Treatments

Breast Cancer Surgery

 

Breast cancer surgery is a key component of breast cancer treatment that involves removing cancer with an operation. Breast cancer surgery may be used alone or in combination with other treatments, such as chemotherapy, hormone therapy, targeted therapy, and radiation therapy.

For people with a very high risk of breast cancer, breast cancer surgery may be an option to reduce the risk of future breast cancer.

Breast cancer surgery includes different procedures, such as:

  • Surgery to remove the entire breast (mastectomy)
  • Surgery to remove a portion of the breast tissue (lumpectomy)
  • Surgery to remove nearby lymph nodes
  • Surgery to reconstruct a breast after mastectomy

Which breast cancer operation is best for you depends on the size and stage of your cancer, your other treatment options, and your goals and preferences.

Types

Breast reconstruction with flap surgery

Breast reconstruction with implants

Lumpectomy

Mastectomy

Sentinel node biopsy

Why it’s done

The goal of breast cancer surgery is to remove cancer cells from your breast. For those who choose breast reconstruction, a procedure to place breast implants or reconstruct a breast from your own tissue (flap surgery) may be done at the same time or in a later operation.

Breast cancer surgery is used to treat most stages of breast cancer, including:

  • A high risk of breast cancer. People with a high risk of breast cancer based on a strong family history of the disease, certain noncancerous breast biopsy results or a gene mutation might consider preventive (prophylactic) mastectomy with or without immediate breast reconstruction as an option to prevent breast cancer.
  • Noninvasive breast cancer. People diagnosed with ductal carcinoma in situ (DCIS) may undergo lumpectomy, which may be followed by radiation therapy, though mastectomy with or without breast reconstruction may also be an option.
  • Early-stage breast cancer. Small breast cancers may be treated with lumpectomy or mastectomy with or without breast reconstruction followed by radiation and, sometimes, chemotherapy, hormone therapy or targeted therapy.
  • Larger breast cancers. Larger cancers may be treated with mastectomy, though sometimes chemotherapy, hormone therapy or targeted therapy is used before surgery to make it possible to perform a lumpectomy. Additional treatment with radiation therapy, chemotherapy, hormone therapy or targeted therapy may be recommended.
  • Locally advanced breast cancers. Breast cancers that are very large or have spread to several lymph nodes are often treated first with chemotherapy, hormone therapy or targeted therapy to shrink the tumor and make surgery more successful. These cancers may be removed using mastectomy or lumpectomy, followed by radiation therapy.
  • Recurrent breast cancer. Breast cancer that returns after initial treatment may be removed with additional surgery. Additional treatments may be recommended.

Surgery is seldom used to treat breast cancer that spreads to other parts of the body (metastatic breast cancer).

Risks

Breast cancer surgery is a safe procedure, but it carries a small risk of complications, including:

  • Bleeding
  • Infection
  • Collection of fluid at the operative site (seroma)
  • Pain
  • Permanent scarring
  • Loss of or altered sensation in the chest and reconstructed breasts
  • Wound healing problems
  • Arm swelling (lymphedema)
  • Risks related to the medicine (anesthesia) used to put you in a sleep-like state during surgery, such as confusion, muscle aches and vomiting

How you prepare

Discuss your options with a breast cancer surgeon

Your initial meeting with a breast cancer surgeon can help you understand your treatment options and what you can expect from surgery. Prepare for this meeting by creating a list of questions to ask, such as:

  • Which operations are best for my particular case?
  • Does each option offer the same chance for breast cancer cure?
  • How much of my breast needs to be removed?
  • Should my healthy breast be removed at the same time?
  • How many operations will I need?
  • What are my options for reconstruction?
  • Can the reconstruction be started at the same time as my cancer surgery?
  • How will my breast look after surgery? Will my breasts look the same?
  • Can you show me pictures of other people that have undergone these procedures?
  • If I choose to forgo reconstruction, what will my breast look like?
  • Is surgery safe for me?
  • How much time will I spend in the hospital?
  • How much time will I need for recovery? When can I return to work?
  • How many breast cancer surgeries have you done?
  • If you had a family member in my situation, what would you recommend?

Breast cancer surgeons work closely with plastic surgeons who do breast reconstruction. If you’re planning to undergo breast reconstruction, make an appointment to discuss these options, too.

During breast cancer surgery

Breast cancer surgery is done in a hospital. Before the procedure, you’re given medicine (general anesthesia) that keeps you in a sleep-like state.

What happens during your surgery will depend on the operation, but you can expect:

  • An incision in your breast to remove cancer and surrounding tissue. How much tissue is removed will depend on whether you undergo lumpectomy to remove part of the breast tissue or mastectomy to remove all of the breast tissue. The placement and length of the incision depends on the location of the cancer within the breast.
  • An assessment of the lymph nodes in your armpit. During a sentinel node biopsy, the surgeon removes a few lymph nodes into which a tumor is most likely to drain first (sentinel nodes). These are then tested for cancer. If no cancer is present, no additional lymph nodes need to be removed.If cancer is found, the surgeon may remove more lymph nodes or recommend radiation therapy to your lymph nodes after surgery. Sometimes both lymph node treatments are combined.
  • Closure of the incision. The surgeon closes the incision with attention to your appearance. Dissolvable stitches are placed to reduce scarring.
  • Reconstruction, if you choose. If you are undergoing mastectomy and choose breast reconstruction, the reconstruction is most frequently started at the time of your cancer operation. In some cases, reconstruction may be delayed and done in a separate surgery.

After breast cancer surgery

After your surgery, you can expect to:

  • Be taken to a recovery room where your blood pressure, pulse and breathing are monitored
  • Have a dressing (bandage) over the surgery site
  • Possibly have pain, numbness and a pinching sensation in your underarm area
  • Receive instructions on how to care for yourself at home, including taking care of your incision and drains, recognizing signs of infection, and understanding activity restrictions
  • Talk with your health care team about when to resume wearing a bra or wearing a breast prosthesis
  • Be given prescriptions for pain medication and possibly an antibiotic
  • Resume your regular diet
  • Shower the day after surgery

Expect to spend one night in the hospital after mastectomy if you also undergo breast reconstruction. Those undergoing mastectomy without reconstruction or lumpectomy may leave the hospital the day of surgery.

Breast Reconstruction

Breast reconstruction is a surgical procedure that restores shape to your breast after mastectomy — surgery that removes your breast to treat or prevent breast cancer.

One type of breast reconstruction uses breast implants — silicone devices filled with silicone gel or salt water (saline) — to reshape your breasts. Breast reconstruction with breast implants is a complex procedure performed by a plastic surgeon.

The breast reconstruction process can start at the time of your mastectomy (immediate reconstruction), or it can be done later (delayed reconstruction). The breast reconstruction process usually requires two or more operations. You can also expect to several appointments over two to three months after your initial surgery in order to expand and stretch the skin on your chest in preparation for the implant.

Breast reconstruction won’t re-create the exact look and feel of your natural breast. However, the contour of your new breast may restore a silhouette similar to what you had before mastectomy.

Risks

Breast reconstruction with a breast implant carries the possibility of complications, including:

  • Breasts that don’t match each other in size or appearance (asymmetry)
  • Breast pain
  • Implant rupture or deflation
  • Poor healing of incisions
  • Increased risk of future breast surgery to replace or remove the breast implant
  • Changes in breast sensation
  • Infection
  • Bleeding
  • Scar tissue that forms and compresses the implant and breast tissue into a hard, unnatural shape (capsular contracture)
  • Risks associated with anesthesia
  • Very low, but increased risk of a rare immune system cancer called anaplastic large cell lymphoma (ALCL) that’s associated with textured breast implants, though more research is needed to understand the relationship between ALCL and breast implants

Correcting any of these complications may require additional surgery.

If you need adjuvant radiation therapy to the skin and chest wall after a mastectomy (post-mastectomy radiation), you might not be an ideal candidate for breast implant reconstruction. Having a breast implant may make it more difficult to deliver the radiation therapy effectively, and the implant may need to be deflated. There may also be a higher risk of complications. The skin and underlying tissue may become firmer, discolored and swollen due to radiation therapy.

How you prepare

Before a mastectomy, your doctor may recommend that you meet with a plastic surgeon. Consult a plastic surgeon who’s board certified and experienced in breast reconstruction following mastectomy. Ideally, your breast surgeon and the plastic surgeon should work together to develop the best surgical treatment and breast reconstruction strategy in your situation.

Your plastic surgeon will describe your surgical options and discuss the advantages and disadvantages of implant-based reconstruction, and may show you photos of women who have had different types of breast reconstruction. Your body type, health status and cancer treatment factor into which type of reconstruction will provide the best result. The plastic surgeon provides information on the anesthesia, the location of the operation and what kind of follow-up procedures may be necessary.

Your plastic surgeon may discuss the pros and cons of surgery on your opposite breast, even if it’s healthy, so that it more closely matches the shape and size of your reconstructed breast. Surgery to remove your healthy breast (contralateral prophylactic mastectomy) can double the risk of surgical complications, such as bleeding and infection. Also, there may be less satisfaction with cosmetic outcomes after surgery.

Before your surgery, follow your doctor’s specific instructions on preparing for the procedure. This may include guidelines on eating and drinking, adjusting current medications, and quitting smoking.

What you can expect

Breast reconstruction begins with placement of a breast implant or tissue expander, either at the time of your mastectomy (immediate reconstruction) or during a later procedure (delayed reconstruction). Breast reconstruction often requires multiple operations, even if you choose immediate reconstruction.

Breast implants

A breast implant is a round or teardrop-shaped silicone shell filled with salt water (saline) or silicone gel. Once restricted because of safety concerns, silicone gel implants are now considered safe.

A plastic surgeon places the implant either behind or in front of the muscle in your chest (pectoral muscle). Implants that are put in front of the muscle are held in place using a special tissue called acellular dermal matrix. Over time, your body replaces this tissue with collagen.

Some women are able to have the permanent breast implant placed at the time of the mastectomy (direct-to-implant reconstruction). However, many women require a two-stage process, using a tissue expander before the permanent implant is placed.

Tissue expanders

Tissue expansion is a process that stretches your remaining chest skin and soft tissues to make room for the breast implant. Your surgeon places a balloonlike tissue expander under or over your pectoral muscle at the time of your mastectomy. Over the next few months, through a small valve under your skin, your doctor or nurse uses a needle to inject saline into the valve, filling the balloon in stages.

This gradual process allows the skin to stretch over time. You’ll go to your doctor every week or two to have the saline injected. You may experience some discomfort or pressure as the implant expands.

A newer type of tissue expander uses carbon dioxide. This remote-controlled expander releases the gas from an internal reservoir. Compared with the expansion using saline, the gradual expansion using carbon dioxide may decrease the amount of discomfort you feel.

After the tissue is adequately expanded, your surgeon performs a second surgery to remove the tissue expander and replace it with a permanent implant, which is placed in the same place as the tissue expander.

Recovery

You may be tired and sore for several weeks after surgery. Your doctor will prescribe medication to help control your pain.

Getting back to normal activities may take six weeks or longer. Take it easy during this period.

Your doctor will let you know of restrictions to your activities, such as avoiding overhead lifting or strenuous physical activities. Don’t be surprised if it seems to take a long time to bounce back from surgery — it may take as long as a year or two to feel completely healed.

Generally, you’ll follow up with your plastic surgeon on a yearly basis to monitor your reconstructed breast after the reconstruction is complete. Make an appointment sooner than that, however, if you have any concerns about your reconstruction.

Nipple reconstruction

Breast reconstruction may also entail reconstruction of your nipple, if you choose, including tattooing to define the dark area of skin surrounding your nipple (areola).

Future breast cancer screening

If you’ve had only one breast reconstructed, you’ll need to have screening mammography done regularly on your other breast. Mammography isn’t necessary on breasts that have been reconstructed.

You may opt to perform breast self-exams on your natural breast and the skin and surrounding area of your reconstructed breast. This may help you become familiar with the changes to your breast after surgery so that you can be alert to any new changes and report those to your doctor.

Results

Keep your expectations realistic when anticipating the outcome of your surgery. Breast reconstruction surgery offers many benefits, but it won’t make you look or feel exactly like you did before your mastectomy.

What breast reconstruction can do:

  • Give you a breast contour
  • Provide improved symmetry to your breasts so that they look similar under clothing or a bathing suit
  • Help you avoid the need for a form (external prosthesis) inside your bra

What breast reconstruction may do:

  • Improve your self-esteem and body image
  • Partially erase the physical reminders of your disease
  • Require additional surgery to correct reconstructive problems

What breast reconstruction won’t do:

  • Make you look exactly the same as before
  • Give your reconstructed breast the same sensations as your normal breast

Choose our Specialist Surgeons Confidently

Our specialist team work together to help our patients before surgery, in recovery and providing the best possible care.

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