Lumpectomy

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]]> .

Lumpectomy

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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.

Simple Mastectomy

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.

Mastectomy Surgery

© 2009 Nucleus Medical Art, Inc.

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.

Breast Reconstruction

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.

Lymphedema

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.