Surgery for breast cancer

Surgery for breast cancer

Most women with breast cancer have some type of surgery. Surgery is often needed to
remove a breast tumor. Options for this include breast-conserving surgery and
mastectomy. Breast reconstruction can be done at the same time as surgery or later on.
Surgery is also used to check the lymph nodes under the arm for cancer spread. Options
for this include a sentinel lymph node biopsy and an axillary (armpit) lymph node
dissection.
Breast-conserving surgery
This type of surgery is sometimes called partial (or segmental) mastectomy. It only
removes a part of the affected breast, but how much is removed depends on the size and
location of the tumor and other factors. If radiation therapy is to be given after surgery,
small metallic clips (which will show up on x-rays) may be placed inside the breast
during surgery to mark the area for the radiation treatments.
Lumpectomy removes only the breast lump and a surrounding margin of normal tissue.
Radiation therapy is usually given after a lumpectomy. If adjuvant chemotherapy is to be
given as well, radiation is usually delayed until the chemotherapy is completed.
Quadrantectomy removes more breast tissue than a lumpectomy. For a quadrantectomy,
one-quarter of the breast is removed. Radiation therapy is usually given after surgery.
Again, this may be delayed if chemotherapy is to be given as well.
If cancer cells are found at any of the edges of the piece of tissue removed, it is said to
have positive margins. When no cancer cells are found at the edges of the tissue, it is said
to have negative or clear margins. The presence of positive margins means that some
cancer cells may have been left behind after surgery. If the pathologist finds positive
margins in the tissue removed with surgery, the surgeon may need to go back and remove
more tissue. This operation is called a re-excision. If the surgeon can't remove enough
breast tissue to get clear surgical margins, a mastectomy may be needed.
The distance from the tumor to the margin is also important. Even if the margins are
“clear”, they could be “close”—meaning that the distance between the edge of the tumor
and edge of the tissue removed is too small and more surgery may be needed, as well.
Surgeons can disagree on what is an adequate (or good) margin.
For most women with stage I or II breast cancer, breast-conserving surgery (BCS) plus
radiation therapy is as effective as mastectomy. Survival rates of women treated with

these 2 approaches are the same. But breast-conserving surgery is not an option for all
women with breast cancer (see the section, "Choosing between breast-conserving surgery
and mastectomy" below).
Radiation therapy can sometimes be omitted as a part of breast-conserving therapy. This
is somewhat controversial, so women may consider BCS without radiation therapy if
ALL of the following are true:
· They are age 70 years or older.
· They have a tumor that measures 2 cm or less across that has been completely
removed (with clear margins).
· The tumor is hormone receptor-positive, and the women are getting hormone therapy
(such as tamoxifen or an aromatase inhibitor).
· No lymph nodes contained cancer.
You should discuss this possibility with your health care team.
Possible side effects: Side effects of these operations can include pain, temporary
swelling, tenderness, and hard scar tissue that forms in the surgical site. As with all
operations, bleeding and infection at the surgery site are also possible.
The larger the portion of breast removed, the more likely it is that you will see a change
in the shape of the breast afterward. If the breasts look very different after surgery, it may
be possible to have some type of reconstructive surgery (see the section, "Reconstructive
surgery"), or to have the size of the unaffected breast reduced to make the breasts more
symmetrical. It may even be possible to have this done during the initial surgery. It's very
important to talk with your doctor (and possibly a plastic surgeon) before surgery to get
an idea of how your breasts are likely to look afterward, and to learn what your options
might be.