Breast surgery

Depending on tumor size and its relation to the size of the breast, the distance to the skin and the nipple, breast cancer surgery can be performed either breast conserving or by mastectomy.
In more than 80% of breast cancer cases breast conserving surgery is the method of choice and can be performed leaving nearly invisible scars without breast deformation using different oncoplastic techniques.
Mastectomies- if oncologically indicated or in the case of hereditary breast cancer- can be performed skin and/or nipple sparing with immediate breast reconstruction.
In those cases where the skin and/or the nipple is involved, a modified radical mastectomy is indicated and can be combined with an immediate reconstruction using for example an expander.
Axillary surgery is another key element in oncological breast surgery: In the case of radiologically and clinically negative axillary lymph nodes, a Sentinel-node-biopsy using blue dye and/or radionuclid is performed.  During the operation the pathologist examines the Sentinel using frozen section. In case of a positive (involved) Sentinel is, more axillary lymph nodes have to be removed.
If mastectomy is indicated, immediate reconstruction can be performed in most of the cases.
Implant-based breast reconstruction is the most used method in breast reconstruction worldwide. Since about two years there is a trend towards prepectoral breast reconstruction. In prepectoral breast reconstruction the implant´s position is on the Pectoralis major muscle and fixed using an acellular dermal matrix (ADM) or a Mesh, leading to less postoperative pain, shorter operating time and hospital stay.
After pre- and retropectoral breast reconstruction a later Lipofilling could be beneficial leading to a more natural breast shape.
Furthermore, asymmetry could occur and contralateral adjustment could be necessary using augmentation, mastopexy or a reduction mammoplasty.
It would be a pleasure to discuss with you different individual options of breast reconstruction with my experience as the head of reconstructive breast surgery at the gynaecological breast cancer center of the AKH Vienna and as organizer and teacher of several reconstructive workshops.