Breast cancer is the most common cancer diagnosed in Australian women. In 2016, there were approximately 16,000 new cases diagnosed nationwide. Although the number of women diagnosed with breast cancer is increasing, survival rates have improved by about 15% over the last 20 years. This is due to earlier diagnosis through screening and improved treatments.
Many treatments are available for breast cancer (surgery, chemotherapy, radiation, biologic therapy, and hormonal endocrine therapy). As a result, the approach to treatment has become more individualized, taking into consideration the clinical situation and patient preferences. After cases have been reviewed with a treatment team (breast oncologic surgeon, medical oncologist and radiation oncologist), treatment options are discussed with the patient.
Tumor biology is what dictates survival. Because not all breast cancers behave and respond the same, it is important for your surgeon to have an understanding of the varying tumor biology. Some treatments such as chemotherapy administered prior to surgery (neoadjuvant chemotherapy) may improve surgical outcomes by shrinking the tumor, while at other times surgery should be done first.
Surgical options take into consideration not only survival, but risk reduction, maintaining function, and cosmetic results. The aim of any surgical approach in treating breast cancer is to remove the entire tumor with a rim of normal breast tissue, called the margin. Studies indicate that one third of patients are displeased with the cosmetic outcome of their breast conserving surgery. In breast conserving surgery (lumpectomy), an incision is made and the lump is removed, which may result in the patient being left with a disfiguring indentation.
A surgical technique called oncoplastic surgery, achieves a satisfactory margin of normal breast tissue while maintaining or improving the cosmetic appearance of the breast. The concept of oncoplastic surgery is a merger of plastic surgical techniques with oncologic surgery to reconfigure, reshape or reconstruct the breast after breast preservation or mastectomy.
A patient should be offered options that will provide the best chance for survival while achieving a good quality of life after all treatment is completed through restoration of function and aesthetics. In other words, whether a patient keeps their breast or has a mastectomy, a good cosmetic result can be achieved with this approach.
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