conserving surgery is not possible. The reason is a major part of the breast will be removed while removing the tumour and margins.

But if the tumour’s size is 5 cm and the breast’s size is 44, breast-conserving surgery can be really helpful.

Skin involvement

Breast-conserving surgery is possible even if there is skin involvement.

We can perform latissimus dorsi flap reconstruction surgery to conserve the breast.

We hope you have a clear idea about when and how we can conserve a patient’s breast while treating breast cancer.

Remember, we do not compromise on the oncological principles while treating breast cancer. Our primary goal is to treat cancer and then conserve the breast if possible.

Although we put in every effort to conserve the breast if possible, there are some cases where we have to remove it to ensure our patient’s safety.

In case if you are thinking of breast-conserving surgery or need some more information on it, feel free to reach out.

Our experts will be happy to assist.

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