One of the first things most breast cancer patients consider as part of their treatment process is breast surgery. What type of breast surgery is right for you? The answer to this question is best given by both the breast surgeon and a medical oncologist who specializes in breast cancer treatment. That’s because the extent of the cancer can impact the right surgery for you.
We recommend a visit with both before scheduling your surgery to remove cancer.
There are two main approaches to breast cancer surgery for patients.
The first type of surgery is called breast-conserving surgery. Also referred to as a lumpectomy, this surgery aims to remove as much cancer as possible while preserving as much healthy breast tissue as possible. Several factors will affect how much breast tissue needs to be removed, but one of the main factors is the size and specific location of the tumor.
The other common breast cancer surgery is a mastectomy. This surgery removes all of the breast tissue and some surrounding chest tissue to remove all potentially cancerous cells. In some cases, a double mastectomy is recommended where both breasts are removed.
Deciding which surgical approach is the best fit for your needs can depend on a variety of factors. However, many younger women with early-stage breast cancer will opt for a breast-conserving surgical approach. While a lumpectomy surgery helps to retain some of the breast tissue, it also generally requires radiation therapy afterward to be sure any residual breast cancer cells near the edges, or margins, of the surgical site, are cleared.
A mastectomy may be recommended by the surgeon based on the tumor size, the type of tumor, or whether they have completed radiation therapy before.
Many people believe that the less invasive surgical option will result in a higher likelihood of cancer returning. However, studies have shown that patients who have an option for either approach have the same survival rates regardless of the type of surgery they selected.
The BRCA1 and BRCA1 gene mutation is a known risk factor for developing breast cancer. If you have other women in your immediate family who have had a breast cancer diagnosis, or you meet other qualifying criteria, the decision about which surgery to use may be impacted.
Your BRCA gene status can be determined by working with your medical oncologist and a genetic counselor through WVCI. The results may impact your decision on whether to have both breasts removed, even if the cancer is only present in one. This is another important aspect of working with the medical oncologist before choosing whether a lumpectomy or mastectomy is the best breast cancer surgical option for you.
One of the biggest concerns about breast cancer is that it may spread to the lymph nodes in the underarm (the axillary lymph nodes). Surgeons will remove one or both lymph nodes to send them to a lab for further evaluation. This is quite often performed at the same time as the breast cancer removal surgery.
As with breast cancer surgery, there are two typical approaches to lymph node removal.
Sentinel lymph node biopsy, or SLNB, is a surgery in which only the lymph nodes that are most likely to have been impacted by cancer are removed and sent to a laboratory. This surgery reduces the chances of lymphedema (swelling in the lymph nodes) and also lowers the potential for other side effects.
Axillary lymph node dissection, or ALND, is an approach that removes many lymph nodes for further evaluation. While this approach is more invasive than SLNB, it is used in certain situations to understand potential cancer spread better.
Because breast surgeries alter how you look, breast reconstruction is an option for many women to help restore their physical appearance. In some cases, the breast cancer surgeon will be a part of the reconstruction, and in other cases, a plastic surgeon specializing in breast reconstruction may be recommended. Find out from your breast surgeon about what you will need.
Several different types of breast reconstructive surgeries can be performed, so it’s essential to talk to your breast cancer doctor before any surgical procedures.
One reconstructive technique takes place during the removal of the cancerous tissue. This surgery is called immediate reconstruction. If patients opt to wait until later to reconstruct their breast tissue, it is called delayed reconstruction.
Some of the techniques used in breast reconstruction utilize the patient’s fat cells extracted from a different area of the body and then placed into the breast. This approach lowers the potential of infection and helps to eliminate dimpling that can be caused by surgery.
Additionally, a standard breast implant may be another option for reconstruction. There are several different types and sizes to choose from, so work closely with your breast cancer specialist to determine which approach will work best for you.
If you have recently been diagnosed with breast cancer and you’re considering your breast cancer treatment options, request an appointment with one of our oncologists so you can gather as much information as possible before identifying the breast cancer surgery(s) you will need.