Surgery Options

Laparoscopic surgery is generally not indicated in the setting of advanced disease. In other words, when patients have wide spread of disease the indicated approach is a laparotomy. This means an open abdominal incision. Typically, only patients with early cervical or endometrial cancer are candidates for laparoscopic surgery. It is important to emphasize that patients with advanced-stage ovarian cancer are not candidates for laparoscopic surgery.

There are other potential contraindications to laparoscopic surgery. These include multiple prior abdominal surgeries, history of multiple bowel surgeries, severe cardiopulmonary disease, or extreme obesity.
Laparoscopic surgery is generally not indicated in the setting of advanced disease. In other words, when patients have wide spread of disease the indicated approach is a laparotomy. This means an open abdominal incision. Typically, only patients with early cervical or endometrial cancer are candidates for laparoscopic surgery. It is important to emphasize that patients with advanced-stage ovarian cancer are not candidates for laparoscopic surgery.

There are other potential contraindications to laparoscopic surgery. These include multiple prior abdominal surgeries, history of multiple bowel surgeries, severe cardiopulmonary disease, or extreme obesity.

Generally lumpectomy is offered for unifocal (one site of disease), and the patient is willing to undergo radiation. If the tumor is large relative to the breast size, neo-
adjuvant (up-front) treatment may be given to shrink the cancer before lumpectomy.

Questions to ask would be:
How large is the cancer? Can clear margins be obtained? Should I receive chemotherapy or endocrine therapy prior to surgery to shrink the tumor? How will the incision lines be placed? Will oncoplastic techniques be used? How much deformity will there be? Is there a reason not to preserve the breast?
Generally lumpectomy is offered for unifocal (one site of disease), and the patient is willing to undergo radiation. If the tumor is large relative to the breast size, neo-
adjuvant (up-front) treatment may be given to shrink the cancer before lumpectomy.

Questions to ask would be:
How large is the cancer? Can clear margins be obtained? Should I receive chemotherapy or endocrine therapy prior to surgery to shrink the tumor? How will the incision lines be placed? Will oncoplastic techniques be used? How much deformity will there be? Is there a reason not to preserve the breast?

There are many state of the art less invasive procedures available to women undergoing breast cancer treatment. These procedures range from nipple sparing mastectomy, new reconstructive materials, new anesthetic options and partial breast radiation.

From the surgical standpoint, many women undergoing mastectomy are candidates for nipple sparing mastectomy. This procedure entails performing the mastectomy via a bra line incision which is barely visible. The entire skin and nipple/areola are left intact while removing the underlying breast tissue. A reconstructive surgeon can reconstruct the breast at the same time. The cosmetic result of this type of mastectomy as compared to a traditional mastectomy is far superior. It is important that the surgeon selects the patient for this type of surgery very carefully ensuring that the cancer is not located near the nipple and the margins are all clear. Data so far have shown that the risk of local recurrence with this type of mastectomy is the same as the traditional mastectomy.

In the reconstructive field, there has been the development of many new implant shapes and materials that achieve superior cosmetic results while necessitating less surgery. These new materials allow the reconstructive surgeon to adequately cover the implant after mastectomy. In some cases this allows the patient to have a one stage reconstruction thereby avoiding future reconstructive surgeries.

In the anesthetic field, many patients undergoing mastectomy in my practice are opting to undergo epidural anesthesia or spinal blocks prior to general anesthesia. This causes numbness of the chest area after the surgery. By having less pain after surgery, there is less need for pain medication and thus less risk of nausea and vomitting. This in turn shortens the time in the recovery room as well as shortens the hospital stay.

In the radiation oncology field, many surgeons are offering partial breast radiation to select patients with small tumors. This is a balloon catheter that is placed in the lumpectomy bed at the time of lumpectomy. Instead of the traditional 6 weeks of whole breast radiation, patients are receiving a 5 day course of radiation to the lumpectomy bed only. Thus far, the data has been promising showing equal local recurrence rates compared to the traditional 6 week course.

Breast cancer surgery and treatment has changed dramatically in the last decade toward the more minimally invasive with superior cosmesis, less pain while maintaining similar local recurrence and survival. There are many state of the art less invasive procedures available to women undergoing breast cancer treatment. These procedures range from nipple sparing mastectomy, new reconstructive materials, new anesthetic options and partial breast radiation.

From the surgical standpoint, many women undergoing mastectomy are candidates for nipple sparing mastectomy. This procedure entails performing the mastectomy via a bra line incision which is barely visible. The entire skin and nipple/areola are left intact while removing the underlying breast tissue. A reconstructive surgeon can reconstruct the breast at the same time. The cosmetic result of this type of mastectomy as compared to a traditional mastectomy is far superior. It is important that the surgeon selects the patient for this type of surgery very carefully ensuring that the cancer is not located near the nipple and the margins are all clear. Data so far have shown that the risk of local recurrence with this type of mastectomy is the same as the traditional mastectomy.

In the reconstructive field, there has been the development of many new implant shapes and materials that achieve superior cosmetic results while necessitating less surgery. These new materials allow the reconstructive surgeon to adequately cover the implant after mastectomy. In some cases this allows the patient to have a one stage reconstruction thereby avoiding future reconstructive surgeries.

In the anesthetic field, many patients undergoing mastectomy in my practice are opting to undergo epidural anesthesia or spinal blocks prior to general anesthesia. This causes numbness of the chest area after the surgery. By having less pain after surgery, there is less need for pain medication and thus less risk of nausea and vomitting. This in turn shortens the time in the recovery room as well as shortens the hospital stay.

In the radiation oncology field, many surgeons are offering partial breast radiation to select patients with small tumors. This is a balloon catheter that is placed in the lumpectomy bed at the time of lumpectomy. Instead of the traditional 6 weeks of whole breast radiation, patients are receiving a 5 day course of radiation to the lumpectomy bed only. Thus far, the data has been promising showing equal local recurrence rates compared to the traditional 6 week course.

Breast cancer surgery and treatment has changed dramatically in the last decade toward the more minimally invasive with superior cosmesis, less pain while maintaining similar local recurrence and survival.