Breast-conserving surgery (partial mastectomy)
Breast-conserving surgery or partial mastectomy is an area that we develop with great interest; supported by cutting-edge technologies and applying the latest trends in oncology that allow us to offer a quality service, for the benefit of all our patients.
What is partial mastectomy?
Basically, partial mastectomy or lumpectomy is a surgery where only the part of the breast that contains the cancer is removed.
In this procedure, the amount of breast tissue that is removed will depend mainly on the location and size of the tumor, although other factors may also play a role.
Some of the normal or healthy tissue around the cancerous tissue is cut out during surgery, and sometimes part of the lining of the chest wall needs to be removed when the cancer is seen nearby.
Likewise, in this surgery, some lymph nodes that are located under the arm are also usually removed, since these are prone to spread the cancer to the rest of the body.
Surgical technique of partial mastectomy
First, to proceed with segmental mastectomy, general anesthesia is applied, the patient is demarcated taking into account the location of the tumor and the best route to approach is selected, considering her subsequent aesthetic reconstruction.
The surgeon then begins the intervention by making a cut with the scalpel until the entire incision in the epidermis and dermis is completed. Then, with the help of an electric scalpel, progress is made until you reach the superficialis fascia, which separates the subcutaneous fat from the breast tissue.
In particular, subcutaneous fat is of utmost importance and must be preserved; as it has a noticeable impact on the outcome of the reconstruction.
Once the superficialis fascia has been identified, all the tissue below it is the mammary gland; where a plane of separation must be developed that begins at the lower vertical and develops circumferentially in a clockwise direction.
In the same way, it should be taken into account that in Spence’s tail the fabric is higher and lateral. However, the fat of the anterior axillary line, which is not part of the breast and whose removal would leave a sequelae that is very difficult to correct, must be preserved.
Subsequently, having completed the circumference in the gland (from the lower portion and with the electric scalpel), the separation of the gland from the pectoral muscle begins.
This fascia is always sought to be preserved if possible. Once the removal is complete, the resection piece is marked and oriented so that the specialist (pathologist) correctly reports the location of the lesions.
Finally, wound closure is performed in planes; suturing the subcutaneous tissue, then the dermis and finally the skin.
Benefits of segmental mastectomy
Breast-conserving surgery has several benefits, such as:
It allows the woman to preserve most of the breast.
Only the localized part of the tumor is removed (although this can vary depending on the size and location of the tumor).
Segmental mastectomy combined with radiation therapies, rather than a total mastectomy; It does not affect the chances of long-term survival.
Who can have breast-conserving surgery?
Obviously, lumpectomy is usually a very good option for women who have been diagnosed with early-stage cancer. In these cases, segmental mastectomy seeks to subject only patients who:
They have one area or multiple areas close to each other and can be removed together, without changing the appearance of the breast much.
Have not had radiation therapy to your breasts or had breast-conserving surgery before.
Have a tumor that is less than 5cm or relatively smaller in relation to the size of the breast.
Do not have a genetic factor such as a BRCA or ATM mutation, which increases the chance of developing another breast cancer.
Do not suffer from any connective tissue disease (lupus or scleroderma).
Are not pregnant and if they are, they should not need radiation therapy right away.
What should I have at home?
The recovery period after a quadrantectomy is several weeks, and even longer if I include some reconstruction. When you return home, it is important that you take the time to recover.
For this reason, we share some general recommendations that you should follow at home to make this time as beneficial as possible:
Comply with all the instructions given by your treating doctor to shower, since the hygiene of that area is of utmost importance to avoid infections. In these cases, it is advisable to use a sponge until the drains and stitches are removed.
Ask for support from family and friends to help you during recovery, which can take time after surgery. Ask for support in the kitchen, doing laundry, shopping, etc.
Rest is vital for your recovery, try to sleep more than usual during the first weeks.
Take pain medication if you need it, as you may feel pain and numbness around your breast incision. If so, take only those that have been prescribed by your treating doctor.
Exercise your arms regularly to avoid stiffness and maintain their flexibility.
Adaptation to the effects of surgery can take months; this being a discomfort that usually disappears on its own. In cases that persist, excruciating itching, tenderness in the chest, arm, and armpit, numbness, or burning is common.
Recovery and postoperative care of quadrantectomy
From medical discharge, the patient must comply with the medication guidelines provided by their treating doctor; where analgesics, anti-inflammatories and in some cases, muscle relaxants will be indicated.
Likewise, you must take care of your wound, which should not get wet and you must keep it clean, applying an antiseptic frequently. You should also make sure that you do not use cigarettes while you have the sutures in your incisions.
During the first 3 weeks, the patient should lead as quiet a life as possible, without making any physical effort and minimizing the movement of the arms. In fact, after the first month, many patients achieve a good recovery and manage to continue their lives normally.
Finally, you should continue to visit your treating doctor about 3 times during the postoperative period, which include one appointment a week, another one after 15 days and the third after a month.
Check-ups during the first year are usually 3, 6 and 12 months apart; but if the patient evidences any change or eventuality outside these periods, they should make an appointment to be checked.
Side Effects of Breast-Conserving Surgery
Side effects after a quadrantectomy are usually temporary, with the most common being:
Swelling.
Pain.
Constriction in the breast area, arm and shoulder.
Numbness feeling.
Scar that usually disappears over time.
Tingling in the area.
Looking for medical oncology help?
"My greatest motivation as a Surgical Oncologist in Panama is to have the opportunity to help each patient find multiple reasons to keep fighting."
- Dr. Roberto García
Breast reconstruction surgery
For the most part, women can undergo breast reconstruction surgery at the same time as the partial mastectomy.
However, it is the doctor together with his team who will indicate the ideal time to carry out this process that treats breast cancer, in coordination with a plastic surgery team.
After undergoing breast reconstruction surgery, many women experience not only an aesthetic improvement, but also an emotional and functional one.
The objective of this surgery is to reestablish the contour of the breast, but above all to make the woman feel her breast again as part of her body at all times; whether looking in the mirror, sunbathing on the beach or hugging their partner.
In particular, there are several breast reconstructive techniques, among which we mention:
Breast reconstruction using implants:
Direct implants.
Expander-type implants.
Becker type implants.
Breast reconstruction with tissue from the body's own body:
Microsurgical reconstruction with tissue from the abdomen.
Microsurgical reconstruction with tissue from the gluteal region.
Microsurgical reconstruction with myocutaneous flap of gracilis.
Microsurgical reconstruction with tissue from the dorsal region.
Lipofilling.
Breast reconstruction using mixed techniques:
Dorsal thoracic flap with implant.
Latissimus dorsi with implant
In such a way, breast-conserving surgery is a method that offers multiple advantages for eligible patients; but that it should be practiced only if the specialist considers it a convenient choice depending on the case under study.
