9 Most Frequently Asked Questions About Breast Cancer Surgery

Breast cancer is becoming more and more common today due to many factors, from unhealthy diet to excess weight, from long-term and uncontrolled use of hormones during menopause to smoking, alcohol and stress. October is recognized as Breast Cancer Awareness Month all over the world in order to raise awareness about breast cancer, which can knock on the door even at a young age, and to raise public awareness of the importance of early diagnosis. Acıbadem University Faculty of Medicine Head of General Surgery Department and Director of Senology (Breast Science) Institute, Acıbadem Maslak Hospital General Surgery Specialist Prof. Dr. Cihan Uras explained the answers to the 9 questions most frequently asked by patients about breast cancer surgery, where aesthetic concerns are as serious as the health aspect, and many problems are in the minds, and gave important warnings and suggestions.

QUESTION: Is surgical treatment necessary for every breast cancer?

REPLY: Surgery is necessary to treat every breast cancer, except for some metastatic breast cancers. However, its place in the treatment order differs according to the stage of the disease at the first diagnosis and the biology of the tumor.

QUESTION: Is surgery the first choice in the treatment of breast cancer?

REPLY: Surgery is not and should not always be the first treatment option. This decision needs to be taken entirely on a patient basis. It is necessary to decide according to the general condition of the patient, the stage of the tumor and the biology of the tumor. Systemic treatment (chemotherapy and smart drug-immunotherapy combinations) is the first treatment option in locally advanced breast cancers where the tumor size is large, the tumor features are aggressive, and one of the features of spreading to the armpit is some or all of them. In early-stage breast cancers that are small in size, soft-headed, and have no metastases to the armpit or distant organs, first surgery and then systemic treatment are applied. In patients with metastatic disease at the first diagnosis, systemic treatment is started first, and surgical treatment is added to the process in patients with appropriate treatment response after this treatment.

QUESTION: Should the breast be removed in breast cancer?

REPLY: prof. Dr. Cihan Uras said, “There is no need to remove the breast in breast cancer. Developments, scientific studies and patient follow-ups from the time when breast cancer surgery was first performed have shown that it is not necessary to remove the entire breast, except for special cases, in the treatment of breast cancer. Today, the gold standard in surgery is breast-conserving surgery, which preserves the breast. In suitable patients, if the tumor is not very large and the tumor is not widespread in the breast, the method to be chosen is breast-conserving surgery, in which the tumor part of the breast is removed. In patients who do not have these conditions, we prefer surgeries in which all of the breast tissue is removed.”

QUESTION: Does the shape of the breast deteriorate in surgeries where the breast is preserved?

REPLY: Breast conserving surgery does not deform the shape of the breast. The shape of the breast does not change in small tumors. We preserve the shape of the breast by performing oncoplastic surgery in large tumors. We combine surgical principles with plastic surgery principles in oncoplastic surgery. We maintain the shape of the breast by sliding the tissues inside the breast and using various techniques.

QUESTION: Is it necessary to remove the entire breast? Is the nipple removed when necessary?

REPLY: If the tumor in the breast is very common in the breast, if the patient has a gene mutation or if the patient has a high risk of familial breast cancer, all of the breast tissue can be removed. The nipple may not always be protected. If the tumor is in a close distance just below the nipple, the nipple can be removed. In order to save the nipple, a sample is sent to the pathology under the nipple during the surgery. The pathologist examines the tissue, if there is no tumor, the nipple can be left very thin. In cases where the tumor is far from the nipple, we prefer to protect the nipple.

QUESTION: When the breast is removed, is the breast made again in the same surgery?

REPLY: Our current practice in surgeries that require removal of breast tissue is to perform breast reconstruction with simultaneous prosthesis or the patient's own tissue. In this way, the patient does not experience breast loss.

QUESTION: Does removal of the entire breast prevent the spread of the disease?

REPLY: Removal of all or part of the breast does not prevent the spread of the disease, the spread of the disease is not related to it. Scientific studies and patient follow-ups have revealed that removal of part or all of the breast does not have a high-level effect on the expected life expectancy of the patient.

QUESTION: What is done when initially spreading to the lymph nodes is detected?

REPLY: prof. Dr. Cihan Uras said, “If we know that there is spread to the lymph nodes at the beginning, we have a chance to protect the lymph nodes. We start this treatment first with systemic therapy-chemotherapy. We evaluate the patient for surgery when systemic therapy is completed. We perform sentinel lymph node biopsy during surgery. If the lymph nodes respond to chemotherapy with chemotherapy and the tumor cells are completely cleared, we finish the procedure by taking a few lymph nodes as in the early stage.

QUESTION: lymph nodes under armpitall n should it be cleaned?

REPLY: Our current practice is to perform sentinel lymph node biopsy in non-advanced breast cancers. In this way, the first few sentinel lymph nodes in the armpit are taken and we decide whether or not the remaining lymph nodes in the armpit should be removed according to the presence of tumor in the pathological examination. In this way, we protect the lymph nodes under the armpit and do not remove all unnecessary lymph nodes.