Breast surgery encompasses any operation performed on the breast tissue, ranging from minimally invasive sampling to extensive reconstructive operations. These procedures address a broad spectrum of needs, from investigating suspicious findings to managing confirmed disease. The goals of breast surgery generally fall into three categories: diagnosis and treatment, managing existing conditions like cancer, or restoring and altering the physical form of the breast.
Diagnostic and Minimally Invasive Procedures
When an abnormality is detected, surgeons perform a breast biopsy to collect small tissue samples for laboratory analysis. The most common method is a core needle biopsy, which uses a hollow needle to extract cylindrical pieces of tissue. A fine-needle aspiration (FNA) collects individual cells rather than a tissue core. These procedures are typically performed under local anesthesia in an outpatient setting to provide a definitive diagnosis without traditional open surgery.
To ensure accurate sample collection, these needles are precisely guided using imaging technologies. Ultrasound guidance is frequently employed for lesions that are easily visualized and palpable beneath the skin. If the abnormality is only visible on a mammogram, stereotactic guidance uses two-dimensional X-ray images to pinpoint the exact location of the target. Vacuum-assisted biopsy uses a specialized device that removes multiple tissue samples through a single, small incision, sometimes allowing for the complete removal of a small, non-cancerous lesion.
The Sentinel Lymph Node Biopsy (SLNB) is often grouped with diagnostic interventions. This procedure involves identifying, removing, and analyzing the first one to three lymph nodes that receive drainage from the breast tumor site. Surgeons inject a tracer substance, such as a blue dye or a radioactive colloid, which travels to these sentinel nodes for identification and removal. Analyzing these nodes helps determine if cancer cells have begun to spread beyond the breast tissue, providing information for subsequent treatment planning.
Therapeutic Procedures for Disease Management
For many patients diagnosed with early-stage breast cancer, a lumpectomy, also known as breast-conserving surgery (BCS), is an option. This procedure involves removing only the cancerous tumor and a small margin of surrounding healthy tissue. The goal is to maximize cancer removal while preserving the majority of the breast’s appearance and structure. Lumpectomy is generally followed by radiation therapy to eliminate any remaining microscopic cancer cells.
When the tumor is large, involves multiple sites, or when the patient cannot receive post-operative radiation, a mastectomy may be recommended. A mastectomy involves the surgical removal of the entire breast gland tissue. This major intervention is designed to completely eradicate the disease by removing the primary site of cancer.
The simple, or total, mastectomy removes all the breast tissue, including the nipple and areola complex, but leaves the underlying chest muscle intact. This approach is standard for localized disease when reconstruction is not immediately planned. The removed tissue is sent for pathological analysis to confirm clear margins were achieved.
A skin-sparing mastectomy is a variation where the surgeon removes the internal breast tissue but preserves most of the overlying breast skin envelope. This technique is often preferred when immediate breast reconstruction with an implant or flap is planned. Saving the skin allows the reconstructed breast to achieve a more natural shape and contour.
The most advanced technique is the nipple-sparing mastectomy, which removes the underlying breast tissue while preserving both the skin envelope and the nipple-areola complex. This option is typically reserved for women whose tumors are located far from the nipple and who have no evidence of cancer cells in the nipple ducts. It offers the best cosmetic outcome for patients undergoing immediate reconstruction.
Aesthetic and Volume Alteration Procedures
Aesthetic breast surgery focuses on modifying the shape, size, or position of the breasts for elective reasons, rather than disease treatment. Breast augmentation is a common procedure intended to increase breast size, most frequently achieved through the surgical insertion of saline or silicone gel implants. Implants are placed either subglandularly (beneath the breast tissue) or subpectorally (beneath the chest muscle).
Augmentation can also be performed using autologous fat transfer, where fat is harvested from another part of the body via liposuction. This fat is purified and injected into the breast tissue to achieve a modest increase in volume and improve contour. Fat transfer offers a more natural feel and avoids foreign materials, but the volume increase is limited compared to synthetic implants.
Conversely, breast reduction surgery decreases the overall volume and weight of the breasts, often to alleviate physical symptoms such as chronic back, neck, and shoulder pain. The procedure involves removing excess breast tissue, fat, and skin, and simultaneously repositioning the nipple to a higher level. This operation is considered both aesthetic and functional, significantly improving quality of life by reducing musculoskeletal strain.
When breast volume is adequate but the breasts appear droopy (ptotic), a mastopexy, or breast lift, is performed. This procedure addresses sagging by removing excess skin and tightening the surrounding tissue to reshape the breast mound. The nipple and areola are repositioned upward without significantly changing the volume, resulting in a more youthful and elevated contour.
Post-Mastectomy Reconstructive Options
Following a mastectomy, reconstructive surgery is an option to rebuild a breast mound, restoring the body’s symmetry and physical appearance. This process can be performed immediately at the time of the mastectomy or in a delayed fashion, sometimes years later. Reconstruction involves several stages and requires careful planning between the oncological and plastic surgery teams.
One primary method uses implants, which often requires the initial placement of a tissue expander beneath the chest muscle or skin envelope. The expander is gradually filled with saline over several weeks or months to stretch the skin and create a pocket for a permanent implant. This method is less invasive than flap surgery and requires a shorter initial operative time.
The alternative method is autologous reconstruction, or flap surgery, which uses the patient’s own tissue to create the new breast mound. Common donor sites include the abdomen, back, or buttocks, with procedures like the Deep Inferior Epigastric Perforator (DIEP) flap preserving abdominal muscle function. Flap reconstruction results in a breast that changes naturally with the patient’s weight and provides a softer, more permanent result.