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. A few 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
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
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.
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. Today even if there is a cancer cell in 2 or fewer sentinel
nodes, further surgery or removal of more nodes may not be necessary.
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
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. Reconstruction is a very personal
choice and many women today are comfortable with “going flat”.
Be sure to discuss all options with your surgeon.