Breast Cancer Surgery: Lumpectomy to Mastectomy

Breast cancer surgery permits tissue removal for diagnostic purposes and control of cancer when a tumor has not yet metastasized. In cases of metastatic breast cancer, surgery may be performed in combination with other treatments.

 

Surgery targets specific areas and can be controlled so that a minimum of normal tissue is affected. Depending on the nature and extent of the suspected cancer, surgical options range from breast biopsy (small, localized tumor) to radical mastectomy (entire breast).

Biopsies are microsurgeries in which a sample of suspicious tissue is obtained and analyzed for signs of cancer. The four types of biopsies are

The option chosen will depend on tumor characteristics, location and whether it can be felt by touch.

The lumpectomy is a localized open surgical procedure for removal of a breast lump. In a lumpectomy, the targeted breast tissue is cut away in a single piece and removed through a small incision. Analysis of the tissue will confirm the lump to be a cyst, or a benign or malignant tumor. The result will determine if an additional breast biopsy or other treatment is required.

A second type of breast biopsy is fine needle aspiration (FNA), which is used to remove varying amounts of fluid and tissue from a targeted lump in a single procedure or in a series of procedures. For very small lumps, a "stereotactic" approach can be applied using computer-based imaging to enhance guidance of the biopsy needle. A core biopsy may be used if the surgeon wants a larger sample of tissue. The core biopsy can provide a more accurate diagnosis than fine needle aspiration. Another option is vaccum assisted breast biopsy. While this procedure does require a very small incision, it can remove several large samples of tissue in a single procedure. In most cases biopsy using core needle or fine needle aspiration will require a number of needle insertions to remove an adequate amount of tissue.

An axillary node dissection is the removal of a layer of fat containing several lymph nodes from the armpit region. The nodes are then examined to assess how far the cancer has spread.

Sentinel node biopsy is selective removal of the first lymph node in the armpit ("axillary") region that receives lymph fluid from the breast. The first node is removed because of the higher probability that cancer cells will accumulate there before metastasizing to other tissues. Sentinel node biopsy is helpful because analysis of nodal tissue will indicate if cancer has reached the armpit, and will help determine if additional treatment is necessary.

One side effect of axillary lymph vessel and lymph node removal is lymphedema, an accumulation of fluid causing swelling in the arm. Lymphedema can occur immediately following treatment or years later. Because of the very slow drainage of waste products in the area, bacterial infection can accompany lymphedema.

Radical mastectomy may be undertaken in patients with Stage IV metastatic breast cancer where malignant cells have migrated to the breast margin and beyond. When patients have metastatic breast cancer, the goal is to lessen their pain and associated discomfort while extending their life. A partial mastectomy may be performed in early metastasis when there is still a high probability of removing all of the cancer.

Sometimes women who are most at risk choose preventive surgery—prophylactic mastectomy—in the hope of reducing the probability of getting breast cancer. The most severe option is to have radical mastectomy followed by breast reconstruction.

Less radical, subcutaneous prophylactic mastectomy removes much of the breast tissue but keeps the nipples and areola intact. Prophylactic mastectomy is a controversial treatment option, not universally supported by the medical profession.

Resources

Imaginis. (2000). Breast cancer screening/prevention: Prophylactic mastectomy.

Kepics, J.M., Stolker, S., Holder, N., Gergich, N., & Packel, L. (2002). What is lymphedema? University of Pennsylvania Medical Center Lymphedema Program, OncoLink.

National Cancer Institute. (nd). Treatment options overview: Surgery. Breast Cancer (PDQ®).

St. Francis Hospital, Milwaukee, Wisconsin (2002, Summer). Overcoming lymphedema. Covenant: The Promise of Healthy Living, p. 5.