Do you have to have a mastectomy if you have breast cancer?

Do you have to have a mastectomy for breast cancer?

Of course not!

Breast cancer is the most common malignant tumor in women, affecting about 1.4 million women worldwide each year, with the vast majority requiring surgical treatment. Traditional radical mastectomy for breast cancer (modified) requires complete removal of the breast and clearance of axillary lymph nodes, which is traumatic and slow to recover, and some patients may experience skin flap necrosis and even need skin grafting. However, the trauma is not only limited to the body, as a woman, because of the loss of breasts, it also causes great damage psychologically. In order to achieve the purpose of treatment with less trauma, breast-conserving surgery has been gradually developed and has become a very mature technology. During the operation, only the breast cancer and some of the surrounding glandular tissues need to be removed and it is ensured that there are no cancerous cells left in the surrounding tissues (i.e., the lump is completely removed), and through breast oncoplastic techniques, the glands are re-sutured so that the breast still retains a relatively normal appearance. Combined with the technique of sentinel lymph node biopsy, some eligible patients may also be able to have their axillary lymph nodes cleared without the need to do so, thus allowing the function of the upper extremities to be well preserved.

But not all patients are suitable for breast-conservation, some of the following conditions need to be met:

1, tumor size: most hospitals now consider the tumor to be within 75px. If the breast is large, the tumor>75px, or even ≥125px, the tumor shrinks after preoperative neoadjuvant chemotherapy, and the extended resection of the tumor does not affect the breast shape, breast-conserving treatment is still feasible; if the breast development is too small, the ratio between the tumor size and breast size should be considered, and breast-conserving surgery requires that the tumor is removed according to the regulations and the breast shape is still retained well.

2. Tumor location: the tumor should be located in the peripheral quadrant, and the edge of the tumor should be ≥50px from the edge of the areola.

3. Pathological type: there is no special requirement, but inflammatory breast cancer should be excluded.

4. Ensure the completion of breast-conserving treatment plan, such as postoperative radiotherapy.

5. The patient has the requirement of breast conservation.

The following conditions are not suitable for breast-conserving treatment:

1. Multiple primary foci located in different quadrants of the breast, or molybdenum X-ray suggesting diffuse microcalcifications in the breast with malignant features.

2. The affected breast has received radiation therapy.

3. Pregnancy is an absolute contraindication to breast radiation, but breast-conserving surgery can be performed in the second trimester of pregnancy and radiation therapy can be performed after delivery.

4. Breast-conserving surgery specimens with positive margins are unable to achieve negative margins even after extended excision, meaning that partial excision is incomplete.