Surgery for breast cancer

Surgery for breast cancer

In many cases, breast cancer therapy requires a Operation recommended or necessary. However, it is not always necessary to lose the breast, as many women today are able to have breast-conserving surgery and thus preserve their natural body image.

A Essential quality requirements in our Breast Centre at the Englischer Garten, the main focus is therefore - where possible - on breast preservation during treatment. However, if breast removal is desired or unavoidable for medical reasons, we will show you the modern possibilities of breast reconstruction if you are interested.

Our specialists in plastic and aesthetic surgery take your individual wishes into account with understanding and sensitivity - together with you, we will find a solution that will make you feel comfortable in your body even after breast cancer surgery.

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Surgical options for or after breast cancer

Breast-conserving surgery

In breast-conserving surgery (also known as breast-conserving therapy or lumpectomy), only the breast tissue is removed. tumour-bearing tissue removed from the mammary gland, while the majority of the breast remains intact. Today, breast-conserving surgery is an important alternative to complete breast removal (mastectomy) and is now used for many women with breast cancer.

The basic principle of breast-conserving surgery is simple: As much as necessary, as little as possible. The aim is to completely remove the cancer while maintaining a sufficient safety margin and at the same time preserving the most natural appearance of the breast possible. This approach takes into account not only medical necessities, but also the physical and psychological well-being of the patient.

Breast-conserving surgery is usually combined with subsequent radiotherapy. This combination has proven to be just as effective as the complete removal of the breast. The methods of breast-conserving surgery have been continuously improved since the 1980s, so that this option is now a standard treatment for many women with breast cancer.

The specialists at our breast centre will analyse whether the requirements for breast-conserving surgery are also met in your case as part of a comprehensive diagnosis.

Advantages of breast-conserving surgical methods

Breast-conserving surgery offers several important advantages over complete breast removal.

Psychological and emotional benefits

Keeping your own breasts can have a significant positive impact on your mental well-being:

• Improved body image and self-esteem
• Less traumatic experience compared to breast loss
• Preserving a sense of femininity and physical identity
• Less impact on sexuality

Studies have shown that women often report a better quality of life after breast-conserving surgery than after complete removal (mastectomy) without reconstruction.

Medical advantages

Breast-conserving surgery also offers medical advantages:

• Less invasive intervention
• Shorter operation time
• Less blood loss
• Faster recovery and shorter hospitalisation
• Less post-operative pain
• Preservation of natural breast sensitivity

Ablative breast surgery (mastectomy)

If the entire breast has to be removed, is referred to as a mastectomy or ablatio. Under certain circumstances, it is also possible to preserve the nipple during a mastectomy. The surgeon will explain the various procedures in detail.

Breast reconstruction after mastectomy

Reconstruction of the female breast involves the restoration of the Shape and aesthetics of the breast the goal. In recent years, breast reconstruction after breast removal has become increasingly popular. Various procedures are available for breast reconstruction, which our specialists discuss individually with the patient.

A reconstruction can, under favourable circumstances, be performed together with tumour removal in one operation. (primary reconstruction of the breast). Under certain circumstances, however, it is advisable to perform the breast reconstruction procedure only after complete therapy. This is referred to as secondary breast reconstruction. Breast reconstruction is possible at any time at a later date.

Breast reconstruction procedure

After careful preliminary examination and individual consultation, the following breast reconstruction procedures are available to you at our breast centre:

Augmentation with exogenous tissue (expander/implant), possibly with so-called acellular matrices (ADM)

Breast augmentation using the body's own tissue

• Build-up with tissue from the back (latissimus muscle or TDAP flap plasty)
• Build-up with tissue from the abdomen (DIEP flapplasty, formerly TRAM flapplasty, and SIEA flapplasty)
• Reconstruction of the breast with tissue from the thigh and gluteal fold (TMG flap surgery)

You can find more details on the various breast reconstruction procedures here.

External breast prostheses

If breast reconstruction is not desired or possible, there are suitable external breast prostheses. These usually consist of a cushion on the operated side, which is sewn into the bra or swimming costume etc. The difference is not visible from the outside. Due to a perfect fit, the difference is not recognisable from the outside.

More recently, gel prostheses have also become available that do not need to be sewn into the underwear and are worn directly on the skin. The cost of a breast prosthesis is usually covered by statutory health insurance.

How does an operation for breast cancer work?

Breast cancer surgery is a complex process that requires careful planning and expertise. The entire process comprises several phases:

Preparation and diagnostics

Before the operation, various examinations are carried out to precisely locate the tumour and determine its extent.

• MammographyA special X-ray examination of the breast that can also visualise small tumours and calcium deposits
• Ultrasound: Particularly helpful to determine whether the tumour is solid or fluid-filled
• MRI (magnetic resonance imaging)Can provide additional information, especially in dense breast tissue or when multiple tumours are suspected
• BiopsyExtraction of a tissue sample to determine the exact type of cancer

For some small or non-palpable tumours, marking is necessary before the operation:

• Wire markingA thin wire is placed under mammography or ultrasound control so that its tip lies in the tumour
• Radioactive or magnetic labellingA small amount of a radioactive substance or a tiny magnet is injected into the tumour
• Dye labelling: A special dye is injected into the tumour

These markings help the surgeon to precisely locate the tumour during the operation.

Tissue examination and further planning

The tissue removed during the operation is examined under a microscope in the pathology department. This examination provides important information:

• Tumour-free marginConfirmation that a sufficient margin of healthy tissue has been removed around the tumour
• Lymph node statusDetermination of whether and how many lymph nodes are affected by cancer cells
• Tumour biologyDetermination of further tumour characteristics such as hormone receptor status, HER2 status and proliferation rate

The results of the tissue examination form the basis for planning further treatments such as radiotherapy, chemotherapy, anti-hormone therapy or targeted therapies, which are carried out at the Breast Centre am Englischen Garten.

After the operation

Suction tubes (drains) are placed under the skin of the chest during the operation to prevent post-operative bleeding into the wound or the accumulation of tissue fluid. These are removed in the hospital before discharge.

The stitches are removed eight to ten days after the operation. The wound usually heals in three to four weeks.

Follow-up treatment after breast cancer surgery

Surgery is usually followed by further treatment steps in breast cancer therapy.

Radiotherapy

Radiotherapy is almost always recommended after an operation. It aims to destroy any remaining, invisible cancer cells in the breast and significantly minimise the risk of recurrence.

Radiotherapy procedure:

• Usually begins about four to six weeks after the operation, when the surgical wound has healed well
• Initially includes radiotherapy of the entire breast
• The standard treatment lasts three to six weeks with daily sessions on working days

Radiotherapy is an essential component of breast-conserving therapy and significantly reduces the risk of local recurrence. Only in exceptional cases (e.g. older patients with small, less aggressive tumours) can radiotherapy be dispensed with.

Further details on radiotherapy for breast cancer can be found here.

Systemic therapies

Depending on the individual characteristics of the tumour, additional treatments that affect the entire body (systemic therapies) may be recommended:

Chemotherapy

Chemotherapy can be carried out before or after the operation:

• Neoadjuvant chemotherapy (before the operation): Can help to shrink larger tumours and thus enable breast-conserving surgery
• Adjuvant chemotherapy (after the operation): Aims to destroy any cancer cells that may remain in the body

The decision for or against chemotherapy is based on various factors such as tumour size, lymph node involvement, biological characteristics of the tumour and possibly special genetic tests.

You can find more details on chemotherapy for breast cancer here.

Anti-hormone therapy

With hormone-sensitive tumours (oestrogen or progesterone receptor-positive), anti-hormone therapy is usually recommended for several years. 

Anti-hormone therapy reduces the risk of both a recurrence of cancer in the affected breast and of new cancer in the other breast.

Further details on anti-hormone therapy for breast cancer can be found here.

Antibody therapy

For certain tumour types, particularly HER2-positive breast cancer, special antibodies can be used to attack specific properties of the cancer cells. The best-known representatives are

• Trastuzumab (Herceptin)
• Pertuzumab
• CDK4/6 inhibitors

This therapy is usually administered over several months to a year and can significantly reduce the risk of relapse.

Further details on antibody therapy for breast cancer can be found here.

Your way back to life - we accompany you beyond the operation

An operation is more than just a medical procedure - it is the beginning of your journey back to life. At the Breast Centre am Englischen Garten, our care does not end in the operating theatre. We accompany you through the entire follow-up therapy right through to long-term aftercare.

Our promise to you: Regular check-ups with fixed contact persons who know you and your history. Modern imaging for maximum safety. Physiotherapy, psycho-oncological support and self-help groups - everything you need for your recovery.

Find out more about our support for rehabilitation and aftercare here.

Your health and well-being are important to us. Let us find the best way for you together.

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