Surgery
Surgery is the most common treatment for breast cancer. You and your surgeon will need to decide which operation may be best for you based on your overall health and:
- Size of the tumor
- Pathological features of the tumor
- Number of lymph nodes that may be involved
The two types of surgery for breast cancer are a lumpectomy or mastectomy.
Lumpectomy
A lumpectomy, also called breast-sparing surgery, removes:
- The tumor
- A small margin of the normal breast tissue surrounding the tumor, and
- Possibly some of the lymph nodes under the arm (called an axillary node dissection)
If the surgeon cannot feel the lymph nodes that have to be removed, he or she will do a sentinel lymph node biopsy to identify the nodes that contain cancer. A lumpectomy does not remove the areola or nipple.
Many women receive radiation after breast-sparing surgery to destroy any remaining microscopic cancer cells that may be left behind.
Mastectomy
Surgery to remove the entire breast is called a mastectomy. There are three types of mastectomy procedures:
- Simple mastectomy, which removes the entire breast
- Modified mastectomy, which removes the entire breast and some lymph nodes in the armpit, but leaves the chest muscle in place
- Radical mastectomy, which removes the entire breast, lymph nodes and chest muscle
Today, a radical mastectomy is rarely done, and performed only in cases of advanced breast cancer that has invaded the chest wall. A modified mastectomy is usually done when lymph nodes are known to be positive.
A simple mastectomy may include either a sentinel lymph node biopsy or no lymph node removal at all. It is usually done in cases of extensive DCIS (ductal carcinoma in situ) or prophylactic (preventive) mastectomy. A prophylactic mastectomy may be an option for women who have a strong family history or high genetic risk for breast cancer. DCIS describes abnormal, cancer-like cells that are confined to the breast duct.
What to Expect
Your hospital stay will depend on whether you are having a lumpectomy or mastectomy. Mastectomy allows for an overnight stay. Your stay will be longer if you have a mastectomy with immediate breast reconstruction.
If you have a mastectomy or expect to have one, you may be entitled to special rights under the Women’s Health and Cancer Rights Act of 1998. Specifically, this act deals with obligations on the part of your insurance company, which, if it covers mastectomy, must also cover reconstructive surgery.
Recovery After Surgery
Recovery varies from woman to woman. Immediately after the surgery you may feel pain and tenderness at the surgical site. Your doctor will prescribe medicine to minimize the pain.
If you have had a mastectomy, you may feel a little off balance. You may also experience some discomfort in your back and neck, and possibly some tightness in your shoulder and arm muscles. Physical therapy can help you regain strength and movement in these areas. Your surgeon will give you post-operative instructions that include gentle stretching exercises to improve your range of motion.
Risks
All surgery carries a risk of infection or bleeding. Your doctor will explain the particular risks to you.
Another risk is the possibility that small nerve endings may be cut during the operation. If so, you may feel some tingling or numbness in your arm, shoulder or chest after surgery. Many of these symptoms resolve over time, but some slight numbness may always be present.
If you had lymph nodes removed under your arm, you may be susceptible to fluid buildup and some swelling. To minimize fluid and any discomfort, you can:
- Elevate the arm and do range-of-motion activities, starting slowly
- Avoid tight sleeves or jewelry on the arm, or carrying a purse on that shoulder
- Avoid blood pressure readings, having shots or drawing blood in this arm
Breast Reconstruction
Beth Israel Deaconess Medical Center provides state-of-the-art techniques in breast reconstruction after mastectomy. There are many choices and options, from breast implants to advanced muscle-sparing procedures that use the body’s own abdominal tissue, such as DIEP flap and SIEA flap. These perforator flap procedures transfer skin, fat and blood vessels from the abdomen to the mastectomy site to reconstruct the breast. Breast reconstruction can be done at the same time as mastectomy or even in a delayed fashion, several years later.
Patients benefit from our dedicated (specialized) breast and reconstructive surgeons, and nursing and operating room staff. Proficient, skilled and experienced in microsurgical techniques, the team specializes in muscle-sparing perforator flap procedures.
Learn more about breast reconstruction »
