From surgery to reconstruction, the journey of treatment and recovery for breast cancer patients

Author: Sun Qiang, Chief Physician, Peking Union Medical College Hospital

Reviewer: Bai Wenpei, Chief Physician, Beijing Century Altar Hospital, Capital Medical University

Breast cancer, as one of the major malignant tumors affecting women's health, its treatment methods and subsequent quality of life issues have always been the focus of social attention.

With the continuous advancement of medical technology, the treatment methods for breast cancer are becoming more and more diverse, from traditional surgery, radiotherapy to chemotherapy, endocrine therapy and targeted therapy, each method provides patients with more choices and hope. At the same time, the preservation and reconstruction of breast appearance has also become an important part of modern breast cancer treatment.

1. Comprehensive treatment strategy for breast cancer

The treatment of breast cancer cannot be solved by a single method, but is a comprehensive treatment process involving multiple disciplines. Local treatment mainly includes surgery and radiotherapy. Surgery removes the tumor tissue to eliminate the lesion, while radiotherapy uses radiation to irradiate the local area to kill the remaining cancer cells. These two methods complement each other and together constitute the important cornerstone of local treatment of breast cancer.

Systemic treatments include chemotherapy, endocrine therapy, and targeted therapy, which have a wider range of effects and are designed to kill or inhibit potential cancer cells in the body and prevent recurrence of the disease. Chemotherapy kills cancer cells through chemical drugs, endocrine therapy inhibits tumor growth by regulating hormone levels, and targeted therapy precisely targets molecules unique to cancer cells. The combined use of these treatments has significantly improved the cure rate of breast cancer and brought patients a longer survival period.

It is worth noting that although the efficacy of methods such as traditional Chinese medicine and immunotherapy in the treatment of breast cancer is still uncertain, scientists are actively exploring their potential and look forward to bringing more good news to patients in the future.

2. Breast-conserving surgery: dual considerations of treatment and aesthetics

Breast-conserving surgery (also known as breast conservation surgery) has gradually become a popular option in breast cancer surgery. It can not only effectively remove the tumor, but also maximize the preservation of the appearance and function of the breast, satisfying the pursuit of beauty for many female patients. However, in order to achieve the same therapeutic effect as radical resection, patients after breast-conserving surgery usually need radiotherapy.

Figure 1 Original copyright image, no permission to reprint

Moreover, breast-conserving surgery is not suitable for all breast cancer patients, and its selection must strictly follow certain conditions.

First, the patient must have a strong desire for breast conservation and be willing to accept the necessary radiotherapy after breast conservation surgery. Secondly, the characteristics of the tumor are also key factors in determining whether breast conservation surgery can be performed, including whether the mass can be completely removed, whether the shaping effect is satisfactory, whether the tumor is single and of moderate size, and whether the patient has contraindications to radiotherapy. Only when these conditions are met will the doctor consider performing breast conservation surgery for the patient.

For patients who undergo breast-conserving surgery, postoperative quality of life is equally important. Studies have shown that breast cancer patients who have undergone regular treatment can consider pregnancy after completing surgery, chemotherapy, and radiotherapy. Childbearing or not has no significant effect on the overall recurrence and survival of breast cancer patients, and some data even suggest that the situation may be better after childbearing. At the same time, for patients who retain their breasts, although radiotherapy may affect the lactation function of the affected breast, the contralateral breast can usually lactate normally.

3. Breast reconstruction: another option to regain confidence

For patients who are not suitable for breast-conserving surgery and must undergo a total mastectomy, breast reconstruction surgery provides them with the possibility of regaining their self-confidence. Breast reconstruction surgery can choose different methods according to the patient's specific situation, including reconstruction using autologous tissue and reconstruction using prostheses. These methods can restore the appearance of the breasts to a certain extent and help patients reintegrate into society and life.

Breast reconstruction surgery is usually performed within a period of time after mastectomy, so that the patient's physical and psychological state can recover. During the reconstruction process, if the patient's nipple and areola are not affected by the lesion, they can be preserved and repaired; if the lesion has invaded the nipple and areola, reconstructive surgery can also be performed to restore its appearance. These meticulous surgical operations not only focus on the morphological beauty of the breasts, but also on the patient's psychological feelings and quality of life.

Figure 2 Original copyright image, no permission to reprint

IV. Review strategy and recurrence risk assessment

It is crucial for breast cancer patients to have follow-up examinations after treatment, especially in the first two years. It is routine to have a full-body examination every six months, which can then be appropriately reduced to once a year.

The review includes clinical examination and imaging examination to detect possible signs of recurrence or metastasis in a timely manner. The recurrence rate of breast cancer is affected by many factors. For patients who are discovered early and receive standardized treatment, such as stage I breast cancer, the long-term recurrence rate can reach 96%, while the recurrence rate of patients in the late stage may be as high as 40%-50%.