Breast cancer has become a disease with a five-year survival rate above 90%. Many patients live for decades after finishing treatment. As a result, the goal of treatment has expanded beyond simply raising survival rates to protecting quality of life afterward.
Mental health is often overlooked in life after treatment. Breast cancer patients experience depression at higher rates than the general population. Some studies report that one in three patients has depressive symptoms. One cause is a body that has changed after surgery. For women, the breast carries meaning beyond being a part of the body. Every time a patient steps in front of the mirror after a shower, the scar brings back memories of the diagnosis and the operation. Even when treatment is over, the psychological wound left by cancer is not easily escaped. Because of scars or a sunken breast, patients avoid swimming pools and public baths, and they pay attention to covering their bodies when choosing clothes. Giving up one small pleasure of daily life after another can build a sense of withdrawal and loss that erodes quality of life.
Breast cancer surgery once meant removing the breast, the chest muscle and even the lymph nodes in the armpit over a wide area. But large-scale studies from the 1970s onward confirmed that breast-conserving surgery — removing only the tumor site and combining it with radiation therapy — produces no difference in survival from a total mastectomy in appropriately selected patients. About two-thirds of breast cancer operations in Korea are now performed as conserving surgery.
Conventional breast-conserving surgery, however, often requires an incision in the skin directly over the tumor or around the areola, plus an additional incision in the armpit to examine the lymph nodes. The larger the tumor, the longer the incision line, and the area where tissue has been removed can sink, leaving the breast depressed or asymmetric.
Robotic breast-conserving surgery is a technique designed to reduce such scarring and deformity. A single incision of about 3 to 4 centimeters is made on the side of the armpit, where it is barely visible when the arm is lowered, and both the lymph node examination and the partial removal of the breast are carried out through it. Magnified three-dimensional images and precision instruments that move as freely as a wrist allow access deep into the breast through a small incision. One advantage is that no incision line is left directly on the breast skin, easing the burden of scarring.
Precisely removing the tissue around the tumor under a magnified view and minimizing damage to healthy tissue also helps reduce depression or deformity of the breast. The smaller incision may also reduce pain and the burden of recovery after surgery. Depending on the patient's condition and recovery, some are discharged the day after the operation.
What matters is that the principles of cancer treatment remain the same even when the surgical method changes. The tumor must be removed with an adequate resection margin, and postoperative radiation therapy and any necessary drug treatment follow the same principles as in conventional breast-conserving surgery. Robotic surgery is not an operation that removes less; it is an operation that seeks to reduce scarring and deformity while upholding the principles of cancer treatment.
Robotic breast-conserving surgery does, however, demand a high level of skill. The robot must be manipulated precisely in a narrow space, and because the tumor cannot be felt by hand, ultrasound must be used during the operation to confirm its location and borders. That is why the procedure requires a surgeon with ample experience in both robotic surgery and ultrasound. Even with the same equipment, outcomes can differ depending on the surgeon's skill. Confirming that no cancer cells remain at the edges of the removed tissue is also essential.
Not every patient can undergo robotic surgery. It can be considered for patients who are already candidates for conventional breast-conserving surgery and who have a single tumor located well away from the skin. By contrast, when a tumor has invaded the skin or the nipple, when the lesion has spread widely, or in cases of inflammatory breast cancer, conventional surgery or a total mastectomy may be more appropriate. Robotic surgery is not covered by national health insurance, so the cost burden must also be weighed. It is important to discuss the options thoroughly with the attending physician based on preoperative imaging results and the patient's condition.
The ultimate goal of surgery is for patients to live having forgotten that they had breast cancer surgery at all. Breast cancer surgery continues to evolve so that patients can preserve the safety and effectiveness of cancer treatment while also reclaiming the ordinary routines of visiting a swimming pool or a public bath.