Surgery Options

Breast Conserving Surgery

Nearly all women with breast cancer will have some type of surgery. Lumpectomy removes the breast cancer and the surrounding area, or margin, of normal tissue. If cancer cells are present at the margin (the edge of the excisional biopsy or lumpectomy specimen), a re-excision can be done to remove the remaining cancer. In almost all cases, 6 to 7 weeks of radiation therapy follows lumpectomy. Doctors call this combination (of lumpectomy and radiation) breast conserving therapy. It's an option for most, but not all, women with breast cancer. Those who probably should not undergo lumpectomy, or breast conserving therapy are:

• Women who have already had radiation therapy to the affected breast or chest.
• Women with two or more areas of cancer, in the same breast, too far apart to be removed in one incision.
• Women whose initial excisional biopsy -- or, when needed, their re-excision -- has not completely removed their cancers.
• Women with certain connective tissue diseases that make body tissues especially sensitive to the side effects of radiation.
• Pregnant women who would require radiation while still pregnant.

Mastectomy

In a simple (total) mastectomy procedure surgeons remove the entire breast but do not remove any lymph nodes from under the arm, or muscle tissue from beneath the breast. In a modified radical mastectomy, surgeons remove the entire breast and some axillary (underarm) lymph nodes. This is the most common surgery for women with breast cancer in whom doctors remove the whole breast.

Radical mastectomy removes not only the entire breast, but axillary lymph nodes, and the chest wall muscles under the breast as well. At one time this surgery was quite common. But it left women disfigured and caused side effects. The modified radical mastectomy has proved as effective as radical mastectomy, which doctors now rarely perform.

Some possible side effects of both mastectomy and lumpectomy include wound infection, hematoma (accumulation of blood in the wound), and seroma (accumulation of clear fluid in the wound).

Reconstructive Breast Surgery

These procedures won't treat cancer, but they restore the breast's appearance after mastectomy. Breast reconstruction can be done at the same time as mastectomy (immediate reconstruction) or at a later time (delayed reconstruction). Surgeons may use implants, or tissue from other parts of the body; they call the latter autologous tissue reconstruction. How do a woman and her doctor decide on the type of reconstruction and when to undergo the procedure? The answer to that depends on the woman's personal preferences and details of her medical situation, such as how much skin is removed and whether she needs chemotherapy.

• Breast Reconstruction Procedure Options:
  The Pluses and Minuses