Breast Cancer - Surgery
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Most people with breast cancer have surgery to remove the cancer. In most cases, a few of the lymph nodes under the arm are also removed and examined under the microscope to see whether cancer cells are present. This is called sentinel lymph node biopsy. When nearly all lymph nodes under the arm are removed, it is called axillary lymph node dissection. You are less likely to have arm swelling (lymphedema) after a sentinel node biopsy than an axillary dissection.
Even if your doctor removes all the cancer that can be seen at the time of your surgery, you may be given treatment with radiation therapy, chemotherapy, or hormone therapy after surgery to try to destroy any cancer cells that may be left. This is called adjuvant therapy.
Surgery that allows you to keep your breast
Procedures include:
- Breast-conserving surgery (lumpectomy), which is theremoval of the lump in the breast along with some of the tissue around it. Thisis sometimes called excisional biopsy or wide excision. It is usually followedby radiation therapy to the remaining breast tissue.
- Partial or segmental mastectomy, which is the removal of thearea of the breast that contains cancer as well as some of the breast tissuearound the tumor and the lining over the chest muscles below the tumor. Some ofthe lymph nodes under the arm are also removed and examined under themicroscope (axillary lymph node dissection or sentinel lymph node biopsy). Inmost cases, radiation therapy follows.
For stages I and II breast cancer, breast-conserving surgery (lumpectomy) with radiation therapy has the same survival rate as mastectomy and some of the same side effects.28
If you plan to have a lumpectomy, talk to your doctor about what your breast might look like after the surgery.
Removal of the breast (mastectomy)
Mastectomy procedures include:
- Total or simple mastectomy, which is the removal of the whole breast.
- Modified radical mastectomy, which is the removal of thebreast, some of the lymph nodes under the arm, and sometimes part of the chestwall muscles.
- Skin-sparing mastectomy, which leaves most of the skin thatwas over the breast, except for the nipple and the areola. This type ofmastectomy removes about as much breast tissue as a modified radicalmastectomy, but leaves less scar tissue and a reconstructed breast that seemsmore natural.
- Radical mastectomy (Halstedradical mastectomy), which is the removal of the breast, chest muscles, and allof the lymph nodes under the arm (axillary lymph node dissection). For many years, radicalmastectomy was the most common operation for breast cancer.This surgery is rarely used now because it does notimprove survival or risk for recurrence when compared with other surgicaltreatments.
Breast reconstruction
You may wish to talk to your doctor about breast reconstruction before you make a decision about which type of surgery to have for breast cancer. If you choose to have a mastectomy, a different surgeon with special expertise in reconstructive surgery may perform this operation at the same time as the mastectomy or after the mastectomy.
Your choice will depend on the size of the cancer, the size and shape of your breasts, the size and shape of your body, how active you are, and other details, such as whether you have chemotherapy or radiation. If you choose to have a mastectomy, discuss reconstructive surgery and the use of a breast prosthesis with your doctor. For more information about reconstructive surgery, see the topic Cosmetic Surgery and Procedures.
| By: | Healthwise Staff | Last Revised: October 22, 2009 |
| Medical Review: | Joy Melnikow, MD, MPH - Family Medicine Douglas A. Stewart, MD - Medical Oncology | |
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