Breast Surgery

Overview

Breast surgery is the most common treatment for breast cancer and may be an important part of your cancer treatment plan. Nearly all women with breast cancer will undergo some kind of surgery as part of their treatment and/or diagnosis. The extent of surgery for breast cancer may range from removal of only a small piece of breast tissue to removing one or both breasts, including underarm (axillary) lymph nodes. The purpose of surgery in the management of breast cancer is to:

• Obtain a tissue sample for determining an accurate diagnosis.
• Determine the stage of the cancer and whether additional treatment is necessary.
• Treat the cancer locally.

Surgery is local therapy that can remove cancer cells in or near the breast but cannot treat breast cancer cells that have spread to other locations in the body. Cancer cells that have spread are called micrometastases and additional systemic treatment using chemotherapy and/or hormonal therapy is required to treat these areas of cancer. The information obtained during surgery and from other tests determines the likelihood that the cancer has spread and whether additional systemic treatment is necessary. 

Your physician can help you determine whether you need surgery and, if so, what type. The two primary types of breast cancer surgery include breast-conserving surgery and mastectomy. Following a mastectomy, there are surgical options to reconstruct the breast. Breast reconstruction aims to restore the tissue to a normal appearance.

In some cases, your physician may recommend surgically removing one or more of your lymph nodes to determine if the breast cancer has spread. The two primary lymph node surgeries are sentinel lymph node biopsy and axillary lymph node dissection.

Side Effects of Breast Surgery

While recovering from breast surgery, women may experience the following side effects:

• Pain and tenderness
• Swelling at surgery site
• Bruising
• Seroma, collection of fluids under the surface of skin
• Limited arm or shoulder movement
• Numbness in chest or upper arm
• Nerve pain in chest, armpit or arm
• Bleeding at surgery site
• Infection at surgery site

Your breast surgeon will talk with you about ways to minimize side effects.

Surgical Procedures

The following is a general overview of the role of surgery in the management of breast cancer. Surgery may be the primary treatment for some breast cancers, but for many women, multi-modality treatment, which utilizes two or more treatment techniques, is increasingly recognized as the best approach for improving a patient’s chance of cure or prolonging survival. In some cases, participation in a clinical trial utilizing new, innovative therapies may provide the most promising treatment. Circumstances unique to each patient’s situation may influence how these general treatment principles are applied. The potential benefits of multi-modality care, participation in a clinical trial, or standard treatment must be carefully balanced with the potential risks. The information on this website is intended to help educate patients about their treatment options and to facilitate a mutual or shared decision-making process with their treating cancer physician.

The type of surgery that a patient with breast cancer undergoes depends largely on the size and location of the cancer, the breast size, feasibility of breast reconstruction, and how important breast preservation is to the patient.

Strategies to Improve Treatment

The development of more effective cancer treatments requires that new and innovative therapies be evaluated with cancer patients. Clinical trials are studies that evaluate the effectiveness of new drugs or treatment strategies. Future progress in the surgical treatment of breast cancer will result from the continued evaluation of new treatments in clinical trials. Participation in a clinical trial may offer patients access to better treatments and advance the existing knowledge about treatment of this cancer. Patients who are interested in participating in a clinical trial should discuss the risks and benefits of clinical trials with their physician. Areas of active investigation aimed at improving the surgical treatment of breast cancer include the following:

Skin-sparing mastectomy

A new mastectomy procedure is being developed at several surgical oncology programs around the United States. A skin-sparing mastectomy removes the entire breast tissue, similar to a mastectomy, but leaves the skin covering the breast intact and capable of housing fat and muscle from other parts of the body. The procedure is more difficult than a traditional mastectomy in that the surgeon must make a small incision in the breast about the size of a half-dollar and then carefully remove all the breast tissue inside the breast. When done correctly, an empty envelope of skin exists that can then be filled with fat and muscle taken from the woman’s back or abdomen. Because the surgery uses fat from the woman’s own body, the newly constructed breast behaves just like the companion breast when weight is gained or lost.

References

1 Fisher B, Anderson S, Bryant J, et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. The New England Journal of Medicine 2002;347:1233-1241

2 Poggi MM, Danforth DN, Sciuto LC, et al. Eighteen-year results in the treatment of early breast carcinoma with mastectomy versus breast conservation therapy: the National Cancer Institute Randomized Trial. Cancer 2003;98(4): 697-702.

3 Veronesi U, Cascinelli N, Mariani L, et al. Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. The New England Journal of Medicine 2002;347;1227-1232.

4 Edge SB, Niland JC, Bookman MA, et al. Emergence of sentinel node biopsy in breast cancer as standard-of care in academic comprehensive cancer centers. Journal of the National Cancer Institute 2003;95:1514-1521.

5 Veronesi U, Paganelli G, Viale G, et al. A randomized comparison of sentinel-node biopsy with routine axillary dissection in breast cancer. The New England Journal of Medicine 2003;349:546-553.

Why Choose Texas Breast Specialists

Our team of breast care professionals is dedicated to your health and well-being. When you come to us for care, you’ll find: