By Ashley M. Newman, MD
For most women diagnosed with breast cancer, surgery is a key part of treatment.
And while the overarching goal of surgery is to remove the cancerous tissue, advancements in surgical techniques are enabling doctors to offer women more options for breast preservation and breast reconstruction.
In the past, breast reconstruction after cancer surgery was often delayed or viewed as cosmetic.
Today, oncoplastic surgery combines cancer removal with reconstructive techniques, often in the same operation. The goal is to ensure effective cancer treatment while restoring the breast’s appearance and helping women reclaim both their physical and emotional health.
At Penn Medicine Princeton Cancer Center, specially trained breast surgeons work together with board certified plastic surgeons to develop a personalized plan for women undergoing surgery for breast cancer.
Most Common Cancer in Women Aside from Skin Cancer
With the exception of skin cancer, breast cancer is the most common cancer in women in the United States, according to the American Cancer Society.
The American Cancer Society estimates that nearly 317,000 new cases of invasive breast cancer will be diagnosed in women in 2025.
Overall, according to the American Cancer Society, the average risk of a woman in the United States developing breast cancer sometime in her life is about 13%.
Additionally, in recent years, the incidence rates for breast cancer have increased by 1% annually, with an increasing number of women under 50 developing the disease.
As the American Cancer Society notes, most women have some type of surgery to treat breast cancer. The two primary options for breast surgery are a lumpectomy or mastectomy.
Breast Conserving Surgery
A lumpectomy, also known as breast conserving surgery, is a procedure in which a tumor is removed from the breast, in addition to a small amount of surrounding breast tissue.
This procedure is considered breast conserving surgery because it leaves your breast intact.
Lumpectomies are typically performed for early-stage breast cancer that has not yet spread to surrounding areas. If breast imaging detected a tumor that was small in size relative to your breast or a tumor that has only affected one area of your breast, you may be a candidate for breast conserving surgery.
There are several approaches to breast conserving surgery, including:
- Hidden scar surgery in which the breast surgeon makes incisions either around the areola or in the crease of the breast, which reduces visible scar surgery.
- Oncoplastic surgery in which breast surgeons and plastic surgeons work together to treat patients whose breast shape and size benefit from a combined procedure. During one surgery, patients undergo a lumpectomy as well as a breast reduction and/or lift.
Mastectomy with Immediate Reconstruction
A mastectomy is a surgical procedure that removes the entire breast and is typically recommended for patients with tumors that are large in size or whose cancer is located in multiple areas within the breast and cannot be safely treated with a lumpectomy. A mastectomy may also be recommended as a preventative measure for patients at considerable risk for developing new or recurring breast cancer.
There are several types of mastectomy procedures, each removing breast skin and tissue in differing amounts. In recent years, breast and plastic surgeons have been able to offer an increasing number of patients more options for mastectomy and breast reconstruction, including, nipple sparing mastectomy and free-flap reconstructive surgery.
As it sounds, nipple sparing mastectomy, spares the nipple, areola and skin during a mastectomy. Breast reconstruction is performed immediately after. This surgery is only an option when cancer is not detected in the tissue underneath the skin.
The free-flap procedure is a procedure for breast reconstruction that typically involves removing a flap of tissue from the abdomen, similar to the area removed during a tummy tuck. The flap is shaped to recreate the breast and contains skin, fat and blood vessels that bring blood supply to the affected area.
Little or no muscle is taken from the abdomen and by using the patient’s own tissue, the reconstructed breast incorporates naturally with surrounding tissue. As a result, patients are left with a more natural feeling and looking breast.
It is important to note that both lumpectomy and mastectomy may be followed by radiation therapy, chemotherapy, or hormone therapy, depending on the cancer’s stage and characteristics.
Restoring Sensation
One of the lesser-known side effects of a mastectomy is loss of feeling in the chest and reconstructed breast. That numbness can be permanent — and for many women, emotionally difficult.
Surgeons at Princeton Cancer Center are offering patients who meet certain criteria a procedure that reconnects the nerves that supply sensation in the breast to one of the sensory nerves in the chest wall. Once the nerve has regenerated, patients should experience the return of some degree of sensation in the new breast.
Nationally Recognized Cancer Care
Princeton Cancer Center is accredited as a Comprehensive Community Cancer Program by the American College of Surgeons Commission on Cancer (CoC), which is dedicated to improving survival and quality of life for patients with cancer. CoC accreditation recognizes programs that provide comprehensive, high-quality and multidisciplinary patient-centered care.
Additionally, PMC and PMC Breast Health Center have earned full accreditation from the National Accreditation Program for Breast Centers (NAPBC), a program administered by the American College of Surgeons to improve quality of care and monitoring of outcomes for patients with diseases of the breast. Less than one-quarter of acute care hospitals in the state of New Jersey have received this accreditation.
Moreover, as part of Penn Medicine, experts at PMC work with teams at the Abramson Cancer Center, a world leader in cancer research, patient care, and education, to provide access to advanced diagnosis and treatment.
For more information about Princeton Cancer Center or to find a breast cancer specialist call (888) 742-7496 or visit www.princetonhcs.org.
Ashley M. Newman, MD, is board certified in general surgery and fellowship trained in breast surgical oncology. She is a member of the medical staff at Penn Medicine Princeton Health.
