Breast Cancer Surgery and Surgical Procedures
But what if it IS cancer?
It is difficult and scary to hear a diagnosis of breast cancer. Fear is normal.
People have historically thought of a breast cancer diagnosis as a mastectomy at best and death sentence at worst. Some people do die, but early detection is the key to improving survival rates and in most cases, less aggressive treatment. Regular mammograms have increased rates of cancer diagnosed, but because women are diagnosed earlier, the percentage of deaths from breast cancer has gone down.
The type and stage of cancer will determine what treatment is best for a woman with breast cancer and what her prognosis will be. That is why early detection and treatment are SO important.
Whenever possible, the first choice is to do a lumpectomy. This means that your surgeon removes the tumor and some surrounding tissue. Many surgeons remove some of the surrounding area to get 'clean margins' the first time. Cancer cells move out from the tumor into surrounding tissue, so it is essential to remove enough tssue to get 'clean' surrounding tissue that is free of cancer cells. A lumpectomy is breast preserving surgery. (Your surgeon will give you more information if together you decide this is the best treatment for you, but Breastcancer.org has a general article of What to Expect in a Lumpectomy.)
In breast cancer surgery, we also need to determine if cancer has spread to the lymph nodes in the armpit. Years ago, it was standard procedure to remove all the lymph nodes in every surgery. Now, whenever possible, we do a sentinel node biopsy. Sometimes it is not the best treatment if you have a large tumor, or we can feel changes in the nodes.
Sentinel node biopsy:
Lymph nodes are a major part of our immune system and act like filters to pick up foreign particles or cancer cells.
Sentinel lymph nodes are the first few lymph nodes that the tumor drains into. To determine which of your lymph nodes are the 'sentinel nodes,your surgeon injects a dye that helps mark the first few sentinal nodes and then removes 2-4 of those. If they come back clear, no further node removal is needed. Removing additional node, if needed, is called Axillary Lymph Node Dissection.
Radiation will often be required to eliminate stray remaining cells with a lumpectomy. While there are no guarantees, it reduces the chance of reoccurrence. For some patients I began using a new procedure for radiation called Mammosite in which I insert a small tube that allows some patients to have targeted radiation for one week instead of for the usual 6-8 weeks. (You can also go to the Mammosite website for additional information and resources.)
Some women do need a mastectomy, but surgical treatment has evolved to take the most conservative approach that still treats the cancer. Mastectomy today comes in various forms:
Although lumpectomy is sometimes considered a partial mastectomy, most people think of partial mastectomy as removing a larger part of the breast, but not the entire breast. For example, some women might require that a quarter of their breast be removed, but most of it is preserved.
Simple mastectomy involves the removal of the entire breast, but does not remove muscle underneath the breast. The surgeon normally does not do an axillary lymph node dissection, although there may be some lymph nodes within the breast area that are removed.
Modified Radical Mastectomy:
In this mastectomy, the surgeon removes the breast and a large number of lymph nodes in the armpit, but no muscle underneath the breast is removed.
Subcutaneous mastectomy -- known as 'nipple sparing or nipple saving' mastectomy:
Some women are good candidates for nipple sparing mastectomy in which the breast tissue is removed, but the nipple and areola are left alone. Even though the other breast tissue is removed, it looks more like a normal breast. Sensation in the nipple after surgery varies from woman to woman.
Click on the link above to see diagrams and more informaiton.
Skin sparing mastectomy:
This is almost the opposite of the nipple sparing mastectomy. In a skin-sparing mastectomy, the nipple and areola are removed and as much breast skin as possible is preserved.
This is what people normally think of when they hear mastectomy, because years ago, it was the only mastectomy and often unnecessarily removed underlying chest muscle. Today radical mastectomy is recommended only when the breast cancer has spread to the muscles underneath the breast. It is rarely performed otherwise, because the 'modified radical mastectomy' is usually just as effective and less disfiguring. But some women will need this.
Depending on the type and stage of breast cancer, some women will need radiation and some will need chemotherapy. Even chemotherapy is different from what it used to be. Some can be targeted for the specific type of cancer a woman has.
Remind yourself each day-- one step at a time!
I have always believed in thoroughly evaluating a woman coming for diagnosis and treatment, but I would not perform procedures that in my opinion were not needed. You and your surgeon can take one step at a time to do everything possible to support your health and well-being.
In the meantime, you may find some of the resources I have listed to be helpful. Breast Disease and Breast Cancer Resource Page. It has links to information on breast disease, breast cancer, help in coping with a diagnosis, ways for your spouse or significant other to support you, and more.