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The treatment of breast cancer is primarily surgical
Conserving treatment involves the removal of the tumour, while conserving the breast. Radiotherapy is almost always required afterwards.
The tumour must be small enough (or become so after Chemotherapy) in relation to the size of the breast so that removal is possible, while still keeping a harmonious appearance.
When the Lumpectomy requires a remodelling of the remaining gland, plastic surgery techniques can be used. The combination of the lumpectomy and breast plastic surgery is called ‘oncoplastic surgery’
The Lumpectomy leaves a cavity which the surgeon must fill so that the breast does not appear deformed.
To achieve a good aesthetic result, it is essential that the remodelling is carried out during the Lumpectomy because radiotherapy (which almost always follows a breast conserving treatment) 'freezes' the breast distortions and makes them more difficult to correct later on.
Intervention in the lymph nodes
In the case of Invasive cancer, it is necessary to check that the nodes in the armpit are free of cancer. To do this, the surgeon carries out a sentinel node Biopsy (tests the node(s) closest to the breast) or an Axillary dissection (removes a part of the nodes in the armpit). These actions are carried out at the same time as the Lumpectomy
Why does the surgeon go 'wide' around the cancerous area ?
The surgeon removes the tumour, but also a large area of healthy gland, 1 to 2 cm all around it. The reason the surgeon goes ''wide' around the cancerous area (sometimes we talk about a 'wide lumpectomy', is because sometimes undetectable tumour foci develop around the tumour, and must be removed to prevent recurrence. When the pathologist's report states that the 'surgical specimen’ measures 6 cm on the major axis and the tumour measures 3 cm, then this 6 cm corresponds to the 3 cm tumour plus the 1.5 cm of healthy gland around it.
For 'simple' lumpectomies (small tumour not requiring complicated glandular remodelling), the location of the scar should be carefully selected depending on the appearance of the breast, the size and the location of the tumour.
Broadly speaking, there are two types of incisions: direct incisions, level with the tumour, and remote incisions (underneath the breast or around the areola). Although the latter are often less visible, they are not always possible either because the tumour cannot be removed that way, or because they do not enable a satisfactory breast remodelling.
Aiming for an inconspicuous incision should not pose any risk to the procedure in terms of removing the tumour, but also aesthetically, when the position of the scar does not enable a remodelling of the breast and could therefore lead to permanent deformation.
For lumpectomies requiring oncoplastic procedures, the scars vary depending on the location of the tumour, the size and shape of the breast. Before surgery, the surgeon will have a consultation with you to explain what he is going to do.
Prophylactic Mastectomy is the preventive removal of the breast. It is recommended for women who have a high risk of developing breast cancer. It is almost always associated with immediate breast reconstruction.
Which women have a higher risk of developing breast cancer ?
- Women with a proven BRCA1 and BRCA2 gene mutation: this genetic abnormality predisposes to breast cancer but also to ovarian cancer.
- Women with a family history of breast cancers are strongly suspected of having this Genetic mutation, even if it cannot be identified.
- Women with extensive benign breast lesions, which predispose to breast cancer, mainly in the extensive lobular neoplasia in situ (atypical cell proliferation in the lobules) and certain extensive atypical ductal hyperplasia (atypical cell proliferation in the lactiferous ducts).
- To a lesser degree, it is known that patients who have had chest radiation at a young age (e.g. to treat Hodgkin's disease) also have an increased risk of developing breast cancer.
- Finally, women who have already had breast cancer have a higher risk of developing cancer in the other breast.