Most women with breast cancer undergo some type of surgery to treat the primary tumor. The goal of surgery is to remove as much of the cancer cells as possible. Surgery may also be done for:
- Find out if the cancer cells have spread to the lymph nodes under the arm,
- To restore the shape of the breast after a mastectomy,
- Or to relieve symptoms in advanced cancer.
Below are the most common types of breast cancer surgery.
Breast Conservation Surgery
In this type of surgery, only part of the breast will be removed. The size of the part to be removed depends on the size and location of the tumor and other factors.
Lumpectomy: this surgery only removes the breast lump and some of the normal tissue around it. Radiation treatment is usually given after this type of surgery. If chemotherapy is also being used, radiation may be delayed until chemotherapy is finished. If there is cancer on the margins of the piece of tissue that was removed, the surgeon may need to come back and remove more tissue.
Partial (segmental) mastectomy or quadrantectomy: this surgery/surgery removes more of the breast tissue that is done in a lumpectomy. This is usually followed by radiation therapy. But radiation may be delayed if chemotherapy is also to be given.
Side effects of this surgery can include pain, swelling in the short term, the texture of the breasts is soft and hard because of the scar tissue formed as a result of the surgery.
The more parts of the breast that are removed, the more likely there is a change in the shape of the breast after that. If your breasts look very different after surgery, you may be able to have some type of breast reconstruction surgery above or make the breast on the other side smaller so that both breasts look the same. It is even possible during the first surgery. So it's best to discuss with your surgeon to get an idea of the shape of your breasts after surgery and the options/options that are available to you.
Mastectomy
Mastectomy involves removing all of the breast tissue, sometimes other nearby tissue is also removed.
Total or Simple Mastectomy: In this surgery the entire breast is removed, but does not include the lymph nodes under the arm or the muscle tissue under the breast. Sometimes both breasts are removed, especially if a mastectomy is performed to prevent cancer. If necessary, the patient can stay in the hospital and go home the next day.
For women planning to have reconstruction, a skin-sparing mastectomy may be performed. For this reason, most of the breast skin (apart from the nipple and areola) is left intact. This can also be done for a simple mastectomy. The amount of breast tissue removed is the same as for a simple mastectomy. Although this approach is not used over standard mastectomy, it is preferred because there is less scarring and the reconstructed breast will appear more natural.
Modified radical mastectomy: This surgery involves removing the entire breast as well as some of the lymph nodes under the arm. This is the most common operation for women with breast cancer to remove the entire breast.
Radical mastectomy: This is a major surgery in which the surgeon removes the entire breast, underarm (axillary) lymph nodes, and chest wall muscles under the breast. this operation used to be very common, but is rarely performed now that modified radical mastectomy has been shown to work just as well. But this surgery can still be done for large tumors that grow into the muscle under the breast.
Possible Side Effects
In addition to postoperative pain and changes in the shape of the breast(s), possible side effects of mastectomy and breast conserving surgery, include: wound due to infection, blood formation in the wound, formation of clear fluid in the wound. If axillary lymph nodes are also removed, another possible side effect is swelling of the arms and chest (lymphedema).
Choosing between Lumpectomy and Mastectomy
Many women with early-stage cancer can choose between Breast-Conserving Surgery and Mastectomy. One advantage of a lumpectomy is that it will save the way the breast looks. The downside is that it can take weeks for radiation after surgery to be done. On the other hand, some women who have had a mastectomy still need radiation.
When choosing between a lumpectomy and a mastectomy, make sure you get all the facts. But the reality is that for most women with stage I or II breast cancer, a lumpectomy (plus radiation) can be as good as a mastectomy. There was no difference in the survival rates of women treated with the 2 methods. Lumpectomy is not an option for all women with breast cancer. Your doctor will tell you if there are reasons why a lumpectomy might not be recommended for you.
Other Breast Cancer Surgery
Excision of lymph nodes in the axillary region: This surgery is performed to find out if the breast cancer has spread to the lymph nodes under the arm. Some nodes are removed and examined under a microscope. This test is done to determine the next type of cancer treatment that you need.
A possible side effect of this removal is swollen lymph nodes in the arm, called lymphedema. This occurs in about 3 out of 10 women who undergo the procedure. Sometimes the swelling only lasts for a few weeks and then subsides. Other times, the swelling lasts a long time. Ways to help prevent or reduce the effects of lymphedema are discussed in the section, "What happens after treatment for breast cancer?" If your hand is swollen, tense, or sore after this procedure, make sure you inform your paramedic right away.
Sentinel lymph node biopsy: a sentinel lymph node biopsy is a way to view the lymph nodes without having to remove them all. For this test, a radioactive substance and/or dye is injected near the tumor. It will be carried by the lymph system to the first (sentinel) nodule to receive lymph from the tumor. These nodules are most likely to contain cancer cells if the cancer has spread. These nodules (often 2 or 3 nodules) are then examined by a pathologist. If the sentinel nodule contains cancer, then the lymph node will then be removed. This type of biopsy requires very high expertise, so make sure it is done by an experienced team.
Reconstructive or breast implant surgery: After a mastectomy (or some breast-conserving surgeries), a woman may want to think about getting her breasts back in shape. This surgery is not meant to treat cancer. They are done to restore the way the breast looks. If you've had breast surgery and are thinking about having breast reconstruction, you should talk to a plastic surgeon before your surgery. .
You can get more detailed information about the different types of surgeries and their possible side effects in our document, Breast Reconstruction After Mastectomy. You may also find it helpful to talk to a woman who has the type of reconstruction you have in mind. Our reach for Recovery volunteers can help you with this. Contact us if you'd like to speak to one of the volunteers.
What to expect with Surgery?
For many people, the thought of surgery can be frightening. But knowing what will happen before, during, and after can help reduce your fear.
Before surgery: A few days after the biopsy, you will know if you have cancer, but the extent of progress won't be known until after surgery. You will most likely meet with your surgeon a few days before your surgery to talk about what will happen. You will be asked to fill out a consent form giving the doctor permission to perform the operation. This is a good time to ask any questions you may have.
You may be asked to donate blood ahead of time, in case you need it during surgery. Your doctor will also ask you about any medications, vitamins or supplements you are taking. You may have to stop taking some vitamins/supplements a week or 2 weeks before your surgery.
You will also be met by a professional paramedic who will give you anesthesia (medicine to make you sleep and feel no pain) during your surgery. The type of anesthesia used depends on the type of surgery performed and your medical history.
Surgery: For your surgery, you may have the option of being treated as an outpatient or in a hospital. General anesthesia, usually given for a mastectomy or removal of lymph nodes, and most often used also for breast-conserving surgery. You also have to be given an IV to give medicines that may be needed during surgery. You will be connected to an electrocardiogram (ECG) and a machine to place blood pressure on your arm cuff, so your heart rhythm and blood pressure can be checked during surgery.
How long the surgery will take will depend on the type of surgery being performed. For example, a mastectomy with lymph node removal will take about 2-3 hours. After surgery, you will be taken to the recovery room, where you will stay until you are awake and your vital signs (blood pressure, pulse, and respiration) are stable.
After Surgery: How long you stay in the hospital depends on the type of surgery you had, your overall health, whether you have any other medical problems, how well you did during surgery, and how you feel after surgery. You and your doctor should decide how long you have to stay in the hospital - not your insurance company. However, it is important to check your insurance coverage before surgery.
As a guide, women having a mastectomy usually stay in the hospital for 1 or 2 nights and then go home. But some women may be placed in a rapid stay unit (23 hours) before going home.
Operations such as lumpectomy and sentinel lymph node biopsy are usually performed on an outpatient basis and do not require an overnight stay.
After surgery, you may have a bandage over the surgical site that is tightly wrapped around your chest. You may have one or more tubes (drains) from your breast or armpit area to remove fluid that has accumulated during the recovery process. The process is about 1 or 2 weeks. After the flow has reduced to 1 ounce per day, the tube is removed.
Most doctors want you to start moving your hand immediately after surgery so it doesn't get stiff. Many women who have had a lumpectomy or mastectomy are surprised by the minimal pain they feel in the breast area. But they are not happy with the strange feeling (numbness, pulling/pinch) in their armpit area.
Talk with your doctor about what you should do after surgery to take care of yourself. You should obtain written instructions that will tell you the following:
- How to treat and cover wounds
- How to care for lines/tubes
- How to know if you have an infection
- When to call the doctor or nurse
- When to start using the arm and how to exercise the arm to prevent stiffness
- When will you start wearing bras again?
- When and how to wear breast foam/support (called prosthesis)
- What to eat and what not to eat
- Medications needed (including pain medication and possibly antibiotics)
- What activities can and cannot be done
- How you feel about how you look (your boobs)
- When to call your doctor for a follow-up appointment
Most patients see their doctor about 7 to 14 days after surgery. Your doctor should explain the results of your pathology report and talk to you about whether you will need more treatment.
Post Mastectomy Pain
Nerve pain after a mastectomy or lumpectomy is called post-mastectomy pain syndrome or PMPs. Signs of PMPs are chest wall pain and tingling under the arms. Pain may also be felt in the shoulder, scar, arm, or armpit. Other common complaints include numbness, stabbing/sharp pain, or unbearable itching.
It is important to talk to your doctor about the pain you are experiencing. PMPs can cause you not to use your arm as you should and over time you may not be able to use it normally.
PMPs are treatable. Medications that are usually used to treat pain may not work as well for nerve pain. But there are drugs and other treatments that work for this type of pain. Talk to your doctor to get the pain management you need.
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