Breast surgery is more than just removing your tumors; it's also about evaluating your lymph nodes to see how far your breast cancer may have spread.
Your surgery options will vary depending on what the cancer is and what you are interested in doing.
Breast cancer surgery options
The main options for breast cancer surgery include:
- Lumpectomy – your surgeon removes the breast cancer and some normal tissue surrounding it
- Breast conserving surgery – your surgeon tries to spare and preserve as much breast tissue as possible
- Mastectomy – your surgeon removes the entire breast
Your breast surgeon will discuss each of these options with you, along with the many variables that need to be considered, which include:
- the size, location and stage of your cancer
- your family history
- your age
- any genetic testing that's been done
Ultimately, the decision on which type of surgery to have is up to you, after considering all the options and your surgeon's best recommendations.
Lumpectomy is one of the most popular current surgical treatment plans for breast cancer. This surgery removes the cancerous area of the breast plus a surrounding area of noncancerous breast tissue. Every attempt is made to preserve breast shape and size.
This approach is appropriate for most small breast cancers and some larger breast cancers. It is accompanied by removal of a portion of the lymph glands under the arm, where breast cancer tends to spread first.
After healing is complete, radiation treatments minimize the chance of recurrence. These treatments are available at the Halvorson Cancer Center at EvergreenHealth Medical Center.
The lumpectomy procedure is usually done with an overnight stay, but can be done as an outpatient. Average recovery time is one week.
Mastectomy removes only the nipple and a small amount of surrounding skin along with all the underlying breast tissue. Additionally, some lymph glands under the arm are removed. No muscles are affected and side effects are rare. Radiation is usually not required.
This surgery is used for very large or extensive tumors. It usually involves an overnight hospital stay, but can be done as an outpatient.
Average recovery time is seven to ten days.
Breast reconstruction can be performed by a plastic surgeon at the same time as a mastectomy, if desired. These procedures require a typical hospital stay of two to five days. Recovery averages from two to six weeks for full recovery, depending on the procedure performed.
Sentinel lymph node biopsy
This surgical technique identifies specific lymph nodes draining the area of the breast where cancer began. These lymph nodes can be precisely identified and removed by an injection of a radioactive tracer and a blue dye in the area of the cancer just before surgery. These lymph nodes undergo extra testing to determine the stage of the cancer with the highest possible accuracy.
This staging process helps determine the likelihood that an individual's cancer cells have spread and allows our team of physicians to develop the most accurate recommendations for treatment. In some cases, sentinel lymph node removal will suffice for standard partial axillary lymph node removal. This procedure is available through our breast surgeons and integrated into our team approach with our radiologists, pathologists, radiation oncologists and medical oncologists.
Should you choose to have a mastectomy, your surgeon will go over the options for breast reconstruction surgery.
We will coordinate with the plastic surgeon to have the procedure done either at the time of your mastectomy, or later in your recovery.
There are two types of breast reconstruction:
- breast reconstruction with natural tissue
- breast reconstruction with implants
Your plastic surgeon can help you determine the right option for you. And if you decide against breast reconstruction surgery, your breast cancer nurse navigator can help you with the process of prosthetics.
What happens during breast cancer surgery?
You will be under general anesthesia for your surgery.
Your breast surgeon will work to make your incisions as small as medically possible. They can often be made where they are less noticeable.
Your breast surgeon will also evaluate your lymph nodes during your surgical procedure. This is to see if your cancer has spread beyond your breast. For most women, this can be done with a sentinel node biopsy. Your surgeon will identify the first few lymph nodes and remove them for testing.
Depending on the type of the tumor and whether it's spread to the lymph nodes, you might need a more extensive procedure in your armpit, called an axillary dissection.
When will I go home?
If you have a mastectomy, you'll likely remain in the hospital overnight. With a lumpectomy, you will likely go home the same day.
Will I need additional treatment?
If you decide on a lumpectomy or breast-conserving surgery, you will typically receive follow-up radiation treatments.
Typically, mastectomies do not need follow-up radiation treatments, unless you have a large tumor or a tumor with involved nodes.
What will my recovery from breast cancer surgery be like?
Your activities will be limited initially, but you'll be encouraged to work toward resuming your normal life as soon as possible.
The area of the surgery may be bruised for a few days. You might be numb, uncomfortable or have tingling on the inner part of your upper arm or in your armpit. This is normal.
You'll want to follow-up with your breast surgeon within a specified period of time, or if you experience side effects that concern you.
Are there any post-surgery challenges?
The breast cancer specialists at EvergreenHealth also have expertise to help you with possible challenges following your surgery.
Lymphedema is the build-up of lymphatic fluid that causes swelling in the arm and hand, and occasionally in the chest/breast on the side of your breast surgery.
You will be referred to the specialized outpatient lymphedema program at EvergreenHealth Rehabilitation Services. Our therapists have received training in massage techniques, bandaging and exercises and have specialized equipment to reduce the discomfort.
What are my chances for a recurrence?
With a breast conserving approach, your survival statistics in general are going to be the same whether or not you keep your breast. There is a little difference in local recurrence and whether or not something comes back in your breast or along the chest wall.
With a lumpectomy and radiation, our statistics suggest about a 4 percent risk of a local recurrence in ten years.
With a mastectomy, it's about a 1 percent or 2 percent risk of something recurring up along the chest wall.
Our expectation is for you to be cured and get on with your life with no limitations.