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Breast Cancer Surgery

MASTECTOMY

Mastectomy is the medical term for surgical removal of the breast. It refers to a number of different operations, ranging from those that remove the breast, chest muscles and underarm lymph nodes, to those that remove only the breast lump.

The different types of breast surgery are described below. Based on the size and location of the lump, your doctor will recommend the type of surgery that offers you the best chance of successful treatment.

Most medical and surgical procedures carry some risk. The risks are categorized small or serious, frequent or rare. Because there is such a wide range of potential risks and benefits from various treatments for the different stages and kinds of breast cancer, you should discuss with your doctor the particular benefits and risks of treatment methods suitable for you.

Radical Mastectomy

This type of surgery removes the breast, the chest muscles, all of the underarm lymph nodes, and some additional fat and skin. It is also called a “Halsted Radical” (after the surgeon who developed the procedure). A radical mastectomy was the standard treatment for breast cancer for over 70 years and is rarely used for treatment.

ADVANTAGES

Cancer can be completely removed if it has not spread beyond the breast or nearby tissue. Examination of the lymph nodes provides information that is important in planning future treatment.

DISADVANTAGES

Removes the entire breast and chest muscles, and leaves a long scar and a hollow chest area. May also cause lymphedema (swelling of the arm), some loss of muscle power in the arm, restricted shoulder motion, and some numbness and discomfort. Breast reconstruction is also more difficult. This procedure is rarely done currently for treatment of primary breast cancer.

Modified Radical Mastectomy or Total Mastectomy with Axillary Node Dissection

This procedure removes the breast, the underarm lymph nodes, and the lining over the chest muscles. It is also called "total mastectomy with axillary (or underarm) dissection."

Today, this is the most common treatment of early stage breast cancer where lymph node involvement has been proven.

ADVANTAGES

Keeps the chest muscle and the muscle strength of the arm. Swelling is less likely, and when it occurs, it is milder than the swelling that can occur after a radical mastectomy. It leaves a better appearance than the radical mastectomy. Survival rates are the same as for the radical mastectomy when cancer is treated in early stages. Breast reconstruction is easier and can be planned before surgery.

DISADVANTAGES

The breast is removed. In some cases, there may be swelling of the arm because of the removal of the lymph nodes. (8%-10% risk of lymph edema).

Total or Simple Mastectomy

This type of surgery removes only the breast. Ideally a few of the underarm lymph nodes closest to the breast are removed to assure complete removal of the axillary tail of the breast. This is most often used to treat non-invasive breast cancers or in prophylactic mastectomies.

ADVANTAGES

Most or all of the underarm lymph nodes remain, so the risk of swelling of the arm is greatly reduced. Breast reconstruction is easier.

DISADVANTAGES

The breast is removed. If cancer has spread to the underarm lymph nodes, it may remain undiscovered.

Skin-Sparing Mastectomy

The mastectomy is performed through a small keyhole incision just encompassing the nipple/areolar complex as the only skin that is removed.

Lumpectomy

This procedure removes the tumor plus a wedge of normal tissue surrounding the cancer. Occasionally the skin and the lining of the chest muscle below the tumor will need to be removed to obtain clear margins. A margin of normal tissue must be removed to insure the tumor has been completely removed. (A 1 cm margin is optimal to minimize the risk of local recurrence) It is followed by approximately seven to eight weeks of radiation therapy.

ADVANTAGES

If a woman is large breasted, most of the breast is preserved. There is little possibility of loss of muscle strength or arm swelling.

DISADVANTAGES

If a woman has small or medium-sized breasts, the procedure may noticeably change the breast’s shape. There is a possibility of arm swelling if an axillary lymph node dissection is performed.

Contact Dr. Lisa Curcio to discuss your risk for breast cancer . Dr. Curcio is a breast cancer heredity risk specialist and she can advise you on your breast cancer risk.

Visit "Advanced Breast Care Specialists of Orange County" in Mission Viejo, California.