Breast Surgery

Some types of breast cancer surgery remove the breast (mastectomy), and others remove the tumor and varying degrees of the remaining breast tissue (lumpectomy).  Your surgeon will consider the following facts in determining which surgery best suits your needs:

• Type of tumor:  The type was diagnosed by biopsy and confirmed by the pathology report.
• Size of the tumor:  Sizes are given in centimeters (cm) and millimeters (mm) - 10mm equal 1 cm; 1cm equals 3/8 of an inch; 1 inch equals 2.5 cm.
• Size of your breast:  Some breasts may be too small in comparison to the size of the lump to give good cosmetic appearance when the lump is removed.
• Location in your breast:  Tumors under the nipple sometimes will not give a suitable cosmetic look when the lump is removed.  Two tumors in the same breast not located close to each other will not give good cosmetic results.
• Lymph nodes:  Possible tumor involvement in the lymph nodes
• Mammogram:  Determines if your tumor may be multi-focal (occuring within one quadrant in the breast) or multi-centric (occuring in more than one quadrant).  This is sometimes evidenced by microcalcifications (small calcium deposits).
• Involvement of other structures:  Skin, muscle, chest wall, bone or other organs
• Reconstruction:  Your desire for reconstruction now or later and the desired outcome for the reconstructive surgery (breast reduction, enlarging or matching present size)
• Health:  Your general health and any treatment limitations related to your present health
• Disease control:  Determines which surgery will give you the best chance for disease control
• Cosmetic results:  Determines which surgery will give you the best cosmetic results
• Range of motion:  Determines which surgery will give you the best functional results for your arm and shoulder
• Personal desire:  Your desires and priorities regarding the surgery

Here is an overview of breast surgery options:

Breast Conservation Surgery (Lumpectomy)

Breast conservation surgery preserves your body image because it saves the majority of the breast tissue, including the nipple and areola. A surgeon removes the breast cancer and some normal tissue around it. Ask your physician what type of lymph node evaluation procedure is recommended for your breast conserving surger.  A sentinel lymph node procedure may be performed along with the lumpectomy.  It is usually followed by radiation therapy to destroy any cancer cells that may remain in the area.  

Segmental Mastectomy

A surgeon removes the cancer and a larger area of normal breast tissue around it. Occasionally, some of the lining over the chest muscles below the tumor is removed as well.  A sentinel lymph node procedure may be perfromed along with the lumpectomy.  It is usually followed by radiation therapy to destroy any cancer cells that may remain in the area.

Total (Simple) Mastectomy

A surgeon removes the whole breast. Some of the lymph nodes under the arm may also be removed.

Modified Radical Mastectomy

A surgeon removes the whole breast, most of the lymph nodes under the arm, and often the lining over the chest muscles. 

Radical Mastectomy

A surgeon removes the breast, the chest muscles, all of the lymph nodes under the arm and some additional fat and skin. For many years, this operation was considered standard for women with breast cancer, but it is rarely used today and only in cases of advanced cancer in which the cancer has spread to the chest muscles.

Breast Reconstruction Surgery

An important but often overlooked facet of cancer care is the physical appearance or cosmetic concerns of the patient. Plastic and reconstructive surgeons work together with our surgical oncologists to provide cancer patients with consultation and assessment before cancer surgery. Many times, the plastic surgeons perform their restorative procedures immediately following or at the same time as the cancer surgery.

Sentinel Lymph Node Biopsy

This procedure involves locating the few lymph nodes near the site of cancer that would receive lymph fluid drainage from the tumor itself. If any tumor cells have moved from the original area involved, those lymph nodes would most likely hold them. These lymph nodes are found using a radioactive tracer and blue dye.  The procedure begins with an injection of a radioactive substance before going to surgery.  During surgery, the surgeon injects the blue dye around the tumor site or areola; it is carried by the lymph fluid to the closest node(s).  A hand-held gamma detection probe first identifies where the radiographic material has concentrated, showing the area for the surgeon to make the incision.  The blue dye helps the surgeon visually identify the node (there may be one or several) for removal.  During and after surgery, the pathologist examines these nodes for cancerous cells.

Skin-Sparing Mastectomy

Skin-sparing mastectomy is a procedure used when performing a simple or total mastectomy.  The method removes the breast tissues from a circular incision around the areola.  The nipple, areola, breast tissues, nodes located near the breast tissues and additional lymph nodes are removed at the surgeon's discretion.  The procedure is often selected when reconstructive surgery is performed because it allows for little need for a period of stretching the skin for reconstruction.  Sensitivity of the skin over the reconstructed breast remains intact.  This is often recommended surgery for women having mastectomy for intraductal disease and desiring reconstruction for a small peripheral tumor.

Prophylactic Mastectomy

For some women, there may be an option for a prophylactic mastectomy (simple mastectomy) of a breast if bilateral reconstruction is desired.  A prophylactic mastectomy takes place before cancer has been found.  Some women with an extremely high risk of breast cancer or pre-cancerous conditions choose this procedure.  This elective surgery is a decision made collaboratively between the patient, surgeon and oncologist.  Reasons for considering this procedure may include:

• Family history of breast cancer, including first degree relatives who died of the disease
• Identified carrier of BRCA1 or BRCA2 genes
• Repeated breast biopsies for suspicious findings

Diagnosis of a cancer type that has a high rate of occurrence in both breasts

• When the weight of a very large remaining breast (after mastectomy) creates imbalance, posture changes and back pain
• Desire for bilateral reconstruction with an increase or decrease in the reconstructed breast size
• Overwhelming psychological fear of occurrence in remaining breast