Surgical oncology contributes to improving the self-esteem of women with breast cancer

On the occasion of the celebration of the World Cancer Day, the Spanish Association of Breast Surgeons reminds that the goal of breast cancer surgery is not only the removal of the tumor, but also the improvement of women’s self-esteem by reducing the impact of the surgical technique on the female physical appearance. This is possible if the following objectives are reached: improvement of the quality of breast-conserving surgery and further development of immediate reconstructive surgery.

The new developments in breast cancer have allowed for a more personalized management of the patients. Just as the personalized approach of systemic treatments (chemotherapy and hormone therapy) or radiation therapy, breast surgery is no longer the same for all the patients diagnosed with breast cancer. Surgical treatments do not only include mastectomies or breast-sparing procedures, but also newly developed techniques that allow for an improvement of both the oncological treatment of the patients and their quality of life.

The reduced aggressiveness of breast and axillary surgeries using breast-conserving techniques and sentinel lymph node biopsies, respectively, resulted in a decrease in physical sequelae, especially after axillary lymphadenectomies and mastectomies. Surgery should allow women with cancer feel like women and avoid mutilations or deformities. The work of a breast surgeon should revolve around two different goals.

Firstly, the improvement of the quality of breast-conserving surgeries through low-visibility scars and the prevention of deformities after the tumor excision. Secondly, the further development of immediate reconstructive surgery, which constitutes the best option for lowering the impact of mastectomies on the physical appearance of women, especially after skin-sparing mastectomies and skin and nipple-areola complex sparing mastectomies.

According to AECIMA, the improvement in women’s self-esteem is the new horizon for breast surgical oncology: the multidisciplinary approach of breast cancer allowed for better safety profile during the surgical excision, which helps us improve in other areas, such as the remodelling and reconstruction of the breast.

Deformities and asymmetries

For many years, the surgical options for breast cancer revolved almost exclusively around mastectomy and the local excision of the tumor, without taking into account the aesthetic outcome and its impact on the well-being of women. However, breast cancer surgery should include now other objectives dealing not only with oncology, but also with the physical appearance of women. There is an increasing interest in reducing the incidence of deformities and asymmetries after breast-conserving surgeries.

These deformities and asymmetries depend on anatomical features of the breast and the localization of the tumor. That is why a local excision (tumorectomy) shows different outcomes depending on the excised area and the type of breast. This is the foundation for a new concept in breast surgery: surgeries tailored to each breast and tumor, with a specific procedure for each tumor localization.

Training

This new concept requires the acquisition of knowledge about multiple excision and remodeling procedures, comprised under the term “oncoplastic techniques”. The new reality makes it necessary to offer specific training for surgeons devoted to breast cancer aimed at adapting the tumor excision to to the type of tumor, thus personalizing the treatments for each woman. This is , one of the main goals of AECIMA, i.e. to promote the training of surgeons and gynecologists in the field of remodeling and reconstructive techniques of the breast. This specific training will offer the best opportunities to women with breast cancer.

Document approved by AECIMA’s Board of Directors, October 19, 2012.