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Surgery


Surgery is the most common treatment for breast cancer. There are several types of surgery. Your doctor can explain each type, discuss and compare the benefits and risks, describe how each will change the way you look.

Breast-Sparing Surgery

With breast-sparing surgery a surgeon removes only your cancer and some normal tissue around it. This kind of surgery keeps your breast intact—looking a lot like it did before surgery. It is also called breast-conserving surgery, lumpectomy, segmental mastectomy, and partial mastectomy. Sometimes an excision biopsy serves as a lumpectomy because the surgeon removes the whole lump at the time of biopsy.

*In some types of breast cancer, the surgeon may need to examine the lymph nodes under the arm to check whether cancer cells have entered the lymphatic system. Through a small incision, the surgeon will remove the first one or two lymph nodes that drain the breast and they will be examined during surgery. This procedure is called a sentinel lymph node biopsy. If these nodes show no presence of abnormal cells, no other lymph nodes are removed.* After breast-sparing surgery, most women receive radiation therapy to the breast. This treatment destroys cancer cells that may remain in the breast.

Oncoplastic Surgery

Oncoplastic surgery is an innovative new surgical technique that combines advanced cancer removal with plastic surgery techniques and state-of-the-art breast imaging. The result is cancer treatment through incisions that are very small or even hidden, while creating a normal breast shape and appearance. Women with breast cancer traditionally see a surgeon to have the diseased tissue removed and then months later see a plastic surgeon for reconstruction. Today, breast surgeons with specialized training are able to successfully remove larger tumors, which allows women who may otherwise be advised to have a mastectomy choose this breast-conserving procedure instead.

The psychological and emotional benefits of oncoplastic surgery are numerous, allowing women to return more quickly and confidently to their lives. This new technique is aimed primarily at women with early-stage cancer who are candidates for breast conservation (lumpectomy), but it can also benefit patients receiving a mastectomy (total breast removal) by allowing a cosmetic approach to immediate reconstruction.

Mastectomy


In a mastectomy, the surgeon removes all of your breast and nipple. Sometimes, you will also need to have radiation therapy, chemotherapy, hormone therapy or all three types of therapy. Here are some types of mastectomy:

  • Total (simple) mastectomy. The surgeon removes your entire breast. Sometimes, the surgeon also takes out some of the lymph nodes under your arm.
  • Modified radical mastectomy. The surgeon removes all of your breast, many of the lymph nodes under your arm, the lining over your chest muscles and maybe a small chest muscle.
  • Double mastectomy. The surgeon removes both your breasts at the same time, even if your cancer is in only one breast. This surgery is rare and mostly used when the surgeon feels you have a high risk for getting cancer in the breast that does not have cancer.

Breast Reconstruction Surgery

At the time of your surgery, you may choose to have breast reconstruction surgery. This surgery is done by a reconstructive plastic surgeon and gives you a new breast-like shape and nipple. Your surgeon can also add a tattoo that looks like the areola (the dark area around your nipple). Or you may not want any more surgery and prefer to wear a prosthesis (breast-like form) in your bra. There are two types of breast reconstruction surgery:

  • Breast implants. In this kind of surgery, a reconstructive plastic surgeon puts an implant (filled with salt water or silicone gel) under your skin or chest muscle to build a new breast-like shape. While this shape looks like a breast, you will have little feeling in it because the nerves have been cut.
    Breast implants do not last a lifetime. If you choose to have an implant, chances are you will need more surgery later on to remove or replace it. Implants can cause problems such as breast hardness, breast pain and infection. The implant may also break, move or shift. These problems can happen soon after surgery or years later.
  • Tissue flaps. In tissue flap surgery, a surgeon builds a new breast-like shape from muscle, fat and skin taken from other parts of the body. This new breast-like shape should last the rest of your life. Women who are very thin or obese, smoke or have other serious health problems often cannot have tissue flap surgery. Tissue flap is major surgery. Healing often takes longer after this surgery than if you have breast implants. You may have other problems as well. For example, you might lose strength in the part of your body where muscle was taken to build a new breast. Or you may get an infection or have trouble healing. Tissue flap surgery is best done by a reconstructive plastic surgeon who has done it many times before.


The time it takes to heal after surgery is different for each woman. Surgery causes pain and tenderness. Medicine can help control the pain. Before surgery, you should discuss the plan for pain relief with your doctor or nurse. After surgery, your doctor can adjust the plan if you need more relief. Any kind of surgery also carries a risk of infection, bleeding, or other problems. You should tell your health care provider right away if you develop any problems.

You may feel off balance if you’ve had one or both breasts removed. You may feel more off balance if you have large breasts. This imbalance can cause discomfort in your neck and back. Also, the skin where your breast was removed may feel tight. Your arm and shoulder muscles may feel stiff and weak. These problems usually go away. The doctor, nurse, or physical therapist can suggest exercises to help you regain movement and strength in your arm and shoulder. Exercise can also reduce stiffness and pain. You may be able to begin gentle exercises within days of surgery.

Because nerves may be injured or cut during surgery, you may have numbness and tingling in your chest, underarm, shoulder, and upper arm. These feelings usually go away within a few weeks or months. But for some women, numbness does not go away. Removing the lymph nodes under the arm slows the flow of lymph fluid. The fluid may build up in your arm and hand and cause swelling. This swelling is lymphedema. Lymphedema can develop right after surgery or months to years later.

You will need to protect your arm and hand on the treated side for the rest of your life:

  • Avoid wearing tight clothing or jewelry on your affected arm
  • Carry your purse or luggage with the other arm
  • Use an electric razor to avoid cuts when shaving under your arm
  • Have shots, blood tests, and blood pressure measurements on the other arm
  • Wear gloves to protect your hands when gardening and when using strong detergents
  • Have careful manicures and avoid cutting your cuticles
  • Avoid burns or sunburns to your affected arm and hand

You should ask your doctor how to handle any cuts, insect bites, sunburn, or any other injuries to your arm or hand. Also, you should contact the doctor if your arm or hand is injured, swells, or becomes red and warm. All women at risk for lymphedema will be referred to a lymphedema specialist in our physical therapy dept.

If lymphedema occurs, the doctor may suggest raising your arm above your heart whenever you can. The doctor may show you hand and arm exercises. Some women with lymphedema wear an elastic sleeve to improve lymph circulation. Medication, manual lymph drainage (massage), or use of a machine that gently compresses the arm may also help.