Surgery for breast cancer includes surgery to the breast and surgery to the axilla (armpit).
Surgery to the breast.
Although there are many operations that we do, they fall into two groups: breast conservation surgery (wide local excision, lumpectomy) and mastectomy.
Breast conservation means removal of the cancer and some surrounding tissue. It is important that there is no cancer or precancer in the surrounding tissue. (We refer to the normal tissue around the cancer as the margin. A negative margin means all the cancer has been removed and normal tissue surrounds the tumour). Breast conservation surgery is generally followed by radiotherapy. If it is not possible to have radiotherapy, breast conservation is not generally advisable.
Mastectomy means removal of the breast. It may be done with or without reconstruction.
On some occasions, the outcome for an individual is better if a mastectomy is performed. Indications for a mastectomy include:
- Patient preference
- Widespread pre cancer (DCIS)
- More than one cancer in the breast
- A strong family history of breast cancer
- If the cancer is large/the breast small, the cosmetic result may be better after a mastectomy with reconstruction than after breast conservation.
Axillary surgery refers to the management of the lymph nodes. The reasons to do axillary lymph node surgery are:
- To see if the cancer has spread. This is very important as we generally base our adjuvant treatment of breast cancer on the behavior of the cancer rather than only on the size or grade. The commonest way to do this is with a sentinel node biopsy. Before surgery, the breast is injected with a dye. At the time of surgery, the lymph node containing dye is removed and is tested.
There are several variations on the techniques used
- The dye used may be blue dye or radioactive dye or both
- There may or not be a preoperative scan
- The lymph nodes may or not be tested at the time of surgery.
- To remove the lymph nodes if they are involved with disease.
Commonly used terms:
Simple mastectomy: removal of the breast
Modified radical mastectomy: removal of the breast and the axillary lymph nodes
(Radical mastectomy is rarely done any more: it involves removal of the underlying muscle).
by Jenny Edge