Surgical Procedures for Breast Cancer
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This page discusses the use of surgery and other procedures for the treatment of breast cancer. For a thorough review of surgery and other procedures for cancer treatment, please see the ]]>surgery and other procedures treatment monograph]]> .
Surgery is the initial procedure in the treatment of many solid cancers. Surgery and other invasive procedures work by removing cancerous tissues.
Depending on the stage, the location, and the type of tumor, you may be a candidate for various forms of surgery. Surgical treatment involves the removal of cancer from the breast. In many women trying to preserve the breast, breast-conserving surgery (surgery that removes only a portion of the breast) may be used. For early or later stages of breast cancer, or as a preventive measure, mastectomy (removal of the breast) may be done instead.
The surgical options for breast cancer treatment include the following:
- Breast-conserving procedures – these procedures will remove cancerous tumors, but not the breast itself:
- Mastectomy – removal of some or all of the breast. Types of mastectomy include:
Other considerations when having surgery for breast cancer include:
Lumpectomy is a breast-conserving surgery. It is a general term for several similar procedures: partial mastectomy, wide excision, segmental mastectomy, and quadrantectomy. In breast-conserving surgery, only the malignant area, and a small portion of the surrounding healthy tissue are removed. Sometimes, lymph nodes under the arm are also removed, this is called axillary dissection. These procedures are almost always followed by a course of radiation therapy]]> .
Today, breast-conserving surgeries are the preferred type of surgery for eligible women in the early stages of cancer, as this operation spares the breast. Studies have shown that breast-conserving surgeries combined with radiation therapy are just as effective as mastectomy for long term survival in the early stages of breast cancer. However, not all women with stage I or II breast cancer are eligible for this type of surgery. Conditions that might make you ineligible include the following:
- Multiple tumors in different areas of the breast (multicentric tumors)
- One tumor spread throughout the breast (diffuse tumor)
- A tumor that is large in relation to breast size
- History of scleroderma, systemic lupus, or dermatitis, which makes radiation therapy difficult or contraindicated
- Current pregnancy (first or second trimester); the radiation used with breast-conserving surgery can injure a fetus
- Previous high-dose radiation therapy to the affected breast
Breast-conserving Procedures: What to Expect
Breast–conserving surgeries are done under general anesthesia. If your tumor is not easily palpable (felt), your doctor may need to do a procedure called wire-localization (also known as a needle-localization) to determine the exact location of the tumor. This is done during a mammogram. For this procedure, the tip of a wire is inserted and guided by the mammogram to the site of the abnormality. The wire is placed at that site; this allows your surgeon to more precisely locate and remove the tumor.
During the procedure, the surgeon opens the breast, removes the tumor and a small amount of normal tissue. Your doctor will try to minimize scarring as much as possible.
If your doctor needs to do an axillary dissection, the area under the armpit on the side of the affected breast will be opened, and about 6 to 25 lymph nodes will be removed. More commonly, doctors are now often opting to do a ]]>sentinel node dissection]]> (described below).
After the surgery is done, the tumor and lymph nodes that were removed are sent to a pathologist for further study. Based on the findings of the pathology report, your doctor will tell you whether more surgery (either re-excision or in some cases, mastectomy) will be needed.
Sentinel Lymph Node Dissection
This procedure is becoming routine in the United States. Because of the possible side effects from a standard axillary lymph node dissection, patients may qualify for this procedure that may not require many lymph nodes to be removed; this has been shown to reduce the chances of swelling, pain, and lymphedema,]]> which is swelling of the arm or breast on the side where surgery was done.
This procedure begins with the injection of a radioactive tracer and blue dye around the tumor in the breast. The first lymph node that picks up the tracer, which is usually a node under the arm, is called the sentinel lymph node—it is the lymph node that is believed to be the first node that is or will be affected by the cancer. The sentinel lymph node is removed and evaluated. If there is no cancer in this node, then there is a 95% chance that none of the other axillary lymph nodes have cancer and no further surgery is required. If the lymph node has cancer, then a complete axillary dissection is performed. Ask your surgeon if you are a candidate for sentinel lymph node dissection.
Length of Hospital Stay
The length of time you will spend at the hospital depends on the type of procedure you had. For standard breast-conserving surgery, including sentinel node dissection, you may return home the same day as the procedure. If your axillary nodes were removed, you may return home the same day, or may stay 1–2 days. Discuss your length of stay with your doctor in advance.
This is the removal of the entire breast, and generally does not include removal of the lymph nodes. A simple mastectomy may be offered when a woman is interested in a preventive procedure to reduce the chances of developing breast cancer. Because all of the breast tissue cannot be removed at the time of a mastectomy, your risk of developing breast cancer (even after surgery) is never 0% because there is always residual breast tissue left behind.
Modified Radical Mastectomy
A modified radical mastectomy involves the removal of the breast, many of the lymph nodes under the arm, and some of the chest muscles. Radiation therapy]]> may or may not be required after a modified radical mastectomy, depending on the size of the tumor and whether any cancer was found in the lymph nodes. This type of surgery may be used in some early stages of breast cancer, as well as some later stages.
Radical (or Halsted) Mastectomy
A radical mastectomy is the removal of the breast, the chest muscles, and most all of the lymph nodes under the arm. This surgery is rarely used today and has not been shown to improve survival when routinely used.
Women have the option of having breast reconstruction done either at the time of the mastectomy, or some time after the operation. Some women may choose not to have breast reconstruction at all. It is your decision to determine what you feel most comfortable with.
If you are considering reconstruction, it is best to discuss this option with a plastic surgeon prior to your mastectomy. If you will need radiation therapy because of the size of the tumor or the presence of any disease in the lymph nodes, make sure your plastic surgeon is aware. Sometimes, the surgeon prefers to wait for a period of time after the radiation therapy before performing the reconstruction.
Mastectomy Procedures: What to Expect
Mastectomy is done under general anesthesia. During surgery, most all of the breast tissue is removed, including the nipple, tissue around the nipple, and the biopsy scar. In addition, either an axillary dissection or a sentinel lymph node dissection]]> is done. The lymph nodes will be sent to the pathologist for further study.
If breast reconstruction is done immediately, the plastic surgeon will perform the breast reconstruction at this point. If breast reconstruction is not being done, or will be done at a later time, the surgeon will sew the area back together, and insert a drainage tube so fluid from the wound can drain.
Length of Hospital Stay
Most women who have a total mastectomy will stay overnight in the hospital. If breast reconstruction was performed, you may stay an additional 1 – 2 days after surgery. Discuss your length of stay with your doctor in advance.
Women who have lymph nodes removed as part of breast cancer surgery may be at an increased risk of developing lymphedema, a condition caused by blockages of the lymph vessels. Lymph vessels may become blocked when lymph nodes are removed. This will result in swelling of the arm and sometimes the breast. Lymphedema increases the chance of infection in the breast or arm.
In order to reduce the risk of developing lymphedema, the following precautions are recommended:
- Treat infections of the affected arm and hand immediately.
- Wear gloves when doing house or garden work.
- Keep the affected hand well moisturized.
- Use the unaffected arm when having blood drawn or getting injections.
- For four to six weeks after surgery, use the unaffected arm when lifting heavy objects.
- Protect the arm from sunburn.
- Do not cut cuticles.
- Use insect repellant when outdoors.
- Keep skin clean.
National Cancer Institute
National Women's Health Center
Way LW, Doherty GM, eds. Current Surgical Diagnosis and Treatment , 11th ed. New York: Appleton & Lange; 2002.
Susan G. Komen Breast Cancer Foundation
Harris JR, Lippman ME, Morrow M, Osborne CK. Diseases of the Breast . Philadelphia: Lippincott Williams and Wilkins; 1999.
Last reviewed February 2003 by John Erban, MD]]>
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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