Surgery

 

There are several different types of surgical procedures used to treat breast cancer, including:
 

Simple or total mastectomy

Removal of the breast, with its skin and nipple, but no lymph nodes. In some cases, a separate sentinel node biopsy is performed to remove the first one to three axillary (armpit) lymph nodes.
 

Modified radical mastectomy

Removal of the entire breast, nipple/areolar region, and often the axillary lymph nodes. This is the most common form of mastectomy performed today.
 

Radical Mastectomy

Removal of the entire breast, nipple/areolar region, the pectoral (chest) major and minor muscles, and lymph nodes. This procedure is rarely performed today.
 

Quadrantectomy

Removal of a quarter of the breast, including the skin and breast fascia (connective tissues). The surgeon may also perform a separate procedure to remove some or all of the axillary (armpit) lymph nodes, either an axillary node dissection or sentinel lymph node biopsy.
 

Partial or segmental mastectomy

Removal of a portion of the breast tissue and a margin of normal breast tissue. This procedure usually involves removing less tissue than a quadrantectomy but more than a lumpectomy or wide excision.
 

Lumpectomy or wide excision

Removal of the breast cancer tumor and a surrounding margin or normal breast tissue. It can be performed utilizing oncoplastic surgery (plastic surgery and oncological planning) for optimal cosmetic results.
 

Excisional biopsy

Also the removal of the breast tumor and a surrounding margin or normal breast tissue. Sometimes further surgery is not needed if an excisional biopsy successfully removes the entire breast cancer tumor. This is most likely to occur if the breast tumor is very small. An excisional biopsy may be performed with “needle” or “wire” localization.
 

Axillary Node Dissection

The surgical removal of the axillary (armpit) lymph nodes. It is usually performed on patients with invasive cancers. A radical mastectomy, modified radical mastectomy, or lumpectomy operation often includes axillary node dissection (this involves a separate incision for lumpectomy patients). After surgery, the axillary lymph nodes are examined under a microscope to determine whether the cancer has spread past the breast and to evaluate treatment options.

The most common side effect of axillary node dissection is lymphedema, chronic swelling of the arm. Approximately 10% to 20% of patients typically experience lymphedema when axillary node dissection is combined with radiation therapy. Patients are encouraged to report any tightness or swelling of the arm to their physicians as soon as symptoms occur to prevent possible long-term suffering. Other side effects of axillary node dissection include temporary to permanent limitations of arm and shoulder movement and numbness in the upper-arm skin.
 

Sentinel Lymph Node Biopsy

A procedure that involves removing only one to three sentinel lymph nodes (the first nodes in the lymphatic chain). To perform sentinel node biopsy, a radioactive tracer and/or blue dye is injected into a region of a tumor. The dye is then carried to the sentinel node (the lymph node most likely to be cancerous if the disease has spread from its original origin). If the surgeon determines that the sentinel node contains cancer, more lymph nodes are removed and examined. Surgeons detect the sentinel lymph node by either spotting the blue dye or by measuring a node’s radioactivity with a Geiger counter. If the removed sentinel node is cancer-free, additional lymph node surgery may be avoided. Research has shown that sentinel lymph node biopsy may safely eliminate the need to remove many lymph nodes and reduce the chances of lymphedema (chronic arm swelling). However, the procedure may not be appropriate for all patients. It is important to discuss your options with your surgeon.
 

Nipple Areola Sparing Mastectomy with Immediate Reconstruction

A procedure that involves removing the breast tissue, sparing the skin, nipple and areola for optimal cosmetic results. This procedure is an option for breast cancer patients and patients who carry the BRCA1 or BRCA2 gene mutation (prophylactic mastectomy).