When it comes to surgery for breast cancer, there is no one-size-fits-all choice. The type of procedure depends on the stage of the cancer, how big the tumor is, whether lymph nodes are involved, the chances of a recurrence, and a woman's own comfort level, among other factors. Here's a rundown of the most common surgeries performed after a diagnosis of breast cancer.
Lumpectomy
The least invasive surgery is a partial mastectomy, or a lumpectomy. In this procedure, the surgeon leaves as much of the breast as possible. "We take the tumor out and we generally take a rim of normal tissue as well," says Jennifer Joh, MD, a breast surgical oncologist at Mercy Medical Center in Baltimore, explaining the need to clear the margins of the tumor. The breast may be left with a slight indentation, although it generally looks normal. "Typically your body will fill that area with fluid, and over time that fluid will be reabsorbed," she says.
Lumpectomy may be a good choice for women whose cancers are unifocal (meaning found in just one spot) and who are not so small breasted that the removal of tissue will significantly impact the contour of the breast. Radiation is almost always recommended after a lumpectomy because of the risk of local recurrence.
Mastectomy
A mastectomy involves the complete removal of the breast, including the skin, nipple, and areola. For women with larger cancers or tumors that are multifocal, a mastectomy may be the best choice. Some women may feel more comfortable choosing a mastectomy over a lumpectomy because the latter usually entails follow-up radiation, but Joh advises that women with mastectomies may still need radiation depending upon their individual situation. Women undergoing a mastectomy may choose to have their breast reconstructed, either immediately or at a later date.
Sentinel Lymph Node Biopsy
For women who have been diagnosed with invasive breast cancer, a sentinel lymph node biopsy enables a surgeon to determine whether the cancer has spread beyond the primary tumor and into the lymph nodes.
During this procedure, the skin near the tumor is injected with either a radioactive isotope or a blue dye (or both) so that the sentinel nodes become readily apparent. If cancer is detected, additional lymph nodes may be removed.
Reconstruction
Many women opt to reconstruct the breast after a partial or complete mastectomy. Ideally, the reconstruction will take place immediately after the breast tissue is removed, while the patient is still under anesthesia. A surgeon may perform tissue-expander reconstruction, in which a small expander is inserted that creates a pocket designed to hold a breast implant that will be inserted at a later point.
Another option is autologous flap reconstruction, in which a woman's own tissue, taken from her belly, back, buttocks, or other locations, is used to build a new breast. According to Joh, women whose particular cancer means further radiation is likely are advised to hold off on reconstructing the breast, especially if interested in flap reconstruction, as radiation on a reconstructed breast may impair the cosmetic outcome.
Joh urges women never to rush into making decisions about your treatment without careful consideration of the side effects and long-term outcome of the various procedures. Input from a skilled and experienced health care team is also essential.
Jennifer E. Joh, MD, reviewed this article.
