The types of surgery
Surgery aims to remove the cancer with a margin (edge) of normal tissue to reduce the risk of the cancer returning in the breast (called a local recurrence) and to try to stop the spread.
Usually, the first treatment for breast cancer is sometimes chemotherapy or hormonal therapy. This is to start treating the whole body or to shrink the cancer so that surgery may be less extensive.
One of the first decisions you have to make is what type of operation will. You may be offered a choice of breast-conserving surgery or total mastectomy.
It is a breast-conserving surgery, usually called wide local excision or partial mastectomy is the removal of the cancer with a margin (edge) of the surrounding breast tissue.
An operation is a much less common quadrantectomy where removes about a quarter of the chest (sometimes called segmental excision). After the breast lumpectomy usually be smaller and may also have a notch because of the amount of tissue removed.
There is an increasing use of oncoplastic surgical techniques, which means the combination of breast cancer surgery with plastic surgery to try to provide the best cosmetic result and the best treatment of cancer. These techniques are more likely to represent the shape and symmetry of the breasts is maintained.
Mastectomy means removing all the tissue of the breast including the nipple area. A simple mastectomy chest means that removes all but lymph nodes and muscles under the breasts are not affected. However, some lymph nodes can be removed with the breast tissue taken during surgery. A simple mastectomy is often adequate treatment for generalized DCIS (ductal carcinoma in situ).
A modified radical mastectomy removes the entire breast and some lymph nodes under the arm. Sometimes one of the small muscles of the chest wall is also removed.
If you are going to have a mastectomy will usually be able to undergo breast reconstruction. This can be done at the same time as the mastectomy (immediate reconstruction) or months or years later (delayed reconstruction). You can offer a delayed reconstruction if there are medical reasons why one is not immediately possible. For more information, see our pages about breast reconstruction.
Surgery Right for You
More than half of the early stages of breast cancer can be treated by breast conservation surgery followed by radiation.
Studies have shown that long-term survival is the same if you have a breast-conserving surgery and radiation or mastectomy.
The type of surgery will be determined by the type of cancer, size, where it is in their midst and the amount of surrounding tissue needs to be removed. It also depends on how big your breasts are.
The surgeon will want to give the best possible cosmetic result and more effective surgery. That means keeping as much of your breast, without increasing the risk of the cancer coming back.
Your surgeon may recommend removal of the entire breast. Total mastectomy may be the best option when:
- Your breast is small so the remaining tissue would deform after conservative surgery
- Cancer occupies a large area of the breast
- More than one area of breast cancer
- Cancer is found in the center of your chest or directly behind the nipple.
If the surgeon recommended a mastectomy must explain why this is necessary. It may also be a preference to mastectomy.
Lymph node removal
For invasive breast cancer, it is recommended that some or all of the lymph nodes under the arm (axillary) are removed to see whether they contain the cancer cells. Knowing whether lymph nodes are involved it is important to help your team of specialists decide on additional treatments to surgery.
People have different numbers of lymph nodes, but on average there are about 20 lymph nodes under the arm. These are arranged in three levels (1, 2 and 3) and the number of nodes in each level may vary. Level 1 is closer to the breast and contains the largest number of lymph nodes.
Sampling removed axillary lymph nodes near the breast of level 1, while cleaning eliminates axillary nodes up to level 3.
Sentinel node biopsy
Another way to find out if breast cancer has spread to lymph nodes under the arm is a sentinel node biopsy. This can be carried out while the main breast surgery or in some cases before. A sentinel node biopsy involves injecting a small amount of radioactive material and a dye into the body to identify the first, or sentinel node (s) to receive lymphatic fluid of cancer. This node is then removed and examined. If the sentinel node is free of cancer cells usually means that the other nodes are not too clear what else will have to be removed.
The result of sentinel node biopsy will normally available one or two weeks after surgery.
Sentinel node biopsy is becoming standard practice for cancer patients who show no evidence of lymph node involvement. They do these tests before surgery and when the surgeon can not feel enlarged lymph nodes under the arm. There is a proper procedure if the evidence before the operation showed that the lymph nodes are involved.
If the results of sentinel node biopsy shows that the node (s) removed is affected by cancer, it may recommend that you have a second operation to remove the remaining lymph. About 20-25% of women who were sentinel node biopsy does have additional surgery to try to ensure that all affected lymph nodes were removed.
Evaluation of sentinel lymph node during surgery
In some hospitals, this evaluation may be possible to check the sentinel node (s) at the time of surgery. This means that the surgeon may discover during operation if the lymph nodes contain cancer cells and, under the same anesthesia, if you make a axillary lymph nodes are involved.
An example of this is a diagnostic test called OSNA (one step of nucleic acid amplification). A substance (label) is produced in breast cancer cells which is not found in healthy lymph node. OSNA can detect small amounts of this substance.
Another type of biopsy is known as a “frozen section” can also be carried out during operation. This involves freezing the tissue to be removed to prepare for examination under a microscope. Samples can then be studied in minutes so that the results can be passed to the surgeon.
These tests can avoid the need for a second operation if the cancer is detected to have spread to lymph nodes. However, some surgeons prefer to wait for the lab exam which is more detailed, to make sure no cancer in the sentinel lymph node.
The sentinel node biopsy is not suitable for everyone and your surgeon will discuss whether this procedure is an option for you. If your surgeon tells you that you do not need any lymph nodes removed during surgery, they should explain why.
Reconstruction after mastectomy
If you are going to have a mastectomy will usually be able to undergo breast reconstruction. This can be done at the same time as the mastectomy (immediate reconstruction) or months or years later (delayed reconstruction).
If you are hoping to breast surgery should be given the opportunity to discuss the reconstruction of antemano.Se recommends discussing the option of immediate breast reconstruction with all patients being advised to have a mastectomy.
Your specialist team will be able to explain your options to you. All appropriate options for breast reconstruction should be offered and discussed, even if they are not available locally. If local services can not offer breast reconstruction or a specific type of reconstructive surgery, you may be referred to another hospital.
Sometimes having a reconstruction is not recommended due to existing medical conditions that may increase the risk of problems or complications after surgery. If you are advised not to carry out reconstruction, your surgeon will explain the reasons why.
Reconstruction may involve major surgery and should be considered carefully.
You may prefer to wait and see how you feel after breast surgery.
Some women find that during the waiting period to get used to living without a breast and decide not to undergo reconstruction surgery.