Breast Cancer

Surgery

Most people with breast cancer have surgery to remove the cancer. In most cases, a few of the lymph nodes under the arm are also removed and examined under the microscope to see whether cancer cells are present. This is called sentinel lymph node biopsy.¹⁷ When nearly all lymph nodes under the arm are removed, it is called axillary lymph node dissection. You are less likely to have swelling (lymphedema) after a sentinel node biopsy than an axillary dissection.

Even if your doctor removes all the cancer that can be seen at the time of your surgery, you may be given treatment with radiation therapy, chemotherapy, or hormone therapy after surgery to try to destroy any cancer cells that may be left. This is called adjuvant therapy.

What type of surgery should I have to treat early-stage breast cancer?

Surgery that allows you to keep your breast

Procedures include:

• Breast-conserving surgery (lumpectomy), which is the removal of the lump in the breast along with some of the tissue around it. This is sometimes called excisional biopsy or wide excision. It is usually followed by radiation therapy to the remaining breast tissue.
• Partial or segmental mastectomy, which is the removal of the area of the breast that contains cancer as well as some of the breast tissue around the tumour and the lining over the chest muscles below the tumour. Some of the lymph nodes under the arm are also removed and examined under the microscope (axillary lymph node dissection or sentinel lymph node biopsy). In most cases, radiation therapy follows.

For stages I, II, and IIIA breast cancer, breast-conserving surgery (lumpectomy) with radiation therapy has the same survival rate as mastectomy and some of the same side effects.⁴³

Removal of the breast (mastectomy)

Mastectomy procedures include:

• Total or simple mastectomy, which is the removal of the whole breast.
• Modified radical mastectomy, which is the removal of the breast, some of the lymph nodes under the arm, and sometimes part of the chest wall muscles.
• Radical mastectomy (Halsted radical mastectomy), which is the removal of the breast, chest muscles, and all of the lymph nodes under the arm. For many years, this was the most common operation for breast cancer. Radical mastectomy is rarely used now because it does not improve survival or risk for recurrence when compared with other surgical treatments.

Breast reconstruction

You may wish to talk to your doctor about breast reconstruction before you make a decision about which type of surgery to have for breast cancer. If you choose to have a mastectomy, a different surgeon with special expertise in reconstructive surgery may perform this operation at the same time as the mastectomy or after the mastectomy.

Your choice will depend on the size of the cancer, the size and shape of your breasts, the size and shape of your body, how active you are, and other details, such as whether you have chemotherapy or radiation. If you choose to have a mastectomy, discuss reconstructive surgery and the use of a breast prosthesis with your doctor. For more information about reconstructive surgery, see the topic Cosmetic Surgery and Procedures.

Should I have breast reconstruction after a mastectomy?

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Author:	Kathe Gallagher, MSW Ralph Poore	Last Updated: October 22, 2007
Medical Review:	Joy Melnikow, MD, MPH - Family Medicine Anne C. Poinier, MD - Internal Medicine Douglas A. Stewart, MD - Medical Oncology
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