Breast Cancer Surgery
Surgery has an important role in the treatment of patients with breast cancer. Most women can choose between breast-conserving surgery (lumpectomy with radiation therapy) or removal of the breast (mastectomy). Clinical trials have proven that both options provide the same long –term survival rates for most type of early breast cancer. However, neither option guarantees that cancer will not recur. Whichever choice you make you will need close medical follow-up for the rest of your life. Types of Breast Cancer Surgeries are as under :
Breast Conserving Surgery
- Lumpectomy: It is the surgical removal of the cancerous lump (or tumor) in the breast, along with a small margin of the surroundings normal breast tissue. Lumpectomy may also be called wide excision biopsy, breast conserving therapy or quadrantectomy (this latter term is used when up to one fourth of the breast is removed). The procedure is often performed on women with small or localized breast cancer because it allows women to maintain of their breast after surgery. The surgeon removes the breast cancer and some normal tissue around it (in order to get clear margins). This procedure usually results in removing all the cancer, while leaving you with a breast that looks much the same as it did before surgery. Usually, the surgeon also takes out some lymph nodes under the arm to find out if the cancer has spread. Women who have lumpectomies almost always have radiation therapy as well.
- Partial or Segmental mastectomy: Depending on the size and location of the cancer, this surgery can conserve much of the breast. The surgeon removes the cancer, some the breast tissue, the lining over the chest muscles below the tumor, and usually some of the lymph nodes under the arm. In most cases, radiation therapy follows.
MASTECTOMY IS THE SURGICAL REMOVAL OF A BREAST. Surgery is presently the most common treatment for breast cancer. Following mastectomy, immediate or delayed breast reconstruction is possible in many instances.
Types of mastectomy are:
- Total (simple) mastectomy : the surgeon removes the entire breast. Some lymph nodes under the arm may be removed also.
- Modified or radical mastectomy : The surgeon removes the breast, some of the lymph nodes under the arm, and the lining over the chest wall muscles.
- Radical mastectomy : The surgeon removes the breast, chest muscles, and all lymph nodes under the arm. This was the standard operation for many years, but it is used now only when a tumor has spread to the chest muscles.
A mastectomy may be recommended when:
- Cancer is found in more than one part of the breast.
- The breast is small or shaped so that lumpectomy would leave little breast tissue or a very deformed breast.
- A woman chooses not to have radiation therapy.
- A woman prefers a mastectomy.
As in any kind of surgery, there is a risk of infection, poor wound healing, bleeding, or a reaction to the anesthesia used in surgery. There may be a collection of fluid under the skin; or tingling, numbness, stiffness, weakness, or swelling of the arm. Physical therapy and exercise can help to restore arm movement and strength.
Removal of Lymph Nodes
Whether you have lumpectomy or mastectomy, your surgeon will probably remove some of the lymph nodes under your arm. This procedure is usually done at the same time as the breast surgery to check if the cancer has spread outside the breast. Clear lymph nodes are reported as negative nodes. If cancer is found, you have positive nodes. Your doctor will talk with you about any additional treatments needed to destroy and control cancer cells.
- Lymphedema: the lymph nodes under your arm drain lymph fluid from your chest and arm. Both surgery and radiation therapy can change the normal drainage pattern. This can result in a swelling of the arm called Lymphedema. The problem can develop right after surgery or months to years later.
Treatment of Lymphedema depends on how serious the problem becomes. Options include an elastic sleeve, an arm pump, arm massage, and bandaging the arm. Exercise and diet also are important. If you have this problem, talk with your doctor and see a physical therapist as soon as possible. Many hospitals and breast clinics offer help with Lymphedema. There is no cure for this condition, so you should do what you can to prevent it.
- Sentinel lymph Node Biopsy: Surgeons are investigating a new procedure in cancer patients used to detect lymph node involvement. In this procedure, either a blue dye or a small amount of radioactive material is injected around the tumor site. The surgeons performs a small incision in the axillary underarm area looking for a lymph node containing the blue dye or uses a scanner to locate the radioactive material. The lymph node(s) where the dye first accumulates after leaving the tumor region is called the “sentinel node(s). This node(s) is then surgically removed and examined by a pathologist. If it is positive for cancer cells, then the rest of the nodes are usually removed; if it is negative, the remaining lymph nodes may not have to be removed.
After underarm lymph nodes are removed, your arm will have to be protected for the rest of your life.
To help prevent or control Lymphedema and to protect your arm after treatment:
- Carry packages or handbag on the other arm or shoulder.
- Avoid sunburns and burns to your affected arm and hand.
- Have shots (including chemotherapy), blood draws, and blood pressure tests done on the other arm.
- Avoid cuts when shaving underarms; use an electric shaver.
- Wash cuts promptly, apply antibacterial medication, and cover with a bandage. Call your doctor if you think that you have an infection.
- Wear gloves to protect your hands when gardening and when using strong detergents.
- Avoid wearing tight jewellery on the affected arm; avoid elastic cuffs on blouses and nightgowns.
- Have careful manicures; avoid cutting your cuticles