Surgery
Women diagnosed with breast cancer often have to undergo some type of surgical procedure to remove the cancer. The main two surgical options are mastectomy (breast removal) and breast-conservation surgery. Breast reconstruction can be done during the surgical procedure or later on. Lymph nodes are also surgically removed to test for cancer and it includes sentinel lymph node or axillary lymph node dissection.
Breast-conserving surgery
It is also called partial mastectomy or lumpectomy and removes only a portion of the affected breast, although the extent of removal is highly dependent on the size and location of the tumor. Lumpectomy will remove only the breast lump and a margin of the normal tissue. This may be followed by radiation treatment. Side effects of lumpectomy are bleeding and infection, pain, swelling, tenderness, and scar formation at the surgical site. Reconstructive surgery may be necessary to regain the shape of the original breast although options for reconstruction may be limited after radiation has been performed
Mastectomy
The removal of the entire breast is called mastectomy, which can include removal of the entire breast tissue along with surrounding tissues. The different types of mastectomy are:
- Total or simple mastectomy involving removal of the entire breast, including the nipple. A double mastectomy (bilateral – both sides) may be performed sometimes as a preventive measure in women who are at a very high risk for breast cancer.
- Skin-sparing mastectomy is done when women are considering immediate breast reconstruction. Most of the breast skin is left intact except the nipple and areola. It is not suitable for larger tumors or if the tumor is too close to the skin. Nipple-sparing mastectomy is a variation of the procedure as an option for a small very early-stage cancer which is not directly below the nipple. Some patients with suitable tumor location may still not be a candidate for a nipple-sparing procedure due to cosmetic concerns.
- Modified radical mastectomy involves a simple mastectomy with the removal of axillary lymph nodes located under the armpit.
- Radical mastectomy is an elaborate surgery where the whole breast is removed along with lymph nodes and chest wall muscles under the breast. The surgery is rarely performed but used to be the only available treatment; it was done for very large tumors that grow into the chest muscles below the breast.
Deciding between lumpectomy and mastectomy
Women diagnosed with early-stage cancers can choose between breast-conserving surgery and mastectomy. A lumpectomy is advantageous because a woman can keep most of her breast, but the disadvantage is that she must undergo radiation treatment after surgery. Some forms of radiation therapy are completed in 3-4 weeks; some are given over a 5-day course, and there is early data supporting the use of intraoperative radiation (one dose at the time of surgery). For some women, mastectomy may be a suitable option because they have already had radiation therapy to the breast. They may also have large tumors that require mastectomy. Lumpectomy is not suitable for women with inflammatory breast cancer.
Axillary lymph node dissection
Removal of lymph nodes in the underarm area is important to determine if the breast cancer has spread. It is important in staging the breast cancer as cancer may have spread to other parts of the body. The procedure can be done along with breast-conservation surgery. Side effects of axillary lymph node dissection include pain, arm numbness, swelling, bleeding, and infection. Lymphedema is a long-term risk of the surgery which results in painful swelling of the arm.
Sentinel lymph node biopsy
The procedure involves removal of the first lymph node to which the tumor drains, and is most likely to contain cancer cells if the cancer has spread. Side effects include pain, swelling, bleeding, and infection. Lymphedema can still occur, but at a much lower rate (5-7%) than with axillary dissection.
Reconstructive surgery
Women undergo breast reconstructive surgery after lumpectomy or mastectomy to retain the original shape of their breast. Sometimes the surgery is done at the same time as lumpectomy or mastectomy. Reconstruction is done using saline or silicone implants, while sometimes autologous tissue reconstruction is done using tissue from other parts of the body. Even if immediate reconstruction is performed, more than one procedure is usually needed, including sometimes procedures to the other breast to regain symmetry.
Content reviewed by Deanna Jean Attai, MD, FACS
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