Breast surgery changes mean less pain, faster recovery

Surgeries that conserve more of the breast tissue. Reconstruction that results in less post-operative pain. And more surgery that is done on an outpatient basis, so women can leave that day and heal at home.

Those are just a few of the advances in breast cancer surgery that are now available to patients, said Lori Gentile, MD, surgeon with Novant Health Carolina Surgical. Gentile, who received fellowship training at Memorial Sloan Kettering Cancer Center, said a lot has changed in the way surgeons respond to breast cancer.

“We’re evolving to not over-treat people,” Gentile said. “We’re basically trying to target and tailor the treatment of breast cancer.”

Dr. Lori Gentile, Novant Health

Historically, she said, “breast cancer surgery was what we would call ‘maximally invasive.’” That meant most patients underwent a complete mastectomy, Gentile said, and the surgeon would remove every lymph node in the armpit area – between 10 and 40 nodes.

Today, the majority of breast surgeries are performed using breast-conservation techniques, which typically means a lumpectomy – the removal of the cancer and a rim of normal tissue – and a sentinel node biopsy, which means one or several key lymph nodes are removed and checked to see if cancer has spread.

And if the lymph node does prove cancerous, responses to that are more conservative than they used to be, Gentile said. In the past, if the sentinel node was cancerous, the surgeon would remove all the other nodes. “Now, in certain circumstances, if they only have one or two positive nodes, we treat them with radiation instead of removing all of them,” Gentile said. That’s a change that dramatically cuts the rate of lymphedema – chronic swelling of the arms – and the risk of hard-to-treat infections.

Other advances in breast cancer surgery include:

  • For lumpectomies, standard procedure has been to locate the cancerous area and, on the day of surgery, insert a wire in the spot to guide the surgeon. Now doctors can place a rice-grain-sized radar reflector at the tumor site any time before the procedure. Then the doctor scans the breast to locate the precise spot for surgery.
  • For women who undergo a mastectomy, anesthesiologists now give local nerve blocks pre-surgery, which decreases pain and allows women to leave the hospital sooner to recover at home.
  • Women that undergo reconstruction can now get implants placed in front of the pectoral (chest) muscle instead of behind, as was done in the past. The new placement can result in less post-surgery pain and a more natural appearance.

“Generally with a diagnosis of breast cancer, women have multiple treatment options that can intertwine with their personal values,” Gentile said. “Most people have a choice in how they treat their breast cancer. There’s a lot of new information and research being done in order to offer the most effective treatment with the fewest side effects.

“The goal is to keep women going about their normal life as they go about their treatment.”