Surgery for Breast Cancer Treatment

How is surgery used in breast cancer treatment?

Surgery to remove as much of the cancer as possible is the primary treatment for breast cancer. Today, women have many surgical options and choices. The type of surgery performed depends upon:

• the size and location of the breast lump or tumor

• the type and stage of the breast cancer (If the cancer has spread within the breast or has spread outside of the breast to the lymph nodes, or to other parts of the body.)

• the size of the breast

• the woman's preference

There are several types of breast surgery. Your physician can explain the benefits and risks of each type, in addition to answering any questions or concerns you may prior to surgery.

Questions to ask your physician before surgery:

• Which type of surgery do you recommend for me? Why?

• Where will the incision be located and how much of the breast tissue will be removed?

• Will any lymph nodes be removed?

• Will I be able to have breast reconstruction if I have a mastectomy?

• Do you recommend breast reconstruction at the same time of the mastectomy surgery or at a later date?

• Will additional treatment such as radiation or chemotherapy be required following surgery?

• What type of follow up care is needed?

• How long will it be before I resume my normal activities?

What are some of the different types of breast cancer surgery?

There are two types of breast conservation (tissue-sparing) surgery. These include a lumpectomy and a partial (segmental) mastectomy.

A lumpectomy is the removal of the breast cancer and a portion of normal tissue around the breast cancer lump (The areas removed during the surgery are shaded in green). The surgeon may also remove some of the lymph nodes under the arm to determine if the cancer has spread. The bean-shaped lymph nodes under the arm (also called the axillary lymph glands) drain the lymphatic vessels from the upper arms, the majority of the breast, the neck, and the underarm regions. Often breast cancer spreads to these lymph nodes, thereby entering the lymphatic system and allowing the cancer to spread to other parts of the body. Radiation therapy is often administered, following a lumpectomy, to destroy cancer cells that may not have been removed during the lumpectomy procedure.

A partial (segmental) mastectomy involves the removal of the breast cancer and a larger portion of the normal breast tissue around the breast cancer (The areas removed during the surgery are shaded in green). The surgeon may also remove the lining over the chest muscles below the tumor and some of the lymph nodes under the arm. The bean-shaped lymph nodes under the arm (also called the axillary lymph glands) drain the lymphatic vessels from the upper arms, the majority of the breast, the neck, and the underarm regions. Often breast cancer spreads to these lymph nodes, thereby entering the lymphatic system allowing the cancer to spread to other parts of the body. Radiation therapy may also be administered, following a partial mastectomy, to destroy cancer cells that may not have been removed during the partial mastectomy procedure.

Mastectomy, as a non-breast-conserving procedure:

If a woman does not choose a breast-conserving surgery, she may choose a mastectomy (removal of the breast). The physician may recommend a mastectomy under the following circumstances (among others):

• if the cancer has spread to other parts of the breast tissue or has spread to the lymph nodes under the arm

• if the breast is very small and a lumpectomy would require removing additional breast tissue, resulting in a very deformed breast

There are three types of mastectomy. Your physician can explain the benefits and risks of each type:

• total (or simple) mastectomy
• modified radical mastectomy
• radical mastectomy

	During a total (or simple) mastectomy, the surgeon removes the entire breast (including the nipple, the areola, and most of the overlying skin) and may also remove some of the lymph nodes under the arm, also called the axillary lymph glands (The areas removed during the surgery are shaded in green). The bean-shaped lymph nodes under the arm drain the lymphatic vessels from the upper arms, the majority of the breast, the neck, and the underarm regions. Often breast cancer spreads to these lymph nodes, thereby entering the lymphatic system allowing the cancer to spread to other parts of the body.
	During a modified radical mastectomy, the surgeon removes the entire breast (including the nipple, the areola, and the overlying skin), some of the lymph nodes under the arm (also called the axillary lymph glands), and the lining over the chest muscles. In some cases, part of the chest wall muscles is also removed (The areas removed during the surgery are shaded in green).
	During a radical mastectomy, the surgeon removes the entire breast (including the nipple, the areola, and the overlying skin), the lymph nodes under the arm, also called the axillary lymph glands, and the chest muscles (The areas removed during the surgery are shaded in green). For many years, this was the standard operation. However, today, a radical mastectomy is rarely performed and is generally only recommended when the breast cancer has spread to the chest muscles.

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