American Medical Association Family Medical Guide - American Medical Association [578]
Surgery
In most cases of breast cancer, surgery is recommended to remove the tumor. Surgery may involve removing all or part of the breast. The type of surgery performed and the amount of tissue removed depend on the size and location of the tumor and whether the cancer has spread. Occasionally, the entire tumor can be removed during a biopsy.
Breast-conserving surgery
If a breast tumor is small, a woman may be offered the option of having just the lump and a small amount of the surrounding tissue removed (called a lumpectomy or a partial mastectomy), followed by radiation therapy. Some lymph nodes in the armpit are also removed and examined for cancer cells (called a sentinel lymph node biopsy). Radiation therapy after surgery reduces the risk of recurrence of the cancer in the breast and chest wall.
Women who have breast-conserving surgery followed by radiation have a survival rate equal to that of women who have mastectomies (surgery in which all or a major part of a breast is removed). However, if a cancer recurs after a lumpectomy, a woman will later need to have a mastectomy. Ask your doctor if breast-conserving surgery is appropriate for you. You may want to consider getting a second opinion from another doctor before you make a decision.
Studies are under way to evaluate the effectiveness of using lasers (high-energy beams of light) or radiowaves to destroy tumors through a needle inserted into the tumor rather than through a surgical incision.
Simple and modified radical mastectomies
In a simple (total) mastectomy, the entire breast is removed, including the nipple and areola. Chest muscles are not removed. This procedure is sometimes performed to treat precancerous growths in the breast or a tumor that has not spread beyond a limited area of the breast. A simple mastectomy is sometimes performed to prevent breast cancer in women who are at high risk of developing the cancer, usually because of a strong family history.
In a modified radical mastectomy, the entire breast is removed along with many of the lymph nodes under the arm. The lymph nodes are examined to see if the cancer has spread. This surgery may be followed by radiation therapy. The incisions are the same for both the simple mastectomy and the modified radical mastectomy.
Skin-sparing mastectomy with reconstruction
Doctors perform a skin-sparing simple or modified radical mastectomy in women who are having breast reconstruction. In these mastectomies, the nipple and areola are the only areas of skin that are removed, which makes reconstruction easier and limits scarring. An incision is made around the areola and to the side and all the breast tissue is removed through this incision. Breast reconstruction is then performed with muscle taken from the woman’s abdomen or back.
Breast reconstruction
Losing a breast is traumatic for every woman. Many women choose to have breast reconstruction surgery (see page 862) after having a mastectomy. Breast reconstruction involves inserting an artificial breast implant into the space or reconstructing the breast using skin, fat, and muscle from another part of the woman’s body (usually the abdomen or back). The procedure may be performed at the same time as the mastectomy or after a woman recovers from a mastectomy. Reconstruction is always done at the same time as a skin-sparing mastectomy. Another option is to wear a breast prosthesis inside a bra. A prosthesis is matched to the other breast and is nearly undetectable.
Incision for lumpectomy
Incision for simple or modified radical mastectomy
Incision for skin-sparing mastectomy
After surgery
After surgery for breast cancer, you may have pain and tenderness at the site; if you are in pain, ask your doctor about pain-relief medication. As with any surgery, there is a risk of infection, slow wound healing, bleeding, or an allergic reaction to the anesthetic used for the surgery.
The skin in the area where the breast was removed may be tight, and the muscles in your arm and shoulder may feel stiff. After a mastectomy, some