Most women undergo surgery for breast cancer and also receive additional treatment before or after surgery, such as chemotherapy, hormone therapy or radiation. That is why an early diagnosis is so important. In countries that most patients are following the checkups regularly, mastectomies are performed in fewer than 15% of the cases. There are many options for breast cancer treatment, and you may feel overwhelmed as you make complex decisions about your treatment but you and your doctor will have to make a share decision, on how to proceed.
SURGERIES THAT ALLOWS YOU TO MAINTAIN YOUR BREASTS
- Lumpectomy: lumpectomy usually removes the least amount of breast tissue. The surgeon removes the cancer and a small portion or margin of the surrounding tissue, but not the breast itself. Even though the lumpectomy is the least invasive breast cancer surgery, it can still be very effective, and further surgery may not be needed.
- Partial mastectomy: partial mastectomy requires the surgeon to remove a larger portion of the breast than in the lumpectomy — perhaps a whole segment or quadrant of tissue — in order to eliminate the cancer. Occasionally, the surgeon will remove some of the lining over the chest muscles as well.
- Oncoplastic surgery: Oncoplastic surgery is a relatively new term and is integral to all breast cancer surgeries. The use of an aesthetic approach to breast conservation or mastectomy greatly enhances the range of options that can be offered to women with breast cancer and facilitates better outcomes from it. The use of breast reduction techniques, initially to remove cancers that were located in areas of the breast that could be removed as part of a standard reduction technique but later to include the use of modified techniques to allow resection of any part of the breast. Having said that, breast surgery will always require a mixture of oncological, plastic, and microsurgery skills provided by a team of specialists.
RADICAL SURGERY
While radical mastectomies are less common today, there are instances in which this surgery is the best option to treat the cancer. There are two types of mastectomies: simple and partial mastectomy. The choice is based on the size of the tumor and its growth. During these surgeries, the chest wall muscles are not removed.
- Simple Mastectomy: this surgery requires removal of the breast, nipple, areola, and sentinel lymph node or nodes. It leaves the chest wall and more distant lymph nodes intact.
- Partial Mastectomy: it requires the surgeon to remove a larger portion of the breast than in the lumpectomy — perhaps a whole segment or quadrant of tissue — in order to eliminate the cancer. Occasionally, the surgeon will remove some of the lining over the chest muscles as well.
IS A MASTECTOMY NECESSARY?
One of the first things that the patients ask, is whether they will need a mastectomy. Truth is that mastectomy can be prevented in 60- 70% of all cases; in countries that people visit their doctor often, mastectomies can be prevented up to 85% of all cases. He indications for a mastectomy, or not, must be discussed thoroughly with your surgeon and have full disclosure of the procedures and the alternatives.
SENTINEL LYMPH NODE AND CHECKING OF THE LYMPS
In cases of aggressive cancer, the axillary lymph nodes must be removed. If cancer is found in the sentinel lymph nodes, your surgeon will discuss with you the role of removing additional lymph nodes in your armpit. To determine whether cancer has spread to your lymph nodes, your surgeon will discuss with you the role of removing the lymph nodes that are the first to receive the lymph drainage from your tumor (sentinel Lymph Node). If no cancer is found in those lymph nodes, the chance of finding cancer in any of the remaining lymph nodes is small and no other nodes need to be removed.
COMPLICATIONS
Complications of breast cancer surgery depend on the procedures you choose. Breast cancer surgery carries a risk of pain, bleeding, infection and arm swelling (lymphedema). You may choose to have breast reconstruction after surgery. Discuss your options and preferences with your surgeon.
