Latest approaches in breast cancer surgery

Each year, about 240,000 women and about 2,100 in men in the United States will learn they have breast cancer and nearly all of them will have surgery as part of their treatment. Recent innovations in breast cancer treatment — new targeted drugs, surgical approaches and determining which treatments come first — have improved patient experiences and outcomes and offer new, hopeful possibilities.

“Breast cancer is a multidisciplinary disease,” says Mariola Poss, MD, FACS, a fellowship-trained breast surgical oncology specialist at Breast Care of Western New York, located in Williamsville, NY, a member of the Roswell Park Care Network. “It’s a cancer that requires a highly individualized level of planning and care, and most patients will experience a combination of surgery, medical therapy and radiation.”

Medical treatments first may mean less aggressive surgery

For decades, surgery was traditionally the first line of treatment for breast cancer, but new advances in science and medicine are changing the landscape. “Nowadays, with certain types of breast cancer, people more often get medical therapy before surgery,” says Dr. Poss. “Thanks to newer, innovative medications that can shrink tumors before surgery, patients who were initially recommended to have a mastectomy can sometimes have a lumpectomy, also called breast-conserving surgery.”

While a mastectomy involves removing the entire breast and often lymph nodes in the armpit, a lumpectomy removes only the tumor and a margin of surrounding healthy tissue as well as one or more lymph nodes if required, allowing for the breast to remain intact.

As part of the Roswell Park Cancer Care Network, patients of the Williamsville location have access to the comprehensive cancer services of Roswell Park, including treatment plans developed with the expertise of Roswell Park’s world-renowned physicians and incorporating the latest drugs and therapies.

What is a nerve-sparing mastectomy?

Another encouraging development in breast cancer surgery is the use of nerve-sparing techniques, also known as sensation preservation. This type of advanced surgery offered at Roswell Park protects and/or repairs the nerves that supply sensation to the chest area, including the breasts and nipples. It involves preserving or grafting nerves that run through the fatty layer beneath the breast skin.

“When cancerous breast tissue is removed, nerves are often severed, and patients will lose feeling in their breasts as well as their nipple-areola complex,” explains Dr. Poss. “Traditional mastectomies cut through nerves that travel through breast tissue to the nipple. With nerve sparing, our surgical team will include a plastic surgeon, who preserves nerve sensation with delicate grafts and connections."

Who is a good candidate for nerve-sparing surgery?

“It really depends on the type of cancer, breast size and other variables,” explains Dr. Poss. “Women who are larger breasted, patients with a prolonged smoking history, and patients who have had previous treatments for breast cancer might not be ideal candidates. Each person’s situation is unique, so we work closely with every patient, going over details during multiple visits to determine their candidacy for these procedures.”

According to the National Institutes of Health, women at high risk for breast cancer who opt to preventatively remove their breasts are among the most ideal candidates for nerve and nipple-sparing surgery. Candidates for this type of surgery are typically younger, healthier and less likely to have coexisting medical conditions that may come with age, such as heart disease and diabetes.

Every surgery is a highly personal decision

“We work with every patient to review all their options," says Dr. Poss. "Some women elect to have a simple mastectomy, which involves having their breasts removed along with the nipple and areola complex. For those patients, we’ll do a flat closure and follow up with a fitting for an external prosthetic if that’s their choice. Some may opt to have reconstruction at a later date and will choose to have an expander or spacer, in preparation for a follow-up surgery when they are ready for implants. For those who choose immediate breast reconstruction, we can do a skin-sparing mastectomy, where the breast tissue is removed while most of the healthy breast skin is retained.”

It’s rarely a quick decision, says Dr. Poss. “Most patients need time to think about their next steps and consult with their partner or family members before deciding their course. It’s important to take time to reflect on your options, ask lots of questions, and ultimately feel comfortable with whatever you decide.” While surgeries take place at our main campus in downtown Buffalo, Dr. Poss notes having a Roswell Park location in Williamsville is helpful for people who may have difficulty traveling downtown, especially if they have transportation or mobility issues. “Being able to come to our office in a smaller setting that’s closer to home is just one more way that Roswell Park can make a difficult time a little easier.”