Surgery is the most common treatment for women diagnosed with breast cancer. Depending on the extent of the cancer, different types of surgery are recommended to help ensure that all cancer cells are removed from the body. Breast-conserving surgeries may be possible for patients diagnosed with Stage I or Stage II breast cancer, while mastectomies and/or axillary lymph node removal may be required for more advanced breast cancer and/or for women who want to minimize the risk of a recurrence. Many women who undergo breast surgery as a treatment for breast cancer also chose to have reconstructive surgery, to maintain a more "normal" appearance.
Breast Conserving Surgery
Surgery that conserves the breast involves the removal of only tissue affected by cancer. Typically, the tumor and some surrounding area of the breast is removed. The most common breast conserving surgery is called a lumpectomy. This involves the removal of the tumor itself and a small margin of surrounding tissue. Radiation is almost always administered, and sometimes small metal pieces are inserted during surgery to signify the target area for radiation. Adjuvant chemotherapy (post-surgical chemotherapy) is also frequently administered after a lumpectomy.
A partial or segmental mastectomy is another option for breast conserving surgery. A partial mastectomy removes approximately 1/4 of the breast (called a quadrantectom) or the amount necessary to fully remove the tumor. This surgery is also generally followed by radiation and possible chemotherapy.
Occasionally while performing surgery, a doctor will identify cancer outside the margins of tissue that was intended to be removed. If this occurs, a re-excision (additional operation to remove the affected tissue) is recommended. In some cases, a mastectomy may become necessary if the tissue can't be removed without removing the entire breast.
Mastectomy
A mastectomy involves the removal of the entire breast tissue, and in some cases the surrounding tissue. The nipple and areola are removed as well. In a simple mastectomy, only the breast is removed and no lymph nodes or muscle tissue are removed. A modified radical mastectomy removes the entire breast, as well as the axillary lymph nodes (the lymph nodes under the arm). A modified radical mastectomy is more common than a simple mastectomy.
A skin-sparing mastectomy is a third option, available only to women with small tumors. In this procedure, the nipple and areola are left intact.
Axillary lymph node dissection (ALND)
An ALND refers to the removal of between 10 and 40 axillary lymph nodes. This procedure is usually performed as part of a radical mastectomy, although it can also be done in conjunction with a lumpectomy or a simple mastectomy. Lymph nodes from underneath the arm are extracted during the surgery and biopsied. The presence or absence of the cancer in the biopsied lymph nodes can help a doctor to stage breast cancer and to decide on possible treatment methods.
Sentinel lymph node biopsy (SLNB)
A sentinel lymph node biopsy involves the removal of the sentinel node. The sentinel nodes are the lymph nodes that are most likely to be affected by cancer cells because the tumor drains directly into these lymph nodes. This procedure involves an injection of a radioactive substance, with dye, into the skin directly over the tumor or surrounding the tumor. The dye and radioactive substance are carried into the sentinel nodes by lymphatic vessels and the doctor can then look for lymph nodes that turn colors. The doctor makes in incision into the skin and removes the colored lymph nodes, which are biopsied. This has fewer side effects and may be more accurate than ALND, but is usually only used with smaller tumors.
Reconstructive Surgery
Reconstructive surgery is an elective procedure undergone by many women who get mastectomies. Reconstruction can be done as part of the original mastectomy (immediate reconstruction) or at a later date (delayed reconstruction). Immediate reconstruction may not be recommended if radiation is going to be administered. Reconstruction uses saline or silicone implants, or tissue from other parts of the body.
Tags: lymph nodes, breast cancer, involves removal, lymph node, axillary lymph
