Most patients with breast cancer have surgery to remove the cancer from the breast. Depending on the type of cancer you have, some lymph nodes under the arm may be taken out at the same time to determine if the cancer has spread.
Breast Conserving Surgery
Breast conserving surgery removes the cancer, but not the entire breast. There are many types of incisions that can be used and each patient’s surgery is uniquely planned. This type of surgery has many names including but not limited to: lumpectomy, partial mastectomy, segmental resection and quadrantectomy, but they all mean essentially the same thing—the surgical removal of the tumor and a small amount of normal breast tissue around it.
Surgeons at The Breast Health Center are trained in the most advanced oncoplastic surgery techniques for removing the cancerous tissue while also reforming the breast to avoid any deformity and preserve or improve a normal shape when possible. They also pair with plastic surgeons as necessary to ensure the best cosmetic results possible.
A Total mastectomy is surgery to remove the entire breast. This can often be paired with reconstruction by a plastic surgeon to recreate a synthetic breast if desired, or can result in a relatively flat chest contour. There are many different types of mastectomy incisions and depending on the case can many times can be done in a way to save the nipple, called a nipple-sparing mastectomy.
Axillary Sentinel Lymph Node Biopsy
If you have breast cancer that has spread outside of the milk duct, an axillary sentinel lymph node biopsy is often performed at the same time as your breast surgery (either breast conserving surgery or a mastectomy). Although imaging evaluates whether the lymph nodes appear normal, and is a good predictor of this, there are some cases where the amount of cancer in the lymph nodes is too small to see on imaging and can only be detected after surgical removal. This procedure uses a radioactive tracer and/or a blue dye injected into the breast in order to find the first few lymph nodes that drain the breast. These are the “sentinel” or guardian lymph nodes and are the very first lymph nodes that could be involved if the cancer has spread. At Kent, the injection is often performed once you are asleep at the time of your surgery followed by identification and removal of the nodes for further in depth evaluation. Each person will have a different amount of “sentinel” nodes, but typically ranges from 1-5 nodes. In some cases, the injection and an xray will be performed prior to your surgery.
Axillary Lymph Node Dissection
If cancer has spread to the lymph nodes, sometimes they can be treated with radiation therapy or medicines, however in some cases they will need to be removed. If your doctor recommends surgical removal, an axillary lymph node dissection will remove approximately 10-40 lymph nodes from under the arm.
Not all patients with breast cancer require medicines for treatment. For those that do, there are several different types of medicines available depending on the type of cancer you have. Not everyone will require chemotherapy, many can take endocrine or hormone blocking pills alone. The type of medicine/s that are recommended will be discussed with you by a medical oncologist and tailored to you and your diagnosis. Medical therapy is most often given after you recovery from surgery, however some patients may benefit from medicine prior to surgery in order to shrink their tumor and allow a smaller surgery.
Not all patients with breast cancer require radiation therapy. Radiation therapy is a targeted energy therapy directed at a specific part of the body. It is typically given in multiple smaller daily doses, called fractions, over several weeks. Most patients continue their normal daily activities during days they receive treatment, but may experience some fatigue similar to the feeling of being out in the sun for a long day. Skin reactions are also common. Radiation does not cause nausea/vomiting or hair loss.