One of the main methods of treating breast cancer is surgical intervention. Special attention is given to both the cosmetic outcome and the preservation of the patient's functional status after the operation when planning treatment.
Types of Surgical Treatment:
Radical modified mastectomy
Lumintectomy + axillary lymphadenectomy
Subcutaneous mastectomy with/without preserving the nipple + axillary lymphadenectomy
Total mastectomy
Segmental resection of the breast
Excision of the affected area of the breast
Sentinel lymph node biopsy using methylene blue
Cosmetic Aspect
Breast-conserving surgeries are a priority, determined by the size of the tumor and the clinical stage. In cases where complete tissue removal is necessary, reconstructive surgery can be performed either during the operation or at a later stage after treatment, involving a plastic surgeon.
Functional Aspect
In cases of breast cancer, regional (axillary) lymph node metastatic damage is often encountered, necessitating lymphadenectomy — the excision of nodes. However, this intervention may be accompanied by the following complications:
Upper limb lymphedema
Limitation of functional activity
Decreased sensitivity in the shoulder and axilla area
Worsening of quality of life
Sentinel Lymph Node Biopsy
The sentinel lymph node is the first lymph node that collects lymphatic flow from the breast, including possible spread of cancerous cells. In the 1990s, the authors of the method described the technique of sentinel lymph node biopsy, which is now considered a standard surgical method in the early stages of breast cancer.
During the biopsy, a blue dye and/or a radioactive substance is used for the visualization of the lymph node. A properly performed biopsy determines the extent of surgical intervention and subsequent tactics.
Indications:
Patients with early-stage breast cancer (T1 or T2) and clinically negative (N0) lymph nodes
Patients diagnosed with carcinoma in situ (DCIS)
Clip Marking
Marking of the tumor focus under ultrasound, mammographic, or MRI control
Accurate determination of location for surgery
Localization of the tumor before the start of neo-adjuvant therapy
Monitoring of the process during treatment
Possible in all imaging methods
Neo-Adjuvant Treatment and the Need for Clip
In locally advanced or aggressive forms, neo-adjuvant chemotherapy, targeted or hormone therapy is prescribed before surgical treatment. Its aim is to reduce and localize the tumor size, allowing a subsequent breast-conserving surgery.
During neo-adjuvant therapy, in cases where the tumor focus is replaced by fibrous tissue, clip marking is crucial for planning the surgery.
Wire Marking — Surgical Planning
Preoperatively, under ultrasound control, a marking device — known as a “wire” — is placed based on the localization of the focus or clip marker. This determines the exact location of the surgical incision. The intraoperative express morphological study assesses the presence of cancer cells at the margins.
This ensures:
The most tissue-conserving excision of breast tissue
Accurate and effective surgical intervention
Preservation of the breast
Wire Marking is used for:
Preoperative marking of pathological tissue
For the surgeon during the planning process of the operation
In excisional surgeries (especially in small tumors)
Compatible with all types of imaging methods