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Surgery remains predominant in the treatment of breast cancer

Unavoidable surgery is very often one of the first steps in the treatment of breast cancer. It remains, above all, the most effective means of controlling the disease at an early stage in its development.

The decision to use a surgical procedure to remove the affected tissues depends on a set of factors contained in the initial diagnosis of breast cancer: the size of the tumour, its characteristics, stage of development, aggressiveness and extent. The patient’s age, health history, and general condition are also important decision-making parameters. However, beyond all these considerations, the surgical procedure remains an essential step on the therapeutic path of the vast majority of patients. “Most women with breast cancer will face surgery,” says Dr. Sindy Monnier, gynaecologist, specialist in breast surgery and co-director of the Breast Centre. However, she goes on to add important details: “While surgery is essential to the treatment of breast cancer – supported by radiotherapy or chemotherapy, among others – the operation itself can take different forms. The entire set of preliminary observations are used to determine the optimal solution for each patient. ”

The role of the weekly Multidisciplinary Consultation meetings (MDC) is essential here: during these exchanges between several doctors, all specialists in the disease, the most effective protocols are selected for each case and subsequently recommended to the patients. Before giving their consent to a particular type of intervention patients therefore always benefit from the opinion of several experts.

“In general, the advances made in breast cancer surgery in recent years favour less invasive and less aggressive interventions for the body. From this viewpoint, about 70% of operations aim to be very local, removing the tumour whilst preserving the breast. The improvement of the surgical techniques specific to these “conservative” treatments is a great step forward, but the conditions must be suitable for their use. Detecting the tumour at an early stage is often a necessary condition for targeted actions,” says Dr. Monnier. While conservative treatments are safe for long-term survival, in 30% of the situations faced by specialised surgeons, mastectomy, i.e. complete breast removal (non-conservative surgery) nevertheless seems inevitable. In the latter case, the surgeon may propose an immediate or delayed reconstruction of the breast. Even with conservative treatment, the aesthetic concern is now present. “The use of techniques derived from plastic surgery in interventions by surgeons specialising in breast cancer – oncoplastic surgery – represents another favourable development in recent years: for example, the aim is to maintain the symmetry of the breast or use natural anatomical features to minimise scarring,” says Dr. Sindy Monnier.

In the treatment of breast cancer, surgery is often performed first, before being supplemented by systemic therapy (chemotherapy-hormone therapy) and/or radiotherapy. Sometimes we proceed in the reverse manner (so-called “neo-adjuvant” chemotherapy), the aim being to reduce the size of the tumour and increase the chances of being able to use a more conservative surgical approach. Note also that, as the tumour can propagate the ganglia of the trough of the armpit are observed with attention. “Again, in a minimally invasive approach, the so-called “sentinel node” surgical technique is now favoured: instead of precautionary removal of numerous axillary lymph nodes that may serve as relays for metastases, i.e. the dissemination of cancerous cells, we now only remove the first in the ganglionic chain when possible. If the analysis of this so-called “sentinel” ganglion makes it possible to rule out any risks, it is not worthwhile removing the others located around,” comments Dr. Monnier.