Depending on the type and stage of your breast cancer, you may need surgery to effectively treat your cancer. The information in this packet covers different surgery options your doctors and health care team may discuss with you, as well as tips on how to care for yourself after surgery. If the information here is different from what your individual surgeon recommends, follow your surgeon’s instructions. If you have questions, please let your doctor and health care team know.

The information in this section will help you plan and prepare for your treatment. However, it is not meant to replace the individual attention, advice and treatment plan of your oncologist and health care team.

• Lumpectomy
• Mastectomy
• Prophylactic Mastectomy
• Lymph Nodes

Lumpectomy

During a lumpectomy or partial mastectomy, a surgeon will remove the cancer (or lump) and a small amount of normal breast tissue surrounding it. The amount of tissue removed depends on the size of the cancer. The surgery is usually performed on an outpatient basis.

The tissue removed during the lumpectomy will be sent to PAMF’s Department of Pathology after your surgery. The pathologist will make a detailed description of what the cancerous cells look like and how they react. The pathologist will also determine if there are cancerous cells at or very near the edge (or margin) of the tissue that was removed. If cancerous cells are found at or near the edge, the surgeon may recommend a second, larger lumpectomy or a mastectomy if that is the best option.

If no cancer cells are found at or near the edge, you will start radiation therapy once you have healed from the lumpectomy. Radiation therapy is recommended following a lumpectomy to reduce the chance that the cancer will return in the breast.

After a lumpectomy, your breast may look a little smaller or have less fullness than your other breast. If a larger amount of tissue is removed, you may wish to wear a partial breast prosthesis (an artificial breast form) in your bra to fill in the area and balance your breasts.
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Mastectomy

During a mastectomy, a surgeon removes almost all of the breast tissue, including the nipple. The muscle behind the breast tissue is not removed.

Your surgeon will try to minimize scarring as much as possible during surgery. However, once you heal from the mastectomy, you will be left with a scar across your chest and the area will be flat. In rare cases, your ribs may look like small bumps underneath your skin.

Following a mastectomy, you may wish to wear an artificial breast form (prothesis) in a bra or attached to your skin. Another option is to have the breast reconstructed or rebuilt using artificial breast implants or your own body tissue. Reconstructive surgery may be done at the time of the mastectomy, or you can wait and have it done at a later time.

Your doctor may recommend a mastectomy if:

• The cancer is large
  
  
• There is cancer in multiple areas of the breast
  
  
• You cannot or do not wish to have radiation therapy after a lumpectomy
  
  
• You feel that a mastectomy is the best option for you

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Prophylactic Mastectomy

A prophylactic (or preventive) mastectomy is removal of a breast even though no cancer has been found. Prophylactic mastectomies are most commonly done for women who are at very high risk for developing breast cancer and want to reduce that risk. Although a prophylactic mastectomy removes almost all of the breast tissue, there is still a small chance that breast cancer may develop in the remaining breast tissue.

During a prophylactic mastectomy, a surgeon removes almost all of the breast tissue, including the nipple. The muscle behind the breast tissue is not removed.

Your surgeon will try to minimize scarring as much as possible during surgery. However, once you heal from the mastectomy, you will be left with a scar across your chest and the area will be flat. In rare cases, your ribs may look like small bumps underneath your skin.

Following a prophylactic mastectomy, you may wish to wear an artificial breast form (prothesis) in a bra or attached to your skin. Another option is to have the breast reconstructed or rebuilt using artificial breast implants or your own body tissue. Reconstructive surgery may be done at the time of the prophylactic mastectomy, or you can wait and have it done at a later time.

You may want to consider a prophylactic mastectomy if you:

• Have breast cancer in one breast and a high risk of developing breast cancer in the unaffected breast over the course of your lifetime
  
  
• Have breast cancer in one breast and a great deal of anxiety over developing breast cancer in your unaffected breast
  
  
• Carry a BRCA 1 or BRCA 2 genetic mutation, regardless of whether you have had breast cancer
  
  
• Have a substantial family history of breast cancer occurring at an early age

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Lymph Nodes

Lymph nodes are small bean-shaped structures that run close to your vascular system (arteries and veins) and are part of the lymphatic system running throughout your body. An important part of your immune system, this elaborate network of vessels and nodes helps fight infection and clean up waste products made by the body. However, if cancerous cells invade these lymph nodes, they can spread to other parts of the body.

The lymph vessels in the breast drain into the lymph nodes under the arm (the axilla). If cancerous cells are found in these lymph nodes during a node biopsy, additional treatments may be recommended.

The information in this section will help you plan and prepare for your treatment. However, it is not meant to replace the individual attention, advice and treatment plan of your oncologist and health care team.

Sentinel Lymph Node Biopsy

If you have an invasive ductal or lobular cancer, or a large amount of ductal carcinoma in situ (DCIS), your surgeon will need to perform a biopsy of the lymph nodes under your arm to see if the cancer has spread from the breast to the nearby lymph nodes.

During a sentinel lymph node biopsy, blue dye and/or a radioactive tracer will be injected into the breast at the time of your surgery to help the surgeon locate the lymph nodes. The surgeon will make a small cut (incision) in your armpit and find and remove the first lymph nodes into which the breast tissue drains. These are called the sentinel lymph nodes. Usually between one and four lymph nodes are removed.

A pathologist, who may be in the operating room at the time of surgery, will look at the lymph nodes. If no cancerous cells are found, no further lymph nodes need to be removed. If cancerous cells are found, then a complete axillary lymph node dissection may be recommended, which would be done during an additional surgery.

Complete Axillary Lymph Node Dissection

If you have an invasive ductal or lobular cancer, your surgeon may need to remove most of the lymph nodes under your arm to see if the cancer has spread from the breast to the nearby lymph nodes.

A complete axillary lymph node dissection may be recommended, rather than a sentinel node biopsy, if the surgeon’s exam or a biopsy shows a suspicious or a cancerous lymph node in the armpit (the axilla). An axillary lymph node dissection is usually done at the same time as the breast surgery. Your surgeon will make a cut (incision) under your arm on the side the cancer was found. Next, the fatty tissue called the axillary fat pad, which contains lymph nodes, will be removed. The number of lymph nodes found in the fat pad varies from person to person. After your surgery, a pathologist will remove the lymph nodes from the fat pad and examine them under a microscope to see if they contain cancerous cells.

You may notice numbness or tingling in the area under and at the back of your upper arm following an axillary lymph node dissection. Your arm and shoulder may also be tight and have limited range of motion immediately after surgery. This should get better soon. There are specific exercises to help ease this stiffness.

Throughout your lifetime, you will be at greater risk of developing a condition called lymphedema (refer to the lymphedema section later in this packet) on the side where the lymph nodes were removed. Lymphedema is a painless chronic swelling of the hand and/or arm. It can affect as many as 20 percent of women who undergo complete axillary lymph node dissections. It is not life threatening, but it can limit movement, increase the chance of infection and change your body’s appearance. Treatment to manage lymphedema is available through a lymphedema clinic.
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