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Breast-sparing techniques
Once breast cancer is detected or diagnosed, treatment plans need to be made
to reduce the chance of the cancer returning in or outside of the breast. The
goal of surgery is to remove localized cancer (cancer that hasn’t spread to
other parts of the body) by removing the tumor itself and a portion of
surrounding tissue, while conserving as much of the breast as possible.
Surgical options
The various surgical techniques differ in the amount of breast tissue that
is removed with the tumor. The technique used depends on the tumor’s
characteristics, whether it has spread (metastasized) and your personal
feelings. The surgeon often removes some axillary (under the arm) lymph nodes as
part of the operation so they can be tested for signs of malignancy. This is
done to help plan your treatment after surgery.
The breast surgeon will discuss your surgery options with you before the
procedure. A specific surgical procedure may be recommended for you based on the
size, location, or type of breast cancer you have. Some of the procedures the
physician may discuss with you include lumpectomy, simple or total mastectomy,
and modified radical mastectomy.
Lumpectomy — This is also referred to as breast conservation. The
surgeon removes the cancerous area and a surrounding margin of normal tissue. A
second incision may be made in order to remove the lymph nodes. Upon completion,
this treatment aims to maintain a normal breast appearance.
After the lumpectomy, a six- to eight-week course of radiation therapy is
used to treat the remaining breast tissue. Most women who have small, early stage breast cancers are excellent candidates for this treatment approach. Women
who usually are not eligible for a lumpectomy include those who:
- Have already
had radiation therapy to the affected breast
- Have two or more areas of cancer
in the same breast that are too far apart to be removed through one incision, or
- Have cancer that was not completely removed during the lumpectomy
surgery
Partial or segmental mastectomy or quadrantectomy — The surgeon
removes up to one quarter more breast tissue than is removed in a lumpectomy.
The cancerous area and a surrounding margin of normal tissue are removed, and
radiation therapy is given after surgery for six to eight weeks.
Simple or total mastectomy —The entire breast is removed, but no
lymph nodes are removed in this procedure. Simple mastectomy is most frequently
used for further cancer prevention or when the cancer does not go to the lymph
nodes.
Modified radical mastectomy — The surgeon removes all of the breast
tissue along with the nipple. Lymph nodes in the axilla (arm pit) also are
removed; the chest muscles are left intact. For many patients, mastectomy is
accompanied by either an immediate or delayed breast reconstruction. This can be
done quite effectively using either breast implants or the patient's own tissue—usually
from the lower abdomen.
Radical mastectomy — The surgeon removes all of the breast tissue
along with the nipple, lymph nodes in the arm pit, and chest wall muscles under
the breast. This procedure is rarely performed today because modified radical
mastectomy has proven to be as effective and does not have the same disfiguring
side effects.
You should thoroughly discuss these surgical options with your physician to
achieve the best outcome. Whichever type of surgery is your best option, you
will be able to return home after a short stay in the hospital.
Hospital stay
The length of stay in the hospital varies depending on the type of surgery
that was performed. Generally, lumpectomies are done on an outpatient basis,
with the patient recovering in a 23-hour, short-stay observation unit after the
procedure. Mastectomies or lymph node removal surgery usually require a one- to
two-night stay in the hospital.
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