Surgery is the primary treatment of breast cancer, and it serves three goals…
- The total resection of the primary tumour reduces the risk of local recurrences and future spread or metastasis
- Aids in determining the pathologic staging of the primary tumour and axillary lymph nodes
- Provides the necessary information on the patient’s prognosis
Because it is at the forefront of advancements in Asian breast cancer treatment, Singapore boasts of having many of the best breast surgeons in the world today. Here are the types of breast cancer surgeries that are being performed by the Singapore’s finest surgeons…
Lumpectomy is the surgery of choice of a breast cancer surgeon when presented with a patient in early stages (Stages 0, 1 and 2) of breast cancer. Also known as wide excision or breast conservation surgery, lumpectomy involves the removal of the primary tumour together with a margin of healthy tissue surrounding the tumour. Both the tumour and margin are examined for the presence of cancer cells. In most cases of lumpectomy, doctors may advise radiation therapy to destroy any cancer cells that have not been removed during surgery. Chemotherapy and hormone therapy may also be given after lumpectomy to prevent cancer recurrence. It should also be known that removal of more than 20-25% of total breast volume will often result in noticeable deformity of the breast. Hence often oncoplastic breast surgery is offered if large lumpectomies are required.
Mastectomy is a surgical procedure that involves the removal of the entire breast including the nipple and areola. If most of the breast skin is preserved then it is called a skin sparing mastectomy. The emerging trend now is the preserve as much native breast skin as possible so that the aesthetic outcome of breast reconstruction is better. Nipple sparing mastectomies, where the nipple and aroelar is preserved, is the new advancing front in mastectomy techniques. For women with a high risk of breast cancer, especially those found with mutations in the BRCA1 and BRCA2, a “prophylactic mastectomy” of both breasts is an option offered to them. This reduces cancer risk by more than 95%. This is the surgery that Angelina Jolie had – nipple sparing mastectomy and immediate reconstruction with implants. This procedure is 1-3 hours in duration and requires the insertion of a drain in order to remove blood and other fluids that leak out from the breast after the operation. Following surgery, the woman has the option to wear breast prosthesis or undergo breast reconstruction.
Sentinel Lymph Node Biopsy/Axillary Lymph Node Dissection
When invasive cancer is diagnosed, the axillary lymph nodes need to be examined for cancer spread. The gold standard examination is a Sentinel Lymph Node Biopsy. In Sentinel Lymph Node Biopsy, a radioactive substance and/or dye is injected near the primary tumour in order to determine the location of a sentinel lymph node. This sentinel node is the very first node that the cancer will spread to. Upon locating this node, it is removed and sent to a pathologist. If cancer is found in the sentinel node, the surgeon proceeds to Axillary Lymph Node Dissection, wherein the lymph nodes in the armpit are removed.
Oncoplastic Surgery is a type of reconstructive breast surgery performed after a lumpectomy. With removal of the breast lump, a cavity in the breast will result in deformities, such as drooping breasts, loss of breast symmetry and contour, scar puckering, and nipple deviation. Depending upon the deformity caused during the removal of the tumor and the size and shape of the patients breast, the oncoplastic surgeon may choose to replace the lost tissue with adjacent skin and fat or reshape the breast using the remaining tissue which has the outcome of performing breast reduction or up-lift surgery.
Breast reconstruction involves the reconstruction of a new breast following mastectomy. The 2 main options are using implant or using own tissue. Implant reconstruction can be done in one or two stages. The second type is autologous tissue reconstruction, wherein a new breast is created out of tissues obtained from the abdomen, back, buttocks or thighs.
Currently, Dr Evan is one of a handful of surgeons in Singapore able to offer both the full range of options in breast cancer removal (lumpectomy / breast conservation surgery / oncoplastic breast surgery), and the full gamut of reconstructive options after both breast removal or breast conservation surgery (including use of perforator flap-free tissue transfer). This ensures a truly integrated and comprehensive breast surgery practice.