Types of Treatment Treatment Guidelines Surgery Chemotherapy Radiation Therapy Drug Therapies

Surgery

Most breast cancers are treated surgically,with removal of all or a portion of the breast containing the cancerous lesion. Breast conservation therapy refers to surgery to remove a breast cancer and a small amount of benign tissue around the cancer, without removing any other part of the breast. Mastectomy refers to surgery to remove the entire breast and sometimes other tissue around the breast. When a woman undergoes a mastectomy, breast reconstruction surgery can be performed during the same operation, or at a later time. Non-palpable breast cancers may require stereotactic localization or mammography.

Breast conservation therapies include lumpectomy and quadrantectomy, which is also referred to as partial or segmental mastectomy. This type of surgery has been shown to be as effective as mastectomy in most women with Stage I or II breast cancer; however, it is not recommended for some women with special health issues. Women considering breast conservation therapy should discus the risks and benefits with their physician before making a decision.

In a lumpectomy, stereotactic imaging is frequently needed to provide a roadmap for the physician to use to determine the precise location of the mass. Aided by this technology, the physician makes an incision and the breast mass and a portion of normal tissue surrounding the mass is removed (excised). The excised tissue is examined and if cancer cells are noted in the outer edge of the excised tissue, additional tissue may need to be removed. Lumpectomy is almost always followed by six weeks of radiation therapy.

Quadrantectomy can involve removal of up to one-fourth or more of the breast. Quadrantectomy is usually followed by six to seven weeks of radiation therapy.

These procedures are usually done in an outpatient surgery center and an overnight stay may not be needed. Side effects may include temporary swelling and tenderness. In some instances, scar tissue formation in the surgical site results in a hardness in the breast and makes follow-up screening examinations more difficult. Women who have had lymph nodes removed as part of breast conservation surgery may experience swelling and/or numbness of the arm and difficulty with movement of the arm and shoulder.

Mastectomy procedures involve removal of the entire breast and, depending on the specific procedure, a portion of tissue surrounding the breasts. There are three types of mastectomy procedures:

• Simple or total mastectomy removes only the breast, but not the lymph nodes from underneath the arm or muscle tissue from beneath the breast.



• Modified radical mastectomy involves the removal of the entire breast and some of the underarm lymph nodes. This is the most common mastectomy procedure.



• Radical mastectomy involves removal of the entire breast, underarm lymph nodes, and the pectoral (chest wall) muscles under the breast. This procedure is rarely performed today because most physicians believe that modified radical mastectomy has proven to be as effective.

Mastectomies are done under general anesthesia, in a hospital setting. The hospital stay for a mastectomy is generally one to two days, but a longer stay may be necessary in some cases, depending on how extensive the surgery is and the overall condition of the patient. The hospital stay may also be extended if breast reconstruction surgery is performed in addition to mastectomy.

Possible side effects of mastectomy include: wound infection, hematoma (accumulation of blood in the wound) and seroma (accumulation of clear fluid in the wound). If the surgery involves removal of lymph nodes, additional side effects may include swelling and/or numbness of the arm and difficulty with movement of the arm and shoulder.

Sentinel lymph node biopsy is a new procedure that is being studied as a potential replacement for standard axillary lymph node dissection. Blue dye or a radioisotope tracer is injected into the tumor site at the time of surgery and the first (sentinel) node that picks up the dye is removed and examined for the presence of cancer cells. If the node is cancer- free, additional surgery for lymph node removal may not be needed.

Breast Reconstruction Surgery

Breast reconstruction surgery is not a treatment for cancer. It is a procedure that restores a normal appearance after a mastectomy. Reconstruction is an important option offered to any woman who has lost a breast because of cancer. A reconstructed breast will not have natural feelings; however, it can boost a woman's feeling of attractiveness. It will also help to maintain a sense of balance and relieve the asymmetrical stress on posture that may occur after a mastectomy.

Breast reconstruction may be done at the time of the mastectomy (immediate reconstruction) or performed months to years after the mastectomy (delayed reconstruction). In some cases, breast reconstruction surgery may need to be delayed if other treatments, such as chemotherapy or radiation therapy, are ongoing.

Some women prefer immediate reconstruction because only one operative session is involved, which generally results in fewer problems from anesthesia and surgery, less recovery time, and lower costs. In addition, the psychological trauma of awakening from surgery without a breast is reduced. Other women prefer delayed reconstruction because it allows more time to consider reconstructive choices and can be easier to coordinate.

The breast may be reconstructed with tissue flaps from one's own body or a synthetic implant.

Implants

Tissue Flap

Skin, muscle and fat taken from another part of the body can be transferred to the chest area to form a new breast. This method of transferring tissue is called a myo-cutaneous flap, or simply a flap.

Tissue can be taken from the following areas:

• Lower stomach area (rectus abdominis flap)



• Back (latissimus dorsi muscle flap)



• Buttocks (gluteus muscle flap)

Flap surgery is more complex than implant surgery, but it can result in the most natural-looking reconstructions, and avoids placing foreign materials into the body. However, flap surgery requires displacement of large areas of tissue, which can damage the blood supply to the area. Inadequate blood supply can cause the tissue to die and have to be removed. In addition, the surgery is lengthy and expensive, with blood transfusions and considerable postoperative discomfort, and there is an additional scar at the donor site.

After the first reconstructive surgery, smaller surgeries are usually needed to complete the process. Creating and tattooing the nipple is one extra step in reconstruction. Small changes in the shape of the rebuilt breast might also be needed, as well as surgery on the opposite breast to create similarly shaped breasts.

There are a number of factors women must consider when making decisions about the most appropriate type of breast reconstruction surgery. A woman should consult with the cancer physician and a plastic surgeon before proceeding with breast reconstruction surgery. While personal preferences play an important role in the decision, body type, age and cancer treatment will also be used to determine which reconstruction method will give the best results.

External Breast Form/Prosthetic

Some women may choose not to undergo any form of breast reconstruction surgery, but to use external breast forms, or prostheses. Breast prostheses are available in a variety sizes, shapes and colors. Some are designed to fit into a special bra, while others are attached securely to the chest with a special adhesive.

A listing of some businesses that supply mastectomy prostheses and accessories is provided in Breast Cancer Resources.

This website provides general information only. A physician should be contacted if you need any medical advice or if medical decisions need to be made.