Surgery For Breast Cancer

As key members of Beaumont’s multidisciplinary cancer team, surgeons work closely with other specialists to plan and provide the most effective treatment strategy for each patient. Our minimally invasive options maximize patient comfort and permit quicker recovery times than traditional surgery, without compromising efficacy.

Select patients with early-stage breast cancer may benefit from breast-conserving therapy (BCT), a technique that combines surgery with other treatments and avoids mastectomy. The surgeon and radiation oncologist can discuss the most appropriate treatment options, based on individual circumstances.

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 have prior to surgery.

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

Lumpectomy

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.

Partial Mastectomy

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

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 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.

Modified Radical Mastectomy

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).

Radical Mastectomy

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.

Breast Surgery Plan

Your doctor and the staff caring for you may alter this plan to meet your specific needs regarding your diagnosis and breast surgery.

Pre-Admission Testing

Diagnostic Tests:

  • You may have blood drawn and other medical testing if your physician determines the need.
  • You and your doctor will review the list of current medications you are taking. This includes vitamins and herbal supplements.

Diet:

  • Follow your normal diet
  • On the day of surgery, do not eat or drink anything after midnight the night before. This includes gum and cough drops and you cannot smoke.

Education (what to expect on the day of your surgery):

  • You may have an IV and possibly a drain
  • You will have an incision on your breast (the extent and details of this incision will be explained to you prior to the procedure)
  • There may be swelling and bruising at the incision site
  • You may experience some pain with arm movement after surgery
  • Numbness, tingling, phantom breast sensation may occur after surgery. These sensations are normal after this type of procedure

Preparation:

  • Make your life easier and safer after surgery by planning and arranging the reduction of household activities prior to surgery.
  • Arrange for assistance for household chores and meal preparation when you first get home.
  • Arrange for transportation to and from the hospital as well as to your physician's office for your after surgery check-up.

Following Breast Surgery

  • Diet: You may follow your normal diet as long as you are not experiencing any nausea
  • Medications and IV's: Pain medication will be given to you as needed
  • Special Consults: If you have a mastectomy or a surgery involving your lymph nodes, a Reach To Recovery referral will be initiated
  • Activity: You will practice your arm and shoulder exercises with the nurse or physical therapist
  • Education: You will learn to empty your drain if you have one.

Post-Op Day One

  • You will learn the signs and symptoms that may indicate wound infection. You will practice emptying your drain if you have one. You will receive information regarding:
    • Activity instruction
    • Incision care
  • You will also be instructed on breast self-exam techniques.

Day of Discharge

  • You will be given information about a cancer support group
  • You will be given the 800.4.CANCER (Cancer Information Service) phone number
  • If you had a mastectomy:
    • You will learn about stores near your home where you can purchase post-mastectomy products
    • You will be provided with a temporary prosthesis

It is very important to keep your follow-up medical appointments

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?

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