Breast-conserving surgery for
breast cancer: a choice
between treatment and quality of life
I. Introduction
Breast cancer, as one of the most common malignant tumors in women in the world, its incidence is increasing year by year. In the course of the treatment of breast cancer, surgery has always occupied an extremely important position. Traditional radical mastectomy for breast cancer often means removing the whole breast, which can control the development of tumors to a certain extent, but causes great trauma to the patient’s body and mind, seriously affecting the quality of life of patients after surgery. With the continuous progress of medical technology, breast-conserving surgery for breast cancer came into being, bringing new hope for breast cancer patients, while effectively treating the disease, as far as possible to retain the appearance of the breast, so that patients can better return to normal life.
II. Development
of breast-conserving surgery for breast cancer The history of breast-conserving surgery for
breast cancer can be traced back to the end of the 19th century. At that time, some doctors tried to perform conservative breast tumor resection. However, due to the lack of understanding of the biological characteristics of tumors and the lack of effective adjuvant treatment, the recurrence rate after operation was high, which made this conservative surgery not widely promoted.
Until the middle of the 20th century, with the in-depth study of the biological behavior of breast cancer, people gradually realized that breast cancer is a systemic disease, and the extent of local surgery is not the only factor determining the prognosis of patients. At the same time, the continuous development and improvement of radiotherapy technology provides a strong guarantee for reducing the local recurrence rate after breast-conserving surgery. On this basis, breast-conserving surgery for breast cancer began to attract attention again, and gradually carried out in developed countries such as Europe and the United States.
In the 21st century, with the rapid development of imaging technology, such as the wide application of breast ultrasound, breast molybdenum target, breast magnetic resonance imaging (MRI) and so on, breast cancer can be detected earlier, which also creates good conditions for the further promotion of breast-conserving surgery. Nowadays, breast-conserving surgery for breast cancer has become one of the important choices for the treatment of early breast cancer, and has been more and more recognized and applied worldwide.
Indications and contraindications
of breast-conserving surgery for
breast cancer
(I) Indications
1. Tumor size: Generally speaking, single lesion with tumor diameter less than or equal to 3 cm is more suitable for breast-conserving surgery. However, with the progress of technology and the application of neoadjuvant therapy, some tumors with slightly larger diameter (such as 3-5 cm) may also meet the conditions of breast-conserving surgery after neoadjuvant chemotherapy and other means to reduce the size of tumors.
2. Location of the tumor: The location of the tumor in the peripheral area of the breast is relatively more suitable for breast-conserving surgery, because it is easier to repair the shape of the breast through plastic technology after the removal of the tumor. However, even if the tumor is located in the central area of the breast, breast-conserving surgery may be performed under the operation of some experienced medical teams, combined with appropriate plastic repair methods.
3. Patient’s willingness: Patients strongly require breast conservation and have a full understanding of the risks of breast-conserving surgery, follow-up treatment and possible appearance changes, and are willing to actively cooperate with follow-up treatment and follow-up, which is also one of the important indications.
(II) Contraindications
1. Absolute contraindications
-Tumors larger than 5 cm in diameter that have not been reduced to the appropriate size by neoadjuvant therapy.
-Multicentric breast cancer (i.e., the presence of two or more cancer foci in the breast that are not connected to each other).
Extensive microcalcifications are associated with breast cancer and are difficult to completely remove by breast-conserving surgery.
-In patients who have previously received breast or chest wall radiation therapy, repeat breast-conserving surgery may result in severe radiation damage.
2. Relative contraindications
-The tumor is too close to the nipple-areola complex, which may lead to poor blood supply or sensory disturbance of the nipple-areola complex after surgery, but with the support of some special plastic repair techniques, some patients may still try breast-conserving surgery.
-Breast conservation surgery may not be suitable for patients whose breast volume is too small to achieve a satisfactory breast shape through plastic repair after tumor resection, but it can also be considered in combination with breast reconstruction and other means according to the specific situation.
-Patients with some serious underlying diseases, such as severe heart disease and lung disease, who cannot tolerate comprehensive treatment such as breast-conserving surgery and subsequent radiotherapy.
4. Specific operation procedures
of breast-conserving surgery for breast cancer
(I) Preoperative assessment
1. Imaging evaluation: Through breast ultrasound, molybdenum target, MRI and other examinations, the size, location, shape of the tumor and the existence of multicentric lesions were understood in detail, which provided an accurate basis for the formulation of the surgical plan.
2. Pathological biopsy: perform puncture biopsy or excision biopsy on the tumor tissue to determine the pathological type, grade and receptor status of the tumor (such as estrogen receptor, progesterone receptor, human epidermal growth factor receptor 2, etc.), so as to determine whether endocrine therapy, targeted therapy and other adjuvant therapies are needed in the follow-up.
3. Assess the patient’s general condition: assess the patient’s cardiopulmonary function, liver and kidney function, etc., to ensure that the patient can tolerate surgery and follow-up treatment.
(II) Operation steps
1. Tumor resection: Under appropriate anesthesia, determine the exact location of the tumor according to the preoperative imaging and pathological results, and then take the tumor as the center to resect the tumor and a certain range of surrounding normal breast tissue. Generally, the resection margin is required to be at least 1 cm away from the tumor to ensure thorough resection. In the process of excision, attention should be paid to minimize the impact on the appearance of the breast, and more concealed incision methods such as arc incision can be used.
2. Axillary lymph node management: For patients with early breast cancer, axillary lymph node dissection or sentinel lymph node biopsy is usually required at the same time. Sentinel lymph node biopsy is performed by injecting a tracer around the tumor to find the first sentinel lymph node to receive lymphatic drainage from the tumor and biopsy. If no metastasis is found in the sentinel lymph node, axillary lymph node dissection can be avoided and complications such as upper limb lymphedema can be reduced.
3. Breast plastic repair: After the removal of tumors, in order to restore the appearance of the breast, breast plastic repair is often needed. For patients with large breast volume and less removed tissue, the shape of the breast can be restored by simple local tissue adjustment, such as the reshaping of breast glands. For patients with small breast volume or more resected tissue, breast reconstruction with implants (such as silicone prosthesis) or autologous tissue transplantation (such as latissimus dorsi flap, rectus abdominis flap, etc.) May be needed to achieve satisfactory breast shape.
(III) Postoperative treatment
1. Wound care: Pay close attention to the healing of the wound after the operation, keep the wound clean and dry, and change the dressing regularly to prevent wound infection.
2. Drainage tube nursing: If a drainage tube is placed during the operation, attention should be paid to the color, quantity and nature of the drainage fluid to ensure that the drainage tube is unobstructed. Generally, the drainage tube can be removed after the drainage fluid is significantly reduced.
3. Radiotherapy: After breast-conserving surgery, radiotherapy is an important adjuvant therapy to reduce the local recurrence rate. Generally, radiotherapy is started 4-6 weeks after operation, and the radiotherapy plan is formulated according to the specific conditions of patients, including the dose of radiotherapy, radiation field, etc.
4. Other adjuvant therapies: determine whether endocrine therapy and targeted therapy are needed according to pathological results. These adjuvant therapies are also very important for improving the survival rate and quality of life of patients.
Advantages
of breast-conserving surgery for
breast cancer
(1) Preserve the appearance
of the breast The greatest advantage of breast-conserving surgery for
breast cancer is that it can preserve the appearance of the patient’s breast, which has a vital impact on the psychological and quality of life of female patients. As one of the important characteristics of women’s body, the complete preservation of breast can enable patients to maintain self-confidence after surgery, wear swimsuits and underwear normally, participate in social activities better, and avoid the negative psychological emotions such as inferiority and depression caused by mastectomy.
(2) The psychological impact is small
.
Because of the retention of the breast, patients are more likely to accept their physical changes psychologically, and the psychological adjustment after surgery is relatively fast. Compared with traditional radical mastectomy, the probability of psychological disorders such as anxiety and depression in patients with breast-conserving surgery is significantly reduced, and they can cooperate more actively with the follow-up treatment and life.
(3) The surgical trauma is relatively small
.
Breast-conserving surgery removes relatively less tissue and causes less damage to the breast and surrounding tissues, so the surgical trauma is relatively small. This means that the recovery time of patients after surgery is relatively short, in general, patients can return to normal life within a few weeks after surgery, such as simple housework, walking and other activities, while traditional radical mastectomy patients may need a longer recovery time.
(4) The therapeutic effect is similar
.
Many studies have shown that in patients with early breast cancer, the therapeutic effect of breast-conserving surgery combined with adjuvant radiotherapy is similar to that of traditional radical mastectomy, and there is no significant difference in survival rate and local recurrence rate. This means that patients can enjoy the benefits of preserving the appearance of the breast while achieving the same therapeutic effect.
Risks and challenges
of breast-conserving surgery for
breast cancer
(I) Risk
of local recurrence
Although breast-conserving surgery combined with radiotherapy and other adjuvant therapies can effectively reduce the local recurrence rate, compared with traditional radical mastectomy, there is still a certain risk of local recurrence. This is mainly because breast-conserving surgery retains part of the breast tissue, which may have residual cancer cells. Therefore, regular follow-up should be carried out in strict accordance with medical supervision after operation, and possible recurrence should be detected in time by breast ultrasound and molybdenum target.
(2) Unsatisfactory
breast shape
Although breast plastic repair will be performed during the operation, some patients may still be dissatisfied with the shape of the breast after the operation due to individual differences and surgical techniques. For example, the breast may be asymmetric, deformed and so on, which requires further plastic surgery or other repair methods to improve.
(3) Complications
related to radiotherapy Radiotherapy is needed after breast-
conserving surgery. Although radiotherapy can reduce the local recurrence rate, it can also bring some complications, such as skin reactions (including erythema, pigmentation, peeling, etc.), radiation pneumonia (although the incidence is low, but the consequences are serious), upper limb lymphedema (especially in the case of axillary lymph node dissection). These complications need close attention and timely treatment during and after radiotherapy.
(4) High
technical requirements for operation Breast
conserving surgery for breast cancer requires surgeons not only to have solid basic surgical skills, but also to have certain plastic repair techniques, which can preserve the appearance of the breast as much as possible and carry out effective plastic repair while removing the tumor. This requires high professional level and experience of surgeons, and it may be difficult to carry out high-quality breast-conserving surgery in some areas where medical resources are relatively scarce.
7. Patient education and follow-up
of breast-conserving surgery for breast cancer
(I) Patient education
Before
deciding on breast-conserving surgery for breast cancer, healthcare workers should fully educate patients to understand the principles, indications, contraindications, surgical procedures, risks and follow-up treatment of breast-conserving surgery. Only on the basis of full understanding can patients make wise choices and actively cooperate with treatment and follow-up after operation. The content of education should also include the method of breast self-examination, so that patients can conduct regular self-examination after surgery and detect possible abnormalities in time.
(2) Follow-up visit
Follow-up of patients undergoing breast-
conserving surgery is critical. It is generally recommended that patients undergo a comprehensive review every three months in the first year, including breast ultrasound, molybdenum target, blood tests and other items, in order to understand the recovery of patients and whether there are signs of recurrence. From the second year, a review can be conducted every six months, and after the fifth year, a review can be conducted every year. In addition to regular review, patients should also seek medical treatment in time if breast pain, lumps, nipple discharge and other abnormal conditions occur in daily life.
VIII. Conclusion
Breast-conserving surgery for
breast cancer is playing an increasingly important role in the treatment of early breast cancer as a surgical method that takes into account both the therapeutic effect and the quality of life of patients. It preserves the appearance of the breast while effectively controlling the tumor, and has a positive impact on the psychological and quality of life of patients. However, we should also be aware that breast-conserving surgery is not suitable for all breast cancer patients, there are certain risks and challenges, need to strictly follow the indications and contraindications to choose, and do a good job of patient education and follow-up after surgery, in order to ensure that patients can get the best therapeutic effect and quality of life. With the continuous development of medical technology, it is believed that the technical level and therapeutic effect of breast-conserving surgery for breast cancer will continue to improve, bringing good news to more breast cancer patients.
