CHICAGO (AP) — Treating breast cancer almost always involves surgery, and for years the choice was just having the lump or the whole breast removed. Now, new approaches are dramatically changing the way these operations are done, giving women more options, faster treatment, smaller scars, fewer long-term side effects and better cosmetic results.
It has led to a new specialty — “oncoplastic” surgery — combining oncology, which focuses on cancer treatment, and plastic surgery to restore appearance.
“Cosmetics is very important” and can help a woman recover psychologically as well as physically, said Dr. Deanna Attai, a Burbank, Calif., surgeon who is on the board of directors of the American Society of Breast Surgeons. Its annual meeting in Chicago earlier this month featured many of these new approaches.
And they’re in the news today — actress Angelina Jolie revealed she had both breasts removed preventively because she carries a gene that puts her at high risk of developing breast cancer. She was able to preserve her nipples and had a series of operations to reconstruct her breasts with implants. There have been many advances and “results can be beautiful,” she wrote in a personal essay in the New York Times.
Some of those advances:
More women are getting chemotherapy or hormone therapy before surgery to shrink large tumors enough to let them have a breast-conserving operation instead of a mastectomy. Fewer lymph nodes are being removed to check for cancer’s spread, sparing women painful arm swelling for years afterward.
Newer ways to rebuild breasts have made mastectomy a more appealing option for some women. More of them are getting immediate reconstruction with an implant at the same time the cancer is removed rather than several operations that have been standard for many years. Skin and nipples increasingly are being preserved for more natural results.
Some doctors are experimenting with operating on breast tumors through incisions in the armpit to avoid breast scars. There’s even a “Goldilocks” mastectomy for large-breasted women — not too much or too little removed, and using excess skin to create a “just right” natural implant.
Finally, doctors are testing a way to avoid surgery altogether, destroying small tumors by freezing them with a probe through the skin.
“Breast surgery has become more minimalistic,” said Dr. Shawna Willey of Georgetown’s Lombardi Comprehensive Cancer Center.
“Women have more options. It’s much more complex decision-making.”
Breast cancer is the most common cancer in women around the world. In the U.S. alone, about 230,000 new cases are diagnosed each year.
Most can be treated by just having the lump removed, but that requires radiation for weeks afterward to kill any stray cancer cells in the breast, plus frequent mammograms to watch for a recurrence.
Many women don’t want the worry or the radiation, and choose mastectomy even though they could have less drastic surgery. Mastectomy rates have been rising. Federal law requires insurers to cover reconstruction for mastectomy patients, and many of the improvements in surgery are aimed at making it less disfiguring.
Here are some of the major trends:
Doctors used to think it wasn’t good to start reconstruction until cancer treatment had ended — surgery, chemotherapy, radiation. Women would have a mastectomy, which usually involves taking the skin and the nipple along with all the breast tissue, followed by operations months later to rebuild the breast.
Reconstruction can use tissue from the back or belly, or an implant. The first operation often is to place a tissue expander, a balloon-like device that’s gradually inflated to stretch the remaining skin and make room for the implant. A few months later, a second surgery is done to remove the expander and place the implant. Once that heals, a third operation is done to make a new nipple, followed by tattooing to make an areola, the darkened ring around it.
The new trend is immediate reconstruction, with the first steps started at the time of the mastectomy, either to place a tissue expander or an implant. In some cases, the whole thing can be done in one operation.