When Does Breast Cancer Require a Mastectomy?

The decision to undergo a mastectomy, or the removal of the entire breast, is a significant and personal one. However, many women can preserve their breasts through breast conservation surgery (BCS) combined with oncoplastic breast reconstruction techniques. This article explores when a mastectomy is necessary and the role of breast oncoplasty in treating breast cancer.

The Role of Breast Oncoplasty

Breast oncoplasty, also known as oncoplastic breast reconstruction, is a novel surgical approach that integrates cancer surgery and plastic surgery principles. Its primary goal is to enhance the chances of successful cancer treatment while preserving the natural contours and symmetry of the breast. This innovative method has broadened the scope of breast conservation surgery, significantly reducing the need for full breast removal (mastectomy) and re-operation while maintaining the same overall survival rates as mastectomy.

Techniques and Procedures in Breast Oncoplasty

Volume Displacement and Volume Replacement are oncoplastic reconstructive techniques that involve strategically moving and reconstructing breast tissue. Some of the key procedures include:

Mammoplasty for therapeutic purposes, such as the Benelli’s and round block techniques. The Grisotti technique. Mammoplasty, also known as batwing or Omega mammoplasty, which involves reshaping breast tissue. Mammoplasty with a vertical decrease breast lift technique. Lateral mammoplasty.

Volume Replacement includes more advanced procedures that permit up to 50% of the breast volume to be resected and replaced with autologous tissues.

Breast Conservation Surgery for Different Stages of Breast Cancer

While breast oncoplasty is particularly useful for more extensive tumors, women with breast cancer at earlier stages (such as Stage 0 or 1) can also benefit from this approach. This method is especially effective for small-breasted women who might find a lumpectomy (partial breast removal) yields a poor cosmetic outcome. Additionally, women might choose oncoplasty to avoid chemotherapy in some cases.

Prophylactic Mastectomy Considerations

Some women with cancer in one breast may opt for a contralateral prophylactic mastectomy—removing the healthy breast to prevent cancer from occurring there in the future. This decision is often based on their genetic predisposition or strong family history. However, the majority of women with breast cancer in one breast will not develop cancer in the other breast. It is crucial to discuss your overall breast cancer risk with your doctor, weighing the benefits and risks of this procedure.

Complications of Breast Cancer Surgery

The choice of surgical procedures can affect the risk of complications. All surgical procedures carry the risks of bleeding and infection. The specific risks and outcomes depend on the type of surgery chosen.

Conclusion

While a mastectomy remains a viable option for many women dealing with breast cancer, breast oncoplasty holds great promise for preserving breast tissue and improving cosmetic outcomes. It's important for patients to engage in informed discussions with their healthcare providers to explore all available options and make an informed decision that aligns with their personal values and health goals.