Definition
In the surgical therapy of breast cancer, a distinction is essentially made between two different methods. The older method is the so-called modified radical mastectomy. In this operation the complete breast (glandular tissue and skin) and, if necessary, the underlying breast muscle is removed.
The second and newer method is the breast conservation therapy (BET). It is used in 70% of all patients with breast cancer. Only the tissue with the tumor and a small piece of skin is removed.
The rest of the glandular tissue and skin is left in place. Both methods always include the removal of lymph nodes from the armpit of the same side. How many lymph nodes are removed depends on whether there are tumor cells in the armpit or not.
Indication for surgery
Surgery is an important part of the therapy concept for breast cancer. This means that all patients in whom no metastases (abnormalities) have been detected will always have surgery. Even in pre-cancerous stages that do not yet grow invasively, early surgery should be performed to prevent further degeneration.
The surgical method has no influence on survival, which means that the two methods described above are equivalent. In Germany, the majority of patients undergo breast conservation therapy, as it is less invasive than complete breast removal. However, there are some indications for the complete removal of the breast. These include an unfavorable tumor to breast ratio in the case of large tumors, multiple tumors in the same breast, or skin/muscle involvement. Further indications for this would be an already performed radiation of the breast, other contraindications against radiation and of course the patient’s wish.
Preparation for surgery
Prior to the operation, the gynecologist provides comprehensive information about the surgical methods and risks. In addition, as with other operations, a conversation with the anesthesiologist must be held to discuss the risks of anesthesia and to clarify possible risk factors. If it is not possible to palpate the tumor in the breast, it is marked with a wire during BET (breast-conserving therapy) in order to find it more quickly and better during the operation.
A radioactive substance is also injected into the region around the tumor. This radioactive substance is transported to the local lymph nodes via the lymph drainage channels and accumulates especially in the degenerated tissue. Using a special camera, the lymph nodes close to the tumor can then be visualized and removed during surgery.
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