Surgical Treatments

Breast Conservation Surgery (Lumpectomy) 

Breast Conservation Surgery (BCS)  is the most common form of breast cancer surgery today. Breast conservation surgery preserves your body image because it saves the majority of the breast tissue, including the nipple and the areola.   The surgeon removes only the part of your breast containing the tumor (the "lump") and some of the normal tissue that surrounds it.  All the tissue removed from your breast is examined carefully to see if cancer cells are present in the margins—the normal tissue surrounding the tumor.  Breast conservation requires post operative radiation to reduce risk of cancer recurrence at the operative site.  Contraindications to breast conservation treatment followed by radiation include:

·      Pregnancy (if radiation therapy will be required before delivery; surgery is possible in the third trimester if radiation can be given after delivery and starting within six weeks of surgery.

·         More than one primary breast tumors

·         Mammogram with evidence of suspicious scattered micro calcifications

·         Location of the tumor in the breast where there may be poor cosmetic results (example: when the tumor is located under the nipple, unless reconstruction is used)

·         Size of the tumor (if the tumor is too large or the breast is too small in relation to the size of the tumor, then there will be poor cosmetic results

·         Prior radiation therapy to breast or chest area

·         Collagen vascular disease (lupus, scleroderma, etc.)

·         Severe chronic lung disease (because may not be a candidate for radiation therapy)

·         Very large pendulous breast (may indicate you may not be a good candidate for radiation therapy; you need to have a radiation oncologist’s evaluation)

·         Evidence of remaining cancer in ducts surrounding tumor after surgical removal (indicating there may be a high risk for recurrence)

·         Inability of the surgeon to obtain clear margins (no evidence of cancer) after re-excision of the area

·         Restrictions on travel or transportation to clinic for daily radiation for five to seven weeks

Lumpectomy Procedures

 There are several types of breast conserving surgeries.  Different amounts of tissue may be removed according to the size and cell type of your tumor.  There variations in the amount of tissue removed have different names.  Lymph node removal during breast conserving surgery also varies.  Ask your surgeon which of the procedures will be performed and the extent of tissue and lymph node removal you will need to have.  The different breast conserving surgeries are defined below:

 1. Lumpectomy

 Lumpectomy removes the tumor and a small wedge of surrounding tissue.  Lymph nodes //may or may not be removed by a separate incision under your arm.

 Incisions for breast conserving procedures appear very similar in relation to the cosmetic appearance of the breast, differing only in accordance to the amount of tissue removed.

 2. Partial or Segmental Mastectomy

 The tumor, possibly the overlying skin, and an area of tissue around the tumor are removed in this surgery.  A portion of the lining of the chest muscle under the tumor may also be removed.  Lymph nodes may or may ot be removed from a separate incision, approximately two inches in length, under the arm.

 
Mastectomy Procedures

 There are several types of mastectomies.  Ask Dr. Murray which of the procedures will be performed and the extent of tissue and lymph node removal you will need to have.  The different mastectomies are defined below:

1.Modified Radical Mastectomy

A modified radical mastectomy remove the breast, nipple areola, underarm lymph nodes and the lining over the chest wall muscles and pectoral nerves are not removed.

2. Total, Simple or Prophylactic Mastectomy

This procedure removes the breast tissue, nipple, areola, and possibly some of the underarm lymph nodes that are closest to the breast.

3. Prophylactic Mastectomy

For some women there may be an option for a prophylactic mastectomy (simple mastectomy) of a breast if bilateral reconstruction is desired.  A prophylactic mastectomy takes place before cancer has been found.  Some women with extremely high risk of breast cancer or precancerous conditions in the breast choose this procedure.  This elective surgery is a decision made collaboratively between the patient, surgeon and oncologist.  A second opinion may be required to ensure that this is a physically and psychologically sound decision.  Reasons for considering this procedure may include:

·         Family history of breast cancer, including first degree relatives who died of the disease

·         Identified carrier of BRCA1 or BRCA2

·         Repeated breast biopsies for suspicious findings

·         Mammograms that show findings which are increasingly difficult to interpret

·         Diagnosis of a cancer type that has a high rate of occurrence in both breasts

·         When the weight of a very large remaining breast (after mastectomy) creates imbalance, posture changes and back pain

·         Overwhelming psychological fear of occurrence in remaining breast

·         Desire for bilateral reconstruction with an increase or decrease in the reconstructed breast size