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Breast Cancer Surgery

Surgery is often needed to treat breast cancer. Options include a mastectomy to remove the entire breast or breast-conserving surgery (lumpectomy) followed by radiation treatments. Samples or the majority of the lymph nodes under the arm pits may be removed. Breast reconstruction can be done at the time of surgery or later.

Doctors evaluate a number of factors to determine what type of surgery is best for each patient. These include the size and location of the cancer, the extent of the disease, your medical history and your age. For example, if your tumor is large and a significant amount of breast tissue would have to be removed, your surgeon may recommend a mastectomy with reconstructive surgery to restore the appearance of the breast. If the tumor is small, breast-conserving therapy might be the best choice. In discussing treatment options with your surgeon, it is important to consider your self-image and personal feelings about a mastectomy vs. breast-conserving surgery. However, keep in mind that your top priority should be getting the treatment that will give you the best hope of a cure. When a choice is available, all research has shown equal survival with either mastectomy or breast conserving surgery.

Lumpectomy

This is a surgical procedure to remove a small tumor while preserving the rest of the breast. This procedure is often recommended for women with early-stage breast cancer. The surgeon will also remove a margin of healthy tissue surrounding the tumor to make sure that no cancer cells remain. Patients also go through radiation therapy following a lumpectomy to prevent local recurrence of cancer in the preserved breast. Oncoplasty is a form of reconstructive surgery. It may be an option for improved cosmetic results following lumpectomy.

Mastectomy

This surgery involves removal of the entire breast (all breast tissue). Radiation therapy may not be needed after a mastectomy. It may be recommended if there is any concern that cancer cells might still be in the breast area, the cancer measures more than 5 centimeters or involves many lymph nodes (greater than 3).

Most women who have this surgery have a total mastectomy that involves removal of the breast and a sentinel node evaluation with possible removal of the majority of the lymph nodes in the armpit. A radical mastectomy is a more extensive operation that involves removal of the breast, lymph nodes and the pectoral muscles under the breast. Radical mastectomy is rarely performed today.

A mastectomy is often recommended when there is a large tumor or cancer in more than one area throughout the breast.

Oncoplasty

When a woman’s breast tumor is found, she may undergo either a mastectomy or a lumpectomy. With a lumpectomy, a breast cavity is created which may eventually shrink even further, deforming the skin on the outside of the breast.

A new method of breast conservation surgery called, oncoplasty, has emerged. Oncoplasty employs techniques to completely take out the breast tumor while preserving the breast’s appearance. This innovative procedure is performed by St. Joseph Hospital Breast Program surgeons who remove the cancerous mass and reshape the remaining breast tissue so that it fills the cavity left by the extracted tumor. Without implants and without taking tissue from somewhere else in the body, a natural-looking breast is created often within a single surgical procedure.

Sentinel Node Biopsy

This procedure eliminates the need to remove a number of lymph nodes under the arm in order to determine whether cancer has spread to the lymph nodes. Instead, surgeons are able to find and remove the "sentinel node," which is the first lymph node into which a tumor drains and the one where cancer cells are most likely to be found. There can be more than one sentinel node. If cancer cells are found, the surgeon will remove additional lymph nodes. If the sentinel node is free of cancer, more extensive lymph node surgery will not be necessary and the recovery process will be easier for the patient. A sentinel node biopsy is not appropriate for every patient. Ask your surgeon whether this is a good option given the size of your tumor and other considerations.

Reconstructive Surgery

Many women choose to have reconstructive surgery to restore the appearance of the breast after a mastectomy. Options include breast implants or the use of tissue from other parts of your body (autologous tissue reconstruction). Some procedures can be done immediately after a mastectomy, or you may choose to do reconstruction later. If you are thinking about having reconstructive surgery immediately, it is important to consult with a plastic surgeon who is an expert in breast reconstruction before you have a mastectomy. For those who do not choose reconstruction, prostheses are available. These breast forms feel natural and are usually covered by insurance if you have a prescription from your surgeon.