Breast Cancer Surgery

by National Cancer Institute

(Page 5 of 9)

Surgery has an important role in the treatment of patients with breast cancer. Most women can choose between breast-conserving surgery (lumpectomy with radiation therapy) or removal of the breast (mastectomy). Clinical trials have proven that both options provide the same long-term survival rates for most types of early breast cancer. However, neither option guarantees that cancer will not recur. Whichever choice you make, you will need close medical followup for the rest of your life.

LUMPECTOMY

The surgeon removes the breast cancer and some normal tissue around it (in order to get clear margins). This procedure usually results in removing all the cancer, while leaving you with a breast that looks much the same as it did before surgery. Usually, the surgeon also takes out some of the lymph nodes under the arm to find out if the cancer has spread. Women who have lumpectomies almost always have radiation therapy as well. Radiation therapy 7 is used to destroy any cancer cells that may not have been removed by surgery.

PARTIAL or SEGMENTAL MASTECTOMY

Depending on the size and location of the cancer, this surgery can conserve much of the breast. The surgeon removes the cancer, some of the breast tissue, the lining over the chest muscles below the tumor, and usually some of the lymph nodes under the arm. In most cases, radiation therapy follows.

Mastectomy

TOTAL (or SIMPLE) MASTECTOMY

The surgeon removes the entire breast. Some lymph nodes under the arm may be removed, also.

MODIFIED RADICAL MASTECTOMY

The surgeon removes the breast, some of the lymph nodes under the arm, and the lining over the chest muscles, and sometimes part of the chest wall muscles.

RADICAL MASTECTOMY

The surgeon removes the breast, chest muscles, and all the lymph nodes under the arm. This was the standard operation for many years, but it is used now only when a tumor has spread to the chest muscles.

A mastectomy may be recommended when:

• Cancer is found in more than one part of the breast.
• The breast is small or shaped so that a lumpectomy would leave little breast tissue or a very deformed breast.
• A woman chooses not to have radiation therapy.
• A woman prefers a mastectomy.

POSSIBLE PROBLEMS: As in any kind of surgery, there is a risk of infection, poor wound healing, bleeding, or a reaction to the anesthesia used in surgery. There may be a collection of fluid under the skin; or tingling, numbness, stiffness, weakness, or swelling of the arm. Physical therapy and exercise can help to restore arm movement and strength.

After a mastectomy, a woman may choose to:

• Wear a breast form, called a prosthesis, that fits in her bra. To find stores that have breast forms and fitters, talk with your doctor, nurse, or a volunteer from the American Cancer Society Reach for Recovery program or other breast cancer organization, or other women who have had breast cancer.
• Have her breast reconstructed by a plastic surgeon.
• Do neither.

Some health insurance plans pay for all or part of the costs of a prosthesis or for breast reconstruction. However, there may be health insurance rules about where aw oman can have breast reconstruction surgery or where to buy a prosthesis. For details about your health plan coverage, contact your insurance company.

QUESTIONS TO ASK YOUR SURGEON BEFORE SURGERY What kind of surgery do you recommend for me? How much of my breast will be removed? If I have a mastectomy, will I be able to have breast reconstruction? 13 Do you recommend it at the time of surgery or later? Will I meet with the plastic surgeon before surgery? Will you remove any of my lymph nodes? Where will the operation be done? Will I have local or general anesthesia? How should I feel after the operation? If I have pain, how can I get relief? What side effects should I report to you? Where will the scars be? What will they look like? Will a nurse or physical therapist teach me how to exercise and care for my arm? How long will I stay in the hospital? Will I need followup care? When can I get back to my normal activities? What activities should I avoid? What do I need to do to prepare for surgery?

Lymph Node Removal

Whether you have a lumpectomy or mastectomy, your surgeon will probably remove some of the lymph nodes under your arm. This procedure is usually done at the same time as the breast surgery to check if the cancer has spread outside the breast. Clear lymph nodes are reported as negative nodes. If cancer is found, you have positive nodes. Your doctor will talk with you about any additional treatments needed to destroy and control cancer cells.

Lymphedema

The lymph nodes under your arm drain lymph fluid from your chest and arm. Both surgery and radiation therapy can change the normal drainage pattern. This can result in a swelling of the arm called lymphedema. The problem can develop right after surgery or months to years later.

Treatment of lymphedema depends on how serious the problem becomes. Options include an elastic sleeve, an arm pump, arm massage, and bandaging the arm. Exercise and diet also are important. If you have this problem, talk with your doctor and see a physical therapist as soon as possible. Many hospitals and breast clinics offer help with lymphedema. There is no cure for this condition, so you should do what you can to prevent it.

Sentinel Lymph Node Biopsy

Surgeons are investigating a new procedure in cancer patients used to detect lymph node involvement. In this procedure, either a blue dye or a small amount of radioactive material is injected around the tumor site. The surgeon performs a small incision in the axillary underarm area looking for a lymph node containing the blue dye or uses a scanner to locate the radioactive material. The lymph node(s) where the dye first accumulates after leaving the tumor region is called the "sentinel node(s). "This node(s) is then surgically removed and examined by a pathologist. If it is positive for cancer cells, then the rest of the nodes are usually removed; if it is negative, the remaining lymph nodes may not have to be removed.

After underarm lymph nodes are removed, your arm will have to be protected for the rest of your life.

• To help prevent or control lymphedema and to protect your arm after treatment:
• Carry packages or handbags on the other arm or shoulder.
• Avoid sunburns and burns to your affected arm and hand.
• Have shots (including chemotherapy), blood draws, and blood pressure tests done on the other arm.
• Avoid cuts when shaving underarms; use an electric shaver.
• Wash cuts promptly, apply antibacterial medication, and cover with a bandage. Call your doctor if you think that you have an infection.
• Wear gloves to protect your hands when gardening and when using strong detergents.
• Avoid wearing tight jewelry on your affected arm; avoid elastic cuffs on blouses and nightgowns.
• Have careful manicures; avoid cutting your cuticles.

QUESTIONS TO ASK YOUR SURGEON AFTER SURGERY What did you learn from the pathology report? Please explain what is in the pathology report. How many lymph nodes were removed? Were they free of cancer? If not, how many showed signs of cancer? Did the tumor have clear margins (normal tissue around the tumor)? Were hormone receptor tests done? What are the results? What other tests will be done on the tissue? When will I know the results? Do I need further treatment? Should I consider joining a clinical trial?

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