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Exploring Breast Cancer Surgery Options

Overview

When breast cancer is discovered early enough, it’s usually treated with surgery. The type of operation you receive depends on several important factors. Two key concerns are the size of the cancer and whether it has spread to your lymph nodes or other parts of the body. Your breast size and personal priorities must also be considered before deciding on a treatment plan.

There are two main categories of surgery. They are operations to remove cancerous tissue and to determine whether the cancer has spread to the lymph nodes. If surgeons find cancer in your lymph nodes, the lymph nodes may be removed as part of the procedure.

According to the U.S. Department of Health and Human Services, the death rate from breast cancer has been on the decline since the 1970s. This may be due to early detection and improved surgical techniques and other treatments.

Know more about your surgery options. It can help you make the best decision for your health, so you can join the growing number of breast cancer survivors.

Breast-conserving surgery

A lumpectomy is surgery that removes only the cancerous tissue or lump in the breast. It also removes a small portion of surrounding healthy tissue. A lumpectomy is also referred to as breast-conserving or breast-sparing surgery. A procedure called a quadrantectomy removes about a quarter of the breast. This is more than is taken with a lumpectomy.

After a lumpectomy, your doctor may recommend local radiation therapy. This therapy destroys any microscopic cancer cells that may be lingering after the operation. Radiation therapy uses precise targeting equipment to focus the energy beam only on the area affected by the cancer. Any healthy cells damaged by radiation therapy can often repair themselves. The most common side effect of radiation therapy is skin damage similar to sunburn.

Drug treatment, known as adjuvant therapy, may be prescribed after surgery. This is intended to reduce the risk of the cancer spreading. There are two types of drugs. Chemotherapy involves powerful medicines designed to destroy cancer cells. Chemotherapy has many side effects, including:

  • nausea
  • vomiting
  • hair loss
  • low blood cell counts

Modern chemotherapy techniques are able to modify these side effects to make them more tolerable. The other class of drugs is called anti-estrogens. Depending on the hormone sensitivity of the cancer and other risk factors, anti-estrogens often are recommended. The medication can be taken orally, and side effects are generally mild.

Mastectomy

Breast-conserving surgery is now the preferred treatment over mastectomy. A mastectomy is surgery to remove the entire breast. However, some women may prefer the more extensive mastectomy for greater assurance that the cancer is gone.

In a simple mastectomy, also known as a total mastectomy, a surgeon removes the entire breast. But they don’t remove lymph nodes under the arm nor the muscle tissue beneath the breast.

A modified radical mastectomy is similar to a simple mastectomy. However, in this surgery, the underarm lymph nodes are also removed. This surgery is more widely performed than a radical mastectomy, which used to be very common. In addition to removing the breast and adjoining lymph nodes, the surgeon also removes the chest muscles (pectorals) in a radical mastectomy. The disfigurement with a radical mastectomy is significant, but a modified radical mastectomy is less deforming. And it’s just as effective at treating the cancer.

Women who are very high risk for breast cancer may choose to have both breasts removed, which is called a double mastectomy. This may prevent cancer from developing in the other breast.

Lymph node surgery

There are two basic surgeries performed to find out whether cancer has spread to the lymph nodes near the breasts. The lymphatic system is a network of vessels and nodes that carry a fluid called lymph throughout the body. The lymph system is an important part of the body’s immune system. Lymph nodes combat infection and filter toxic materials in the body.

The lymph node that’s most likely to be invaded by breast cancer is called the sentinel node. It’s located in a group of lymph nodes in the armpit (axilla). In a procedure called a sentinel lymph node biopsy (SLNB), a doctor removes the sentinel node. The node is then studied to see if it contains any cancer cells. If no cancer cells are found in the sentinel node biopsy, it’s likely you won’t need to have more lymph nodes removed.

If cancer cells are found, the next step may be a surgical procedure known as an axillary lymph node dissection (ALND). An ALND involves the removal of many lymph nodes from under the arm. They’re tested for the presence of cancer cells. This procedure may be done at the same time as a mastectomy or breast-conserving surgery. Or it may be done in a separate procedure.

One of the more serious side effects of an ALND is lymphedema. Lymphedema is a swelling of the arm due to fluid build-up. The lymph nodes help balance fluid levels in the body, so fluid can build up due to the loss of lymphatic vessels.

Breast reconstruction

Many women choose to have a breast restored after cancer surgery. This is called breast reconstruction. It can sometimes be done in conjunction with the surgery or at later date. A surgeon may use your own skin and fat (taken from your belly or other part of your body) to duplicate the shape of the original breast. Alternatively, a saline-filled or a silicone-filled implant may be used.

There have been concerns about the safety of silicone implants, but advances in technology have addressed them. A newer, thicker form of silicone material, known as cohesive gel, is now widely used.

If breast reconstruction surgery is something you’re interested in, talk with your surgeon and a reconstruction specialist. They can discuss your options and the risks associated with this procedure.

Breast cancer surgery can have both physical and psychological consequences. Addressing your feelings before and after surgery is an important part of the coping process. But the development of less-invasive surgeries and breast reconstruction techniques are helping to make the long-term effects of breast cancer surgery a little more acceptable.

If you’ve been diagnosed with breast cancer, discuss all the treatment options with your doctor. Getting a second opinion consultation about surgery and your prognosis is common and may be reassuring. Breast cancer surgery can be a life-changing and life-saving decision. 

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