Surgery is the cornerstone of treatment for breast cancer, a disease affecting more and more women across the Maghreb and Africa. With 15,000 new cases diagnosed each year in Algeria and more than 10,000 women screened annually in Tunisia, understanding the surgical options becomes essential for any woman facing this diagnosis.
When should breast cancer surgery be considered?
An unavoidable first-line treatment
Surgery is generally the first step towards recovery. Its main goal? To remove the tumour completely, through two distinct approaches:
- Breast-conserving surgery (lumpectomy): preserves the breast
- Non-conserving breast surgery (mastectomy): partial or total removal of the breast
In contrast to the 75% of conserving surgeries performed in Europe, the countries of the Maghreb show lower rates. In Tunisia, only 23.8% of patients undergo breast-conserving surgery, mainly because of late diagnoses.
A comprehensive therapeutic approach
Surgery is often accompanied by additional treatments:
- Radiotherapy: combined in most cases after breast-conserving surgery
- Chemotherapy: used in around 30% of patients
- Hormone therapy: prescribed according to the tumour profile
In Tunisia, 75% of patients with HER2-positive breast cancer now receive treatments in line with international standards.
Types of breast surgery: making the right choice
| Type of surgery | What it involves | When it is offered |
|---|---|---|
| Breast-conserving surgery (lumpectomy) | Removal of the tumour with a safety margin; preserves the breast | Reserved for small tumours |
| Mastectomy (non-conserving breast surgery) | Partial or total removal of the breast | Tumour too large relative to the breast, several tumour sites, or a location that makes conserving surgery impossible |
Conserving surgery: preserving to heal better
This preferred technique removes only the tumour, with a safety margin. Even so, it remains reserved for small tumours, which is why early screening is so crucial.
Before the operation:
- Precise localisation of the tumour by mammography
- Skin marking and placement of a metal guide wire
- Neoadjuvant chemotherapy if the tumour measures 3 to 5 cm
During the operation:
- A localised incision near the tumour
- Preservation of the areola and nipple
- Immediate reshaping of the breast to avoid deformities
Post-operative follow-up: Every tissue sample removed undergoes a thorough analysis to determine its sensitivity to targeted therapies and to fine-tune the treatment.
Mastectomy: when radical measures become necessary
This procedure becomes necessary when:
- The tumour is too large relative to the breast
- Several tumour sites coexist
- The location makes conserving surgery impossible
In Morocco, 90.3% of patients undergo a surgical procedure, a testament to the commitment of the medical teams despite the logistical challenges.
The groundbreaking sentinel node technique
Targeted detection for optimal care
This innovative procedure identifies the first node that receives the lymphatic drainage from the breast. If it is affected, the spread progresses gradually towards the other nodes.
Precise localisation: Two methods make it possible to locate the sentinel node:
- Patent blue dye: injected in the operating theatre
- A radioactive tracer: administered a few hours before the operation
This technique avoids routine axillary clearance in low-risk patients, significantly reducing post-operative complications.
Lymph node clearance: sometimes unavoidable
When invasive cancer is confirmed or the sentinel node contains malignant cells, the removal of 8 to 10 nodes becomes necessary. This analysis determines the extent of the disease and guides later treatments.
Side effects: anticipating them to support patients better
Short-term complications
The immediate aftermath of surgery may include:
- Temporary fatigue
- Pain around the incision
- Localised oedema
- Lymphatic leakage
- Sensory disturbances in the arm
Long-term after-effects: prevention and management
Lymphoedema of the arm, a dreaded complication of lymph node clearance, calls for particular monitoring. Several preventive measures are needed:
- Protect the operated arm from injury
- Avoid heavy loads
- Maintain an optimal weight
- Wear a suitable bra
Giving up smoking several weeks before the operation considerably reduces the risk of complications.
Towards preventive surgery: the future of prevention
For women carrying the BRCA1 and BRCA2 genetic mutations, which are particularly prevalent in North Africa, prophylactic surgery represents a radical prevention option. This procedure, reserved for women over 30, calls for careful consideration and the approval of a multidisciplinary team.
The hope of early diagnosis in the Maghreb
National initiatives are multiplying. Algeria has raised its early detection rate from 30% to 70% in a decade thanks to mobile mammography units. In Morocco, 1.8 million women benefit from national screening each year.
However, with only 32.3% of breast cancers in Tunisia diagnosed at an early stage, awareness efforts must be stepped up. Every woman deserves access to the same chances of recovery, regardless of her geographical or socio-economic situation.
Breast cancer surgery is constantly evolving, offering growing prospects of hope. Today, buoyed by technical progress and multidisciplinary care, many women can face their recovery with optimism while preserving their femininity.
