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How have the surgical options for breast cancer improved?

Surgical options for breast cancer have improved in a number of ways. There are now many approaches to breast conserving surgery designed to minimize the scar and improve the cosmetic appearance. There are also numerous reconstruction advances like total skin sparing (nipple sparing) mastectomy.

Forty years ago, the standard operation for cancer was the radical mastectomy. The breast, underlying muscles and many lymph nodes were removed along with the overlying skin. A skin graft was frequently used, making this surgery more painful, and extending the hospital stay. Because of the extensive lymph node removal, arm swelling (lymphedema) was common.

During the 1970s, the modified radical mastectomy became the standard and is still performed today. This procedure removes the breast but leaves more of the overlying skin and all of the underlying muscle.

By the 1980s, surgeons began doing lumpectomies if the tumor was small enough and the patient preferred to avoid a mastectomy. This procedure involves removing the lump and some normal surrounding tissue and is followed by radiation.

There have been two other significant advances. One is the sentinel node biopsy, where dye is injected into the breast before and during surgery. This demonstrates which underarm lymph nodes would most likely have cancer. Doctors remove them (usually one to three range) and if they are negative, they leave the remaining, presumably normal nodes alone. This diminishes the chance of arm swelling if the nodes are negative.

Another increasingly common operation is a unilateral or bilateral skin sparing mastectomy. Here, all of the breast tissue is removed through a very small incision, occasionally even sparing the nipple. This is followed by reconstruction of varying types, the excess skin allowing for better cosmetic results. This is frequently chosen by women with a small cancer, a large family history, prior worrisome biopsies or a high risk of cancer because they carry the BRCA gene mutation. The results with reconstruction are usually excellent, and outcomes continue to improve.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.