The Future of Breast Cancer Surgery Is Here

M. Michele Blackwood, MD, FACS

Thanks to advances in research, targeted therapies, and a more personalized approach to treating patients diagnosed with breast cancer, more surgical options exist for patients with breast cancer patients than ever before.

With numerous options for reconstruction, surgeries can be minimal or advanced. Breast preservation and scar minimization have become real options for women undergoing surgery. Surgeons, once solely interested in the removal of the primary tumor, are now incorporating techniques to precisely remove all cancerous cells while preserving healthy breast tissue, skin and nipples, and giving patients the option to receive their desired cosmetic outcome.

Due to more frequent detection of smaller cancers and a better understanding of cancer biology, de-escalation of therapy is becoming increasingly more common in the breast cancer world.

Steps Forward in Breast Conservation

Only a couple of decades ago, patients diagnosed with early-stage breast cancer (stage 0/stage 1) were often limited to lumpectomy with radiation or mastectomy to achieve recovery, and most received the same care. Now, patients have many choices, and there are many changes in the way that surgeons approach breast cancer removal that have evolved over the past 10 to 20 years; this involves surgical techniques such as lumpectomies that hide scars, nipple-sparing mastectomies, reconstruction, and in some cases, no surgery at all.

During a lumpectomy procedure, the surgeon removes the cancer or other abnormal tissue and a small amount of the healthy tissue that surrounds it. This ensures that all of the abnormal tissue is removed and is also breast-conserving, leaving the natural breast intact. Now, surgeons have options such as an oncoplastic breast reduction and mastopexy, which allows tumors in problematic locations to be treated, while avoiding a poor cosmetic result or asymmetry. To do this, surgeons will combine breast cancer tumor removal and plastic surgery techniques at the same time of breast conservation surgery, giving patients confidence in knowing they can have their cancer removed while receiving their desired aesthetic outcome.

Reconstruction, Tattoos, and More

Although breast conservation surgery has become the gold standard for patients with early breast cancer, mastectomy remains an option for patients and is sometimes necessary, and we often find that women may experience a feeling of safety from having the whole breast removed. However, long gone are the radical mastectomies that removed not only breast tissue, but also extensive breast skin, lymph nodes, and underlying chest muscles. 

New techniques can often preserve the skin and nipple of the breast during surgery so that a later reconstruction looks and feels more natural; this includes procedures such as DIEP flap, which even offers a mini tummy tuck as part of the procedure. Surgical reconstruction of the breast following mastectomy has also become an important aspect of the patient’s rehabilitation process, as this can improve self-esteem.

Women have many options available to them today to strengthen their confidence after breast cancer. As another form of reconstruction post-mastectomy that does not require additional surgery, we have seen in recent years that patients may opt for acquiring 3D nipple tattoos. Tattoo artists can create an amazingly realistic image of a nipple that appears to have physical dimension, but is flat to the touch. These permanent nipple tattoos are designed and performed by tattoo artists in shops and in some specialized medical centers.

Patients are often shocked to learn that one of their options may be no surgery at all. Depending on the type of cancer, the quality of their health, age, and pre-existing conditions, it may be determined that the patient should take a daily antiestrogen pill. With this option, we see that their cancers are either shrinking or drying up dramatically, or they haven't grown at all.

Moving Forward

Breast cancer is a complex disease with multiple causes, types, and treatment options. Although the surgical emphasis remains on removal for the cancer, the future of breast cancer care began only a short time ago with the revolutionary concept of breast conservation, and has not yet finished. Clinical research, multidisciplinary approaches, and more effective treatments are continually evolving through research and clinical trials. Surgeons must keep up with this process, and lead future changes to reach the goal of complete recovery for every patient.

M. Michele Blackwood, MD, FACS, is chief, section of breast surgery at Rutgers Cancer Institute of New Jersey and northern regional director of breast services for RWJBarnabas Health.