by Badash M

Surgical Procedures for Breast Cancer

Depending on the stage, the location, and the type of tumor, there may be various surgical options available. The goal of surgery is to remove the cancerous tissue and preserve as much healthy breast tissue as possible. Surgery is often one part of a treatment plan that includes chemo- or radiation therapy. In some cases, chemotherapy may be given before surgery to shrink the tumor.

Breast-conserving Surgeries

Breast-conserving surgeries, often combined with radiation therapy, are the preferred type of surgeries for eligible women in the early stages of cancer. These surgeries include the removal of the tumor and a small portion of the surrounding healthy tissue. Breast-conserving, also called breast-sparing, surgery options include:
  • Lumpectomy
  • Wide excision
  • Segmentectomy
  • Quadrantectomy
  • Partial mastectomy
Lumpectomy
Diagram of lumpectomy
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Not all women with stage I or II breast cancer are eligible for these procedures. Conditions that may decrease the benefits of breast-conserving surgeries include:
  • Multiple tumors in different areas of the breast—multicentric tumors
  • One tumor spread throughout the breast—diffuse tumor
  • Tumor located directly beneath the nipple
  • A tumor that is large in relation to breast size
  • History of scleroderma, systemic lupus erythematosus, or dermatopolymyositis
  • Current pregnancy in the first or second trimester—the radiation used with breast-conserving surgeries can injure a fetus
  • Previous high-dose radiation therapy to the affected breast

Mastectomy

A mastectomy is the removal of the breast, with or without lymph nodes. There are different types of mastectomies. The best option depends on the extent of the cancer and whether or not breast reconstruction will be done.
Mastectomy
IMAGE
Copyright © Nucleus Medical Media, Inc.
Simple (Total) Mastectomy
A simple mastectomy is the most common breast cancer surgery. During this procedure, all breast tissue is removed. A simple mastectomy may be done for women who:
  • Have ductal carcinoma in situ (DCIS)
  • Have no risk of lymph node spread
  • Are not good candidates for breast-conserving surgeries
Lymph nodes may be removed and examined for cancer during a simple mastectomy. If they contain cancer, they may be removed in another procedure.
A simple mastectomy may also be an option for women who are at a very high risk for developing breast cancer. Removing one or both breasts before cancer is present is considered a prophylactic or preventive measure. Prophylactic surgery can also be considered for women who have cancer in one breast and have a high risk of cancer in the other breast.
Skin-sparing Mastectomy
The same amount of tissue is removed as with a simple mastectomy, but the skin over the breast is spared. This can be used when immediate breast reconstruction surgery is planned. Leaving skin for reconstruction is not associated with increased risk of cancer recurrence when compared to a simple mastectomy, but the risks and benefits should be discussed with your doctor when designing a treatment plan.
A variation of this procedure can spare the nipple and areola. The nipple area will be checked for cancer to see if it can be left behind. As an added measure, radiation may be given to the nipple area during or after surgery to reduce the risk of recurrence. This variation may not be an option for all women.
Modified Radical Mastectomy
A modified radical mastectomy may be done if cancer is more invasive or has spread beyond the breast. It involves the removal of the entire breast, the lining of the chest muscle, and possibly some of the muscle in the chest wall. Lymph nodes from under the arm are also removed. 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.
Radical Mastectomy
This procedure is only considered in rare cases. It is done if the tumor is large and has spread to the muscle in the chest wall under the breast. A radical mastectomy involves removal of the breast, chest wall muscles, lymph nodes under the arm, and some additional fat and skin.

Other Surgical Procedures

Surgery for breast cancer can involve more than just removing the tumor or breast tissue. The lymph nodes are often removed and tested depending on the spread of cancer. Lymph procedures may include:
  • Sentinel node biopsy —A sentinel node is the first lymph node that a tumor drains into. If the node is cancer free, it is unlikely that the cancer has spread and the remaining nodes are spared. If cancer is present, more lymph nodes may be removed to see how far the cancer has traveled.
  • Axillary node dissection—Several lymph nodes from the underarm area are removed and examined under a microscope for cancer. It may be done at the same time as breast surgery or in a separate procedure.
Women who have lymph nodes removed as part of breast cancer surgery may be at an increased risk for developing lymphedema, a condition caused by blockages of the lymph vessels. Lymph vessels run throughout the body carrying fluid, cells, and other material, but may become blocked when lymph nodes are removed. This can cause a backup of fluid into tissue. Your healthcare team can help you manage lymphedema symptoms.
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 will be 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 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 a waiting period is needed between radiation therapy and breast reconstruction.

References

Breast cancer. American Cancer Society website. Available at: http://www.cancer.org/acs/groups/cid/documents/webcontent/003090-pdf.pdf. Accessed October 28, 2015.
Breast cancer. Merck Manual Professional Version website. Available at: http://www.merckmanuals.com/professional/gynecology-and-obstetrics/breast-disorders/breast-cancer. Updated September 2013. Accessed October 28, 2015.
Breast cancer in women. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated June 18, 2015. Accessed October 28, 2015.
Surgery for early and locally advanced breast cancer. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated March 18, 2015. Accessed October 28, 2015.
Treatment option overview. National Cancer Institute website. Available at: http://www.cancer.gov/types/breast/patient/breast-treatment-pdq#section/%5F185. Updated October 22, 2015. Accessed October 28, 2015.

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