Breast cancer surgery involves the surgical removal of a breast tumour and a portion of the surrounding normal tissue to prevent its spread to the other parts of the body. Breast cancer is generally malignant (spreads to other parts), developing from the uncontrolled growth of breast cells. The cause is usually unknown. In about 10% of cases it is due to a genetic abnormality. Breast cancer becomes more common with increasing age.
Breast cancer generally begins in lobules (milk-producing glands) or ducts (milk-draining passages extending from the lobules to the nipple). Breast cancer can sometimes occur in the fatty and fibrous breast tissues. If left untreated, the tumour cells may invade the nearby healthy breast tissues and into the lymph nodes of the underarm, which can spread to other body parts such as armpit (axilla).
Self-breast examinations, mammograms, biopsies, blood tests and imaging studies can be ordered by your doctor to detect and monitor breast cancer.
Breast cancer is generally treated with a combination of surgery, hormone therapy (blocks some hormones), radiation therapy (use of high-energy rays) and chemotherapy (use of certain drugs). Deciding on the appropriate type of surgery for you will depend on the stage of cancer, type of cancer and its long-term benefits.
The two main types of breast cancer surgeries include:
1. Wide local excision, lumpectomy or breast-conserving surgery : This involves the removal of only the tumour along with a small margin of the surrounding breast tissue.
2. Mastectomy: involves removal of the complete breast tissue.
The various types of mastectomy procedures include:
- Simple or Total Mastectomy : Your surgeon will remove the entire breast and sometimes the lymph nodes from the armpit by making a 6 to 7-inch long elliptical cut starting from the inside of the breast, close to the breast bone, and continuing up and out toward the armpit.
- Skin-Sparing Mastectomy : Your surgeon will cut an opening around the nipple and areola to remove the breast tissue. Most of the breast skin is preserved with this technique, which is generally lost in traditional mastectomy. It offers the advantage of negligible scarring and provides the best option for immediate breast reconstruction.
- Nipple-Sparing Mastectomy : Your surgeon will make an incision in the fold of skin under or to the side the breast, or around the areola, where the cut cannot be easily seen after healing, and will spare the nipple.
- Preventive/prophylactic or risk-reduction mastectomy : If you are genetically predisposed and have a high risk of developing breast cancer, you may choose to have preventive surgery. A simple mastectomy or nipple-sparing mastectomy can be performed.
- Radical or Halsted mastectomy : Your surgeon will remove the entire breast along with the underlying chest wall muscles and lymph nodes. It is rarely performed to treat patients with advanced breast cancer, and is the most disfiguring of all the mastectomy procedures.
In some cases, you can choose between mastectomy and lumpectomy. If you have only one cancerous site, less than 4 cm of tumor and a clear margin of healthy tissue, lumpectomy with radiation is as effective as mastectomy.
Lymph node dissection: The removal of the lymph nodes is an important step in breast cancer surgery as the cancer cells can spread to the other parts of the body through the lymph. Your surgeon may remove the sentinel node (see Sentinel Node Biopsy), or perform an axillary clearance. Your surgeon can remove five to thirty lymph nodes or sentinel nodes, which are the first lymph nodes into which the cancer cells can spread.
Breast and nipple reconstruction
Following the removal of breast tissue, the breasts can be rebuilt to achieve a similar shape and size of the original breasts. Your doctor may perform reconstruction either during the surgical procedure or a few months after the procedure. Breast reconstruction can be performed in two ways:
- Using saline or silicone implants to replace the breast tissues
- Replacing the breast tissue with tissue transplanted from your stomach, buttocks, back or thigh
The nipple can also be reconstructed using tissue transplanted from another part of your body or a skin substitute, or by having a nipple tattooed on the reconstructed breast.
Related surgical techniques
Other surgical therapeutic or preventive procedures can also be performed. Cryosurgery uses extreme cold to kill cancerous cells of the breast. Your surgeon will insert small needles to deliver liquid nitrogen or argon gas into the cancer tissue. The procedure is performed under local anaesthesia and a mild sedative. Another procedure is prophylactic ovary removal, which is a preventive surgery where ovaries and fallopian tubes are removed to lower estrogen levels in the body so that the chances of triggering the development of breast cancer are lowered.
Wide Local Excision may be performed as a day case or with a one night stay in hospital. Mastectomy with or without lymph node dissection usually involves one or two nights in hospital.
You will be prescribed medicines to relieve pain. You will be discharged with an external drainage device to collect fluid from the surgical site. You should keep the incisions clean and dry for a week after the surgery. A special surgical bra can be used to hold the bandages in place. You may experience tingling, numbness or discomfort in the armpit. The bluish-black colour and swelling will lessen after a few days. You will be instructed to begin arm exercises on the next day after surgery to prevent stiffness, and to increase the exercise routine after consulting with your doctor.
You will be able to continue with your normal activities a few weeks after mastectomy, but may require only a few days for lumpectomy.
Risks and complications
As with any surgery, breast cancer surgery involves potential risks and complications. They may include:
- Hematoma (accumulation of blood in wound) and seroma (accumulation of fluid in wound)
- Excessive bleeding
- Lymphedema (accumulation of lymph fluid in the arm)
- Wound infection
- Nerve pain
- Scar formation in the armpit