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Surgery for Breast Cancer

Most women with breast cancer will have some type of surgery to remove as much of the cancer as possible. Surgery may also be followed by other treatments such as chemotherapy, hormone therapy or radiation therapy.

Surgery may also be done to:

  • find out whether the cancer has spread to the lymph nodes under the arm (axiliary node dissection)
  • restore a more normal appearance (reconstructive surgery)
  • relieve symptoms of advanced cancer

Types of breast cancer surgery

The most common types of breast cancer surgery are described below.

Lumpectomy

This procedure is also called a partial mastectomy. Other names include wide excision, wedge excision, segmental mastectomy and quadrantectomy.

The surgery removes the breast lump as well as some of the surrounding tissue. The amount removed varies with the size of the lump but is generally anywhere between one and 25 percent of the breast tissue. Once the tumour is removed, a specimen of it is examined in the operating room and the rest is sent to the pathology lab to confirm whether cancer is present.

This procedure is most commonly followed by several weeks of external beam radiation therapy.

For most women, a lumpectomy or partial mastectomy plus radiation is just as effective as a mastectomy. There are many factors, however, which affect the best choice for surgery.

Simple or total mastectomy

A simple or total mastectomy involves the surgical removal of the entire breast, but not the lymph nodes from under the arm nor muscle tissue from below the breast.

Modified radical mastectomy

This procedure removes all breast tissue including the nipple. Some of the lymph nodes under the arm will also be removed to see whether the cancer has spread.

Radical mastectomy

This surgery involves removal of the entire breast, lymph nodes and the chest wall muscles. This surgery is now rarely used because the modified radical mastectomy has proven to be just as effective with less disfigurement and fewer side effects.

Axiliary Dissection

This surgery removes a sample of lymph nodes from the underarm (axilla) to find out whether the cancer has spread. This surgery can be done separately or as part of a lumpectomy or modified radical mastectomy. Samples are sent to the lab. Final results can take one to two weeks.

A condition called lymphedema can also develop in four to five percent of women after axillary node dissection. This causes fluid retention and swelling of the arm or hand. Lymphedema occurs when the lymph node system is not draining enough fluid now that some of the nodes have been removed. Although the condition is becoming less common, it can occur right after the surgery or months or even years later.

Sentinel lymph node biopsy

This procedure is being studied as an alternative to a full axillary node dissection. The procedure involves injecting a radioactive dye into the region of the tumour. The dye is carried by the lymph system to the lymph node closest to the tumour. This node is called the sentinel node.

Once the sentinel node is identified, a biopsy is taken. If the cancer has spread, this node is the most likely to contain cancer cells.

If the sentinel node contains cancer, more lymph nodes are removed. If no cancer is found, further lymph node surgery may not be required

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