Surgery

Most women with breast cancer will have some type of surgery to treat the main breast tumor. The purpose of surgery is to remove as much of the cancer as possible. Surgery can also be done to find out whether the cancer has spread to the lymph nodes under the arm (axillary dissection); to restore the breast's appearance (reconstructive surgery); or to relieve symptoms of advanced cancer. Here is a summary of some of the most common types of breast cancer surgeries:

Lumpectomy (lump-EK-tuh-me): Also called breast conservation therapy, lumpectomy involves removing only the breast lump and some normal tissue around it. Radiation treatment is often given for about six weeks after this type of surgery. If chemotherapy is going to be used as well, the radiation may be postponed until the chemotherapy is finished.

Partial (segmental) mastectomy (mas-TEK-tuh-me): This surgery involves removing more of the breast tissue than in a lumpectomy. It is usually followed by radiation therapy.

Simple or total mastectomy: In this surgery, the entire breast is removed but not the lymph nodes under the arm or muscle tissue from beneath the breast.

Modified radical mastectomy: This operation involves removing the entire breast and some of the lymph nodes under the arm.

Radical mastectomy: This is extensive removal of entire breast, lymph nodes and the chest wall muscles under the breast. This surgery is rarely done now because modified radical mastectomy has proven to be just as effective with less disfigurement and fewer side effects.

Other Breast Cancer Surgeries

Axillary dissection: This operation is done to find out if the breast cancer has spread to lymph nodes under the arm. Some nodes are removed and examined under a microscope. Knowing whether there are cancer cells in the lymph nodes can help guide other treatment decisions. A possible side effect of removing these lymph nodes is swelling of the arm, called lymphedema. It happens to about 10 to 30 percent of women who have had these nodes removed. Women who have swelling, tightness or pain in the arm after lymph node surgery should tell their doctor right away. Often there are measures to prevent or reduce the effects of the swelling.

Sentinel lymph node biopsy: This is a way to look at the lymph nodes without having to remove all of them first. For this test, a radioactive substance and a dye are injected near the tumor or under the nipple. They are carried by the lymph system to the first (sentinel) node to receive lymph from the tumor. This lymph node is the one most likely to contain cancer cells if the cancer has spread. Once this node is found, it is removed and examined. If the sentinel node contains cancer, more lymph nodes are removed. If it is free of cancer, further lymph node surgery might not be needed. This type of biopsy is complex, so it is best to have it done by experts who have significant experience.

Reconstructive or breast implant surgery: These operations are not meant to treat the cancer, but are done to restore the way the breast looks after a mastectomy. If you are having a mastectomy and are thinking about having reconstruction right away, you should talk to a plastic surgeon before your operation. There are several choices about when the surgery can be done and exactly what type it will be.

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