What are the surgical options for breast cancer?
The various surgical techniques differ in how much breast tissue is removed with the tumor. The technique that is used depends on how big the tumor is, where it is located, whether it has spread (metastasized), and your personal feelings. The surgeon often removes some axillary (underarm) lymph nodes as part of the operation; the lymph nodes are then tested to see if they have any cancer cells. This is done to help plan your treatment after surgery.
The breast surgeon will discuss your surgery options with you before the procedure. The surgeon may recommend a specific surgical procedure for you based on the size, location, or type of breast cancer you have. Some of the procedures the physician may discuss with you include lumpectomy, simple or total mastectomy, and modified radical mastectomy.
Lumpectomy — This is also referred to as partial mastectomy. The surgeon removes the cancerous area and a surrounding margin of normal tissue. A second incision (cut) may be made in order to remove lymph nodes. This treatment tries to save as much of the normal breast as possible.
After the lumpectomy, the patient usually has a 4-5-week course of radiation therapy to treat the remaining breast tissue. (Sometimes, a 3-week course of radiation, or even a one-time dose of intra-operative radiation therapy, can be offered). Most women who have small, early stage breast cancers are excellent candidates for lumpectomy.
Women who usually are not eligible for a lumpectomy include those who:
- Have already had radiation therapy to the affected breast
- Have two or more areas of cancer in the same breast that are too far apart to be removed through one incision (though there are currently research trials looking at this option)
- Have a very large tumor or one that is close to or attached to the chest wall or nipple
Women who have cancer that is not completely removed with the lumpectomy may need further surgery to take out the rest of the cancer cells. The margins of the specimen that was removed are evaluated to help in making this decision.
Simple or total mastectomy: In this procedure, the entire breast is removed, but no lymph nodes are taken out. Simple mastectomy is most often used to prevent breast cancer in a woman who is at increased risk for the disease, or for cancer that is confined to the milk ducts (which is known as ductal carcinoma in situ).
Sometimes a nipple-sparing mastectomy, which preserves the nipple and areolar complex, can be offered. Reconstruction of the breast can be done using implants or the patient’s own tissue, usually from the lower abdomen. In cases of early stage invasive breast cancer, a sentinel lymph node biopsy procedure is also performed.
Modified radical mastectomy: The surgeon removes all of the breast tissue along with the nipple. Lymph nodes in the axilla (underarm) are also removed, and the chest muscles are left intact. Reconstruction of the breast is often offered.
Radical mastectomy: The surgeon removes all of the breast tissue along with the nipple, lymph nodes in the underarm, and chest wall muscles under the breast. This procedure is rarely performed today unless the breast cancer has become very large and involves the chest wall muscles.
You should thoroughly discuss these surgical options with your physician to get the best outcome. Whichever type of surgery is your best option, you will be able to return home after a short stay in the hospital.