What’s New in Breast Surgery
Since the 1970s, breast surgery has continued to evolve toward a more minimally invasive approach. It is now an extremely rare patient who requires the radical “Halstedian” mastectomy. The primary modality used today to identify a breast abnormality is the bilateral screening mammogram. The American Cancer Society and National Cancer Institute continue to recommend a yearly mammogram for women between the ages of 40 and 74.1
Fortunately, using our modern technologies of mammogram and ultrasound, the majority of breast abnormalities (either imaging detected or palpable) can be pathologically evaluated with a needle core biopsy. This spares the 80% of women who have a benign entity from surgical intervention. This form of biopsy, rather than surgical biopsy, offers patients the most minimally invasive means to obtain a diagnosis with the lowest risk for complications.2
For women who do require surgery for treatment of a breast cancer, there are now a number of surgical options leading to excellent cosmetic outcomes with breast conservation. For patients with multi-centric disease or women with a large breast who desire reduction, oncoplastic surgery now offers options for “restructuring” the breast to provide the optimal balance between oncologic outcome for surgical removal of the cancer and cosmetic outcome. These procedures can be done by an experienced breast surgeon who has used some of these novel incisional approaches or collaborating with a plastic surgeon to achieve the best potential outcomes.3
For women who require mastectomy and who are candidates for breast reconstruction, the implant and TRAM flap are no longer the only options for “making” a new breast. The plastic surgeon who is experienced in microvessel anastamoses can now offer patients autologous reconstructions which use their fat but not necessarily the adjoining muscle tissue. Click here to read more about breast reconstruction at UW Health.
In addition, as breast surgery has evolved so have the anesthetic choices for the patients undergoing breast interventions. For years it was expected that a woman undergoing a mastectomy would have significant postoperative nausea and vomiting from her surgery. Now with modern anti-emetics and low dose steroids these side effects can be markedly reduced. There is also the more novel option of a regional block, or paravertebral block, for patients undergoing all types of breast surgery. This anesthetic choice is quickly becoming more widely adopted in the United States as it has been shown to improve the short-term pain and narcotic requirements for patients undergoing outpatient or short stay surgery.4
As we gain more knowledge about the heterogeneous disease we call breast cancer, the surgery offered to our patients will continue to evolve and change with this knowledge.