Breast cancer surgery

Overview

The majority of breast cancer types are treated primarily by breast cancer surgery. Tumors can be removed through either a mastectomy or a lumpectomy. The patient could require more procedures to reconstruct their breast following excision or to check for cancer in their lymph nodes.

The patient’s medical team will nearly always advise surgery to remove the breast cancer, either before or after other forms of treatment. Breast cancer surgery stands as the foremost effective method for removing breast cancer when it is surgically feasible to do so. In cases when breast cancer has metastasized to other regions of the body, this treatment may not always be successful.

Surgery for breast cancer can be performed alone or in combination with other therapies such radiation, hormone therapy, chemotherapy, and targeted therapy. Breast cancer surgery may involve removing a singular tumor from the breast in some cases, while in others, the entirety of the breast may need to be removed to eradicate the cancer.

Although the main purpose of breast surgery for cancer is treatment, it can also be used for diagnostic or even cosmetic purposes. To check for indications of cancer spreading, they may have exploratory surgery. Following cancer therapy, the patient may potentially have breast reconstruction surgery. For individuals at a significantly elevated risk of breast cancer, breast cancer surgery might be considered as a viable option to lower the risk of developing breast cancer in the future.

Types

The following surgical procedures are used to remove breast cancer:

• Lumpectomy (partial mastectomy): Involves removing a single tumor, or “lump,” from the breast along with a border of healthy tissue. When treating early-stage breast cancer, a lumpectomy is one option.
• Mastectomy: One or both breasts are removed entirely during a mastectomy. Certain mastectomy also involve the removal of nearby afflicted tissues, such as the muscles or other structures of the chest wall.

Other surgical procedures for breast cancer may encompass:

• Sentinel node biopsy: In order to evaluate if breast cancer has spread to nearby lymph nodes, one to several lymph nodes next to the afflicted breast are removed during this surgery.
• Lymphadenectomy: Mostly the underarm lymph nodes next to the impacted breast are removed and dissected in order to assess whether the cancer has spread to other lymph nodes.
• Breast reconstruction: Following the excision of breast cancer, this procedure restores the contour of the breast. Implants, the patient’s own tissue, or both might be used.

The type and stage of the patient’s breast cancer, as well as their overall health and preferences, will all have a role in the type(s) of surgery that the healthcare provider recommends. Surgery could be all that is required for certain patients. It could only be a small part of a more comprehensive therapy strategy for others. Most individuals will have surgical procedures more than one time.

Reasons for undergoing the procedure

Cancer cell removal from the breast is the aim of breast cancer surgery. For individuals opting for breast reconstruction, they may undergo a procedure involving the placement of breast implants or the reconstruction of a breast using their own tissue (known as flap surgery) which can be performed concurrently or as a follow-up treatment.

The majority of breast cancer stages are treated by breast cancer surgery, including:

• Risk of breast cancer: Consider preventative (prophylactic) mastectomy with or without immediate breast reconstruction as a preventive measure against breast cancer in individuals who have a high chance of developing the disease due to a strong family history, certain noncancerous breast biopsy results, or a gene mutation.
• Noninvasive breast cancer: When ductal carcinoma in situ (DCIS) is diagnosed, the treatment options include lumpectomy which may be followed by radiation therapy, mastectomy with or without breast reconstruction, and other procedures.
• Early-stage breast cancer: Treatment options for small breast cancers include lumpectomy or mastectomy, with or without breast reconstruction, followed by radiation treatment, and sometimes chemotherapy, hormone therapy, or targeted therapy.
• Larger breast cancers: Larger cancers may be treated with a mastectomy, although chemotherapy, hormone treatment, or targeted therapy may occasionally be given before to surgery to enable a lumpectomy. Further therapy in the form of targeted therapy, hormone therapy, chemotherapy, or radiation therapy could be advised.
• Locally advanced breast cancers: Larger breast tumors or those that have spread to several lymph nodes are frequently treated with hormone treatment, targeted therapy, or chemotherapy in order to reduce the tumor size and improve the outcome of surgery. Mastectomy or lumpectomy may be used to remove these malignancies, and radiation treatment may come next.
• Recurrent breast cancer: If breast cancer recurs after first therapy, another surgery may be required to eliminate it. It could be advised to have additional therapies.

Risk

Although surgery for breast cancer is a safe procedure, there is a slight chance of risk, such as:

• Pain
• Bleeding.
• Blood clots.
• Infection.
• Seroma (accumulation of fluid at the incision site).
• Hematoma.
• Numbness and tingling.
• Shoulder stiffness.
• Arm swelling or lymphedema.
• Loss or change in chest and breast reconstruction sensation.
• Permanent scarring.

Before the procedure

After a breast cancer diagnosis, the healthcare provider will schedule a consultation to discuss the patient’s surgical options. The treatment plan and the optimal timing for surgery will be based on the patient’s health and the stage of cancer. For early-stage breast cancer, surgery is usually the first-line treatment. Additionally, the patient can consider the timing and necessity of breast reconstruction surgery.

During the procedure

After talking with the healthcare provider, the breast cancer surgery will be customized to meet each patient’s needs. Any tissue that could contain cancer cells will be attempted to be removed by the surgeon. A portion of the breast, the entire breast, or both breasts may be removed in this way. Alongside the afflicted breast, there may also be an option to remove and dissect some or all of the axillary (underarm) lymph nodes.

If the patient opts for breast reconstruction, the surgeon may choose to perform the reconstruction either concurrently with or separately from the cancer-related procedure. To reconstruct the breast, additional incisions may be necessary, possibly involving tissue removal from other areas of the body. Alternatively, the patient may decide to delay breast reconstruction until after completing their cancer treatment.

The duration of surgery depends on the type of procedure, with a simple lumpectomy taking one to two hours, with or without a sentinel node biopsy. In contrast, a mastectomy that includes breast reconstruction or axillary lymph node dissection may require three to four hours of surgery. Following the procedure, the patient may need to spend one or more nights in the hospital.

After the procedure

A pathologist can be analyzing the lymph node biopsy results while the patient is recovering from surgery. Ensuring that every cancer cell in their body has been eliminated is important. Once the findings are in, they will talk with them about these and the next actions. Treatment with chemotherapy, radiation therapy, or further surgery may be necessary if they discover cancer in one or more lymph nodes.

Following surgery, patient should anticipate:

• Patient will be brought to the recovery room for further monitoring of the vital signs.
• Cover the operation site with a bandage or dressing.
• They could experience discomfort, numbness, and a pinching feeling in their underarm region.
• Be given guidance on self-care at home, such as how to clean their wound and drains, spot infection symptoms, and comprehend activity limitations.
• Discuss with the healthcare provider the best time to use a breast prosthesis or to start wearing a bra again.
• Receive prescriptions for painkillers and/or an antibiotic.
• Patient may resume their normal diet.
• Patient can shower a day after the procedure.

Outcome

In few weeks following the procedure, patients may experience discomfort and limited range of motion in their arms and chest. Healthcare providers will prescribe medications and provide daily arm and shoulder exercises to be performed at home, crucial for preventing stiffness. Fatigue may persist for a while, and it may take several weeks to regain normal energy levels. Typically, after a month, most individuals can resume their regular activities.

Scarring is an inevitable outcome of any surgical procedure. The appearance of scars following breast surgery varies among individuals, influenced by the type of procedure, the surgeon’s incisions, and the healing process. Initially, they may appear red and raised, but over the course of few months, they tend to become flatter and paler in appearance. Surgeons performing reconstructive breast surgery make efforts to minimize the visibility of these scars.

Patients should expect a follow-up appointment with their healthcare provider within one to two weeks after the procedure. During this visit, the provider will assess the patient’s condition, discuss any test results, and plan the subsequent phases of their treatment. If any signs or symptoms of post-operative complications, such as severe swelling, fever, or cording, arise, it is essential to promptly seek medical attention from the healthcare provider.