An Article by Gregory M. Senofsky , M.D., F.A.C.S. as published in Breast Cancer, a report to the community from Providence Holy Cross Medical Center

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In years past, women had few surgical options when it came to breast cancer: radical mastectomy versus lumpectomy, axillary node dissection and radio therapy. However, along with time comes progress, and with it, choice. Women's options now include quadrantectomy (removal of 25% of the breast), mammogram assisted wide excision of a mass, and sentinel node techniques. The latter procedure is a more accurate and less invasive approach than the conventional axillary node dissection.

Lumpectomy, which removes the abnormal lump from a woman's breast, has given way to wide excision and quadrantectomy. Clear margins play a major role in the treatment of breast cancer by minimizing recurrence and increasing survival. Larger and more directed resections of breast tissue are necessary to obtain healthy clearance of the malignant cells. In many cases, the tumor cannot be felt by hand and it si necessary to place several J-wires around the abnormal area prior to surgery. These wires are placed through the skin of the breast using mammography. The J-wires help to accurately locate the tumor so that the entire cancer can be removed.

In some cases, following larger resections, it is desirable to rebuild the remaining breast so that it has a natural and healthy appearance. Flap advancement closure, a technique which is particularly effective in this regard, is performed immediately after surgery is completed. Flap advancement refers to the technique of gently separating the remaining back of the breast from the muscle beneath it and reconstructing it. Before flap advancement can be performed, the pathologist must confirm that the cancer has been removed along with a healthy rim or normal tissue. This technique requires a meticulous approach so that the final result is a well-shaped natural looking breast.

The amount of axillary lymph node dissection is an area of controversy. In the recent past, extensive axillary node dissections were performed removing as many nodes as possible in order to see if the cancer had spread. However, in the past five years, a method called sentinel node mapping has evolved. This allows the surgeon to seek out the specific lymph nodes that most likely contain cancer. These lymph nodes, as well as some surrounding nodes, are removed through a small incision hidden in the edge of the harline under the arm. This new method of sentinel node mapping is one of the most exiting advances in breast cancer surgery: in minimizes the risks and complications of routine axillary node dissection and still gives physicians the important staging information they need. When the sentinel nodes have cancer in them, a full axillary node dissection is performed at the same time in order identify patients who need more aggressive treatment.

Unfortunately, not all patients can be treated with breast preservation, and for these patients a modified radical mastectomy may be recommended. But now breast reconstruction following a mastectomy is readily performed using either the patient's own abdominal all tissue or implant. In most cases, the reconstruction is performed at the same time as the mastectomy. One popular technique technique, the TRAM flap, incorporates an automatic tummy tuck and has lifelong durability, with no implant complications.

Surgery for breast cancer has evolved tremendously in the past several years. New surgical techniques not only give women a choice, but also a more accurate means of removing the cancerous tumor. These surgical breakthroughs, along with the advancement of breast reconstruction, all contribute to improving a woman's quality of life.

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