Carcinoma in a lymph node may not require the most extreme surgery.

This has been an exciting year for breast cancer patients and their treating physicians. New data has shown that surgeons do not have to remove additional lymph nodes in some women with disease in the sentinel lymph node. There are new reconstructive options, and increasing use of nipple-sparing mastectomies for women undergoing breast cancer surgery.

The American College of Surgeons Oncology Group (ACOSOG) performed a randomized prospective clinical trial in breast cancer patients undergoing lumpectomy followed by radiation to study whether additional lymph node surgery in women with sentinel lymph node disease affected local control or survival. Six-year follow-up showed no significant difference between women who had no further surgery versus a complete axillary lymph node dissection.

Furthermore, women who had an additional axillary lymph node dissection had more complications, such as infection, upper arm numbness, and lymphedema. This new data has influenced many surgeons to decide not to perform additional lymph node dissection in select breast cancer patients with sentinel lymph node disease undergoing lumpectomy followed by radiation. This can be good news for women with sentinel lymph node disease, who should discuss these new findings with their physicians to see if this treatment option is appropriate for them.

In addition, the last several years have seen many new reconstructive options become available to patients. Implant reconstruction has dramatically improved, with the availability of more natural-shape implants and new implant coverage materials to recreate natural breast contour. Some plastic surgeons inject a patient’s fat around the implant to improve cosmesis. In addition to the traditional TRAM reconstruction, in which a reconstructive surgeon mobilizes a patient’s fat and muscle from her belly to recreate the breast, there are many alternative reconstructive flap options depending on body type. Increasingly, many surgeons are performing nipple-sparing mastectomies in women undergoing prophylactic surgeries and in those with small cancers. The use of nipple-sparing mastectomies in combination with these new reconstructive techniques offers breast cancer patients superior cosmesis with equally effective local control.

In summary, the trend in breast cancer surgery is toward less invasive surgery with improved reconstructive options. This has resulted in improved cosmesis, body image, and quality of life while maintaining breast cancer local control and survival.

And that really is good news.

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