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Surgery as a Treatment for Breast Cancer

Surgery is the most common breast cancer treatment modality. It is often used in combination with other modalities such as radiation and chemotherapy, as part of a treatment regimen. Surgery alone can be curative in very early stages of breast cancer.

The goal in surgery is to remove the primary tumor and either sample for cancer in the lymph nodes or remove lymph nodes in the axilla (armpit). There are two main categories of surgery for breast cancer: Breast Conserving Therapy (BCT) and mastectomy.

Breast Conserving Therapy

Breast Conserving Therapy is a combination of minimal surgery followed by radiation to the tumor site, to prevent local recurrence. [1] The surgery is more commonly known as a “lumpectomy”, partial mastectomy or partial tylectomy. This simply means that the entire breast is not removed, but conserved after the tumor has been removed. During surgery, a sample of the axillary lymph nodes may be taken and tested to see if the cancer has spread.

The term “lumpectomy” implies that only the tumor is removed, however, the tumor is excised with a rim of normal tissue surrounding it entirely. Some patients are not candidates for BCT. These include those with a history of prior radiation to the area, those with large primary tumors and/or small breasts, where removing the entire tumor with a rim of normal tissue would create a large deformity that is not aesthetically pleasing, multiple tumors in the same breast and pregnant women since they cannot have radiation.[2]

This is considered a minimally-invasive surgery with fewer complications than a mastectomy, however, all surgeries have potential complications. The complications associated with this surgery are:

  • Dimpling or change in the breast shape
  • Breast asymmetry
  • Scarring
  • Infection
  • Numbness
  • Bleeding
  • Seroma formation
  • Failure to remove all of the cance

Mastectomy

A mastectomy is defined as the removal of all breast tissue. There are a few procedures that involve a mastectomy, with or without removal of the lymph nodes in the axilla. These are described below from most invasive to the least:

Radical Mastectomy – Fortunately, this procedure is very rarely done anymore, as a result of many years of research.[3] This involves removal of the entire breast, the axillary lymph nodes and the chest wall, which is composed of the pectoralis major and minor muscles. This was a very morbid procedure and often left women with some permanent disability from the loss of muscle as well as severe disfigurement of the chest.

Modified Radical Mastectomy (MRM) – This is one of the more common breast cancer surgeries performed today. It involves removal of the entire breast along with the axillary lymph nodes (levels I and II). The nipple-areolar complex must always be removed with this procedure.

Total Mastectomy – This procedure, also known as a “simple” mastectomy, involves removal of only the breast tissue without removal of axillary lymph nodes.[4] This is often done for the contralateral breast (opposite breast) to reduce the risk of developing breast cancer in the future, when a MRM is being performed on the cancer-side. When this is done, it is called a “prophylactic” or “risk-reduction” mastectomy.

Skin-Sparing Mastectomy – This procedure involves removal of all breast tissue without excising a large amount of skin. It is often performed for women having immediate breast reconstruction, as the patient’s own skin provides adequate coverage of breast implants or tissue-expanders once their own breast tissue is removed. One must always keep in mind that the goal of the surgery is first, to remove all of the cancer, and second to reconstruct. Occasionally, a surgeon may determine intraoperatively that immediate reconstruction may jeopardize the patient’s overall treatment or chance for cure and forego reconstruction at that time. However, once a patient is found to be free of cancer, reconstructive efforts can proceed.

After all mastectomies, surgical drains are left in place to remove serous fluid, or the fluid that bathes all of our tissues. The body will try to replace the tissue that has been removed with fluid but over about two weeks, your body will begin to reabsorb this fluid. You will be instructed after your surgery on how to take care of these drains, record their output and when you can expect your surgeon to remove them.

Removal of the entire breast lessens the possibility that the cancer was not completely removed and negates the need for radiation in most cases. The complications that can be associated with this surgery are:

  • Lymphedema (discussed later)
  • Bleeding
  • Infection
  • Limited range of motion
  • Loss of skin sensation or a burning sensation
  • Seroma formation

The most important thing to think about when deciding which surgery is best for treating your cancer, is that the survival for those treated with BCT vs. Mastectomy is the same. There is a slightly decreased risk of local recurrence with mastectomy, but survival is equal.

 

1  Harmon J. Eyre, M. D. (2002). Informed Decisions. Atlanta: American Cancer Society – Health Content Products.

2  Andrew H. Ko, M. M. (2002). Everyone’s Guide to Cancer Therapy. Kansas City: Andrews McMeel Publishing.

3  Harmon, op. cit.

4  Deborah A. Cohen, R. M. (2000). Just Get Me Through This The Practical Guide to Breast Cancer. New York City: Kensington Publishing Corporation.

This article was originally published on July 27,2012 and last revision and update of it was 9/2/2015.