<p>Breast cancer is the most common cancer among women in Pakistan, and one of the leading health challenges worldwide. According to the National Cancer Registry of Pakistan (2023), breast cancer accounts for 21.4% of all cancers and nearly 39% of cancers in women.</p><p>While awareness and treatment options are improving, many women in Pakistan are still diagnosed at later stages. In such cases, a mastectomy (complete removal of the breast) often becomes the only surgical option. However, when breast cancer is detected early, another option—<strong>breast-conserving surgery</strong>—may be possible. Breast-conserving surgery removes the tumour while keeping most of the breast intact. The choice between mastectomy and breast conservation depends on the cancer's stage and type, medical factors, and importantly, the patient's own preference.</p><p>A significant finding to remember is that overall survival rates for mastectomy and breast-conserving surgery are the same. A landmark study published in the <em>New England Journal of Medicine</em> (2022) confirmed that while chances of the cancer coming back are slightly higher after breast conservation, the overall survival rate stays the same for both procedures. Simply put, what matters most is whether the cancer has spread beyond the breast—not how much of the breast is removed.</p><p>As survival rates continue to rise and more younger women are being diagnosed, the focus of breast cancer treatment is now shifting towards quality of life after surgery. Research published by the Aga Khan University (2023) found that quality of life—including self-esteem, body image, and sexual health—should be central in treatment planning. Studies have shown that women who undergo breast-conserving surgery often report greater satisfaction than those who undergo a mastectomy.</p><p>Despite these benefits, breast-conserving surgery remains uncommon in Pakistan. Many women opt for mastectomy due to limited awareness, cultural taboos, financial constraints, or the misconception that removing the entire breast guarantees better survival. Some also decline breast reconstruction after mastectomy due to expense or fear of complications. Additionally, limited surgeon training in advanced breast-conserving techniques in Pakistan contributes to the low adoption of these procedures.</p><p>Modern medicine now offers a powerful advance in breast conservation: oncoplastic surgery—a technique that combines cancer surgery with plastic surgery principles. Oncoplastic surgery allows surgeons to remove the tumour while preserving the breast's natural shape, helping patients maintain their appearance without compromising cancer safety. </p><p>Breast-conserving approaches such as oncoplastic surgery enable women to treat their cancer effectively while preserving their femininity, confidence, and emotional well-being. These techniques also reduce the psychological and sexual distress that can accompany mastectomy.</p><p>With the introduction of neo-adjuvant therapy (treatment given before surgery), even more women now qualify for breast-conserving procedures. For low- and middle-income countries like Pakistan, this approach offers added value—it is cost-effective, reduces the need for repeat surgeries, and lessens the burden on healthcare systems.</p><p>Modern breast cancer treatment also depends on a multidisciplinary team—including breast surgeons, oncologists, plastic surgeons, radiologists, and counsellors. This collaborative approach ensures that all aspects of a patient's care are considered. By discussing every case together, the team helps patients make informed choices that not only focus on treating the cancer but also support their physical and emotional well-being.</p><p>The future of breast cancer surgery in Pakistan lies in the wider adoption of oncoplastic techniques and the strengthening of surgeon training programmes. By bridging the gap between developed and developing countries, Pakistan can provide its patients with surgical options that prioritise not only survival, but also dignity, confidence, and long-term quality of life. </p><p>Ultimately, our goal as breast surgeons is to provide every person with breast cancer the highest standard of care—care that respects their medical needs, honours their personal choices, and helps them emerge from treatment healthy, whole, and hopeful.
</p><p><strong>Author: </strong><a href="/pakistan/patientservices/pages/profiles.aspx?ProfileID=67&Name=Lubna%20Mushtaque%20Vohra&page=findadoctor">Dr. Lubna Vohra</a>, Consultant and Section Head of Breast Surgery, AKUH. </p><p><strong>Note:</strong> This article was originally published in <a href="https://drive.google.com/file/d/1eX4AmfcYxs_TosYFvafV6pCZ3xu40lRt/view?usp=sharing">Jehan Pakistan</a>.
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