The introduction of radioactive seed localization (RSL) has enhanced the surgical options for patients who require surgery for the removal of a tumor that cannot be identified on physical exam.
RSL is a procedure in which a radiologist uses mammography to place a very low-energy radioactive seed into the abnormal tissue or tumor in the breast. A radiologist who has been trained in this procedure performs the seed implantation, assisted by a mammography technician.
The seed placement procedure is very similar to the needle biopsy procedure you underwent to obtain your diagnosis. The radiologist will inject a local anesthetic to numb the area before starting the procedure. Since mammography is used to place the seed, you will feel pressure from the paddles.
The seed (called Iodine 125 or I-125) is of very low energy, and its placement is not considered to be dangerous to you. The radiologist can implant the seed up to a week before your surgery. Once the seed is removed with the breast tissue, all of the radioactivity is gone.
With RSL, the surgeon knows the precise location of the tumor and can more accurately plan the surgical incision. This also reduces the length of the surgery. In addition, studies show that RSL reduces the need to have a second surgery due to incomplete removal of the abnormal tissue.
During the surgery, the surgeon uses a handheld Geiger counter (a device that detects radioactivity) to more precisely identify the location of the tumor. The Geiger counter also allows the surgeon to obtain a three dimensional view of the tumor’s location.
Nipple sparing mastectomy (NSM) may be an option for women who are undergoing a prophylactic mastectomy due to a high risk of breast cancer, or for women who do not have advanced disease.
The surgery is performed by a surgical oncologist in conjunction with a plastic surgeon. Working together, the surgeons can remove the necessary amount of tissue from a cancer prevention perspective, while maintaining the best possible cosmetic result as well.
During the procedure, the breast surgeon makes an incision on the outer edge of the breast, toward the armpit, and takes out the breast tissue under the skin and nipple. A plastic surgeon then creates a pocket under the pectoralis muscle and uses a tissue expander to create a space the desired size and shape of the breast.
Once the space is created, you will return for another surgical procedure in which the plastic surgeon removes the expander and places the final implant under the muscle.
Candidates for NSM include:
- women with a strong family history of breast cancer, particularly women who test positive for the BRCA1 or BRCA2 gene mutation
- women who have other reasons for being classified as high risk for breast cancer development
- women who have had cancer in one breast and are at high risk to develop the disease in their healthy breast
- select women with cancer in a breast, but there are restrictions on tumor size and distance of the tumor from the nipple
A welcome option for some women facing the prospect of a lumpectomy, during oncoplastic surgery, our specially trained surgical oncologists remove cancerous tissue from the breast and repair the breast cosmetically – all in one surgery.
During oncoplastic surgery, the surgeon removes the breast tumor while also removing some surrounding normal tissue to ensure that all cancer cells have been removed. At the same time, the surgeon fills the gap created by reshaping or moving the tissue around it.
The result is a whole breast without an empty cavity, thereby decreasing the risk of a deformed breast. The benefits are many. Since there is only one surgery, you undergo anesthesia once and experience one recovery period. Emotional and psychological benefits include reduced anxiety at the thought of multiple surgical procedures and less trauma since you do not have to endure the time between surgeries during which the breast is misshapen.
The greatest benefit of oncoplastic surgery is that it may allow women with larger tumors who would otherwise require a mastectomy to instead undergo a lumpectomy using oncoplastic surgery and preserve a natural-appearing breast.
Post-lumpectomy radiation is still required as is standard for all breast conservation treatment.
There are times where breast conservation is not appropriate and that a mastectomy (likely with breast reconstruction performed by a plastic surgeon) is still sometimes the safest option from a cancer standpoint or the best option from a cosmetic standpoint. Talk to your breast surgeon about your options.