Removing The Lymph Nodes
Cancer cells might have spread into the lymph nodes close to the breast.
Lymph nodes are found in many parts of the body. They filter out bacteria and damaged cells from the lymphatic fluid, and contain cells that fight infection.
Before your surgery you have an ultrasound scan to check the lymph nodes in the armpit close to the breast. You will have a biopsy of the lymph nodes if they look abnormal. This is to see if they contain cancer cells
Doctors need to know if the lymph nodes in the armpit contain cancer as this helps them to plan your surgery.
You may have a sentinel lymph node biopsy or an axillary lymph node dissection. You usually have one of these at the same time as your breast surgery. But some people might have an axillary lymph node dissection at a second operation.
Questions About Treatment After Breast Surgery
What other types of treatment might I need after breast cancer surgery?
If you choose to have a lumpectomy or other breast-sparing surgery, you will usually need radiation therapy. Radiation treatments are often given 5 days a week for 1 to 6 weeks.
If you have a mastectomy, you may still need radiation therapy.
No matter which surgery you choose, you might need
Will I need more surgery?
|Lumpectomy or other breast-sparing surgery
|After surgery, if there are cancer cells at the edge of the removed breast tissue, then you may need more surgery to make sure that all of the cancer is removed.
|If you have problems after your mastectomy, you may need more surgery.
|Mastectomy with reconstruction
|You will most likely need more than one surgery to build a new breast-like shape. The number of surgeries you need will depend on the type of reconstruction you have and if you choose to have a nipple or areola added.Some women may also decide to have surgery on the opposite breast to help it better match the reconstructed breast.If you have an implant, you are likely to need surgery many years later to remove or replace it.
With all three surgeries, you may need more surgery to remove lymph nodes from under your arm. Having lymph nodes removed can cause lymphedema.
Going Into Hospital And Pre
Going into hospital may be a new experience for you and you might feel anxious, particularly if youre not sure what to expect.
You may find it helpful to read our booklet Your operation and recovery, which has more information about your admission to hospital, during your stay and your recovery at home.
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What Happens During A Mastectomy
A mastectomy typically requires a hospital stay. Procedures may varydepending on your condition and your doctor’s practices.
Generally, a mastectomy follows this process:
Think About What Is Important To You
After you have talked with a breast cancer surgeon and learned the facts, you may also want to talk with your spouse or partner, family, friends, or other women who have had breast cancer surgery.
Surgery Choices: Theresa, Cindy, Paula
Three women describe how they decided which type of breast cancer surgery was right for them.
Then, think about what is important to you. Thinking about these questions and talking them over with others might help:
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Wire Localization During Surgery
Sometimes, surgeons need to use a technique called wire localization to guide cancer removal during lumpectomy or mastectomy surgery. This technique is used when a breast cancer tumor can be so small it cant be felt or is hard to find, or if the cancer is in a part of the breast thats difficult for the surgeon to get to. In wire localization, a radiologist uses imaging to guide a thin wire through your breast tissue to the tumor location. This is called wire localization, needle localization, or sometimes, stereotactic wire localization.
What Are The Risks Of Breast Surgery
All surgeries have risks, and breast surgery is no different. Possible risks include, but are not limited to:
- Changes in nipple or breast sensation.
- Needing revision surgery.
A warning if you have breast augmentation surgery: breast implants can prevent the detection of cancer. Breast cancer is a serious condition. Also, note that breast implants may not last your entire lifetime. You may have to have surgery in the future. Weight loss, pregnancy and menopause can also change the shape of your breasts.
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Questions About The Effectiveness Of Breast Cancer Surgery
Which type of breast cancer surgery is best for my cancer?
|Lumpectomy or other breast-sparing surgery
|Most women with DCIS or breast cancer can choose to have breast-sparing surgery, usually followed by radiation therapy.
|Most women with DCIS or breast cancer can choose to have a mastectomy.A mastectomy may be a better choice for you if
|Mastectomy with reconstruction
If you have a mastectomy, you might also want breast reconstruction surgery.You can choose to have reconstruction surgery at the same time as your mastectomy or wait and have it later.
Your surgeon can talk with you about how much skin, including the nipple and areola, might be preserved for reconstruction.
Will the type of breast cancer surgery I have affect how long I live?
No. Research shows that women who have breast-sparing surgery live as long as women who have a mastectomy. This does not change if you also have reconstruction.
What are the chances that my breast cancer will return in the same area?
What Is Lumpectomy Vs Mastectomy
A lumpectomy, or breast-conserving surgery, removes the cancer and a small rim of healthy breast tissue around it, called the margin. Doctors may refer to this type of surgery as breast-sparing surgery, wide excision, or partial mastectomy. This may be an outpatient surgery, meaning that you dont have to stay in the hospital overnight unless you have other severe health problems. For most women, a lumpectomy must be followed by radiation to get rid of any remaining cancer cells, lowering the risk that the cancer will return.
Mastectomy is the removal of the entire breast to treat cancer. Doctors may remove one breast or both. When both breasts are removed, doctors refer to it as a bilateral mastectomy. This surgery usually includes the removal of the nipple and the areola . The chest muscles under the breast are left intact unless the cancer is near or touching the muscles. If that happens, a small area of muscle may be removed. Types of mastectomy include:
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Types Of Mastectomy The Following Types Of Mastectomy May Be Offered
A total mastectomy, or simple mastectomy, removes all of the breast and the tissue that covers the chest muscles . The lymph nodes, nerves and muscles in the chest are left in place. The nipple may or may not be removed.
If you plan to have a breast reconstruction, your doctors may try to do a skin-sparing mastectomy when they remove the cancer. A skin-sparing mastectomy is like a total mastectomy except that the surgeon doesnât remove the skin that covers the breast. This approach means that breast reconstruction can be done with very little scarring that can be seen.
Modified radical mastectomy
A modified radical mastectomy removes all of the breast, the nipple, most or all of the lymph nodes in the armpit and the tissue that covers the chest muscles . Nerves and muscles are usually left in place.
This type of mastectomy is used for breast cancer that has spread to lymph nodes. It is also used to treat inflammatory breast cancer.
A radical mastectomy is an operation that removes more muscle, lymph nodes and other tissues than a modified radical mastectomy. It is now very rarely used to treat breast cancer.
Types Of Breast Cancer Surgeries
Types of breast cancer surgeries include lumpectomy and mastectomy to remove cancer from the breast, and lymph node removal to confirm whether or not cancer cells have traveled beyond the breast. Breast reconstruction surgery can rebuild a breast after mastectomy. It can also be performed for local tissue rearrangement after an extensive lumpectomy.
Knowing you need surgery can cause a lot of anxiety, and understanding more about the surgery can help you prepare and recover. Below, well talk about the different types of surgery your doctor may recommend, and why they may be recommended.
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Preparing For Breast Cancer Surgery
No matter what type of breast cancer surgery you have, youâll need to take steps to get ready.
One of the first things youâll need to do is to give your medical history. Your doctor will ask you about any medications youâre taking, including vitamins and supplements. Theyâll also want to know if youâve had any reactions to medications or surgical procedures in the past. If you have any conditions that could affect how your body responds to surgery, such as heart disease, diabetes, or high blood pressure, you should let your doctor know at this time.
Your doctor may suggest that you donate a pint or two of blood in case you need it during surgery. If you do this, youâll need to allow extra time in your pre-op schedule to donate and recover.
As your surgery date gets closer, your doctor may order tests for you. These can include a chest X-ray, EKG, and blood and urine tests. These tests let your doctor know if your body is ready for the operation. They may also request a CT scan to check the size and location of your tumor.
Some Breast Cancer Patients Could Skip Surgery Study Suggests
In a small trial, chemotherapy alone was sufficient to treat women with certain kinds of tumors.
Chemotherapy being administered to a breast cancer patient in October.Credit…Annie Flanagan
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The conventional approach to fighting breast cancer is to deploy all the tools modern medicine has to offer. Surgery to excise the tumor is considered a critically important step, along with drugs, radiation, and hormone treatments and immunotherapy when appropriate.
A new study questions that approach, suggesting surgery may not always be necessary for all patients. The study, an early-stage clinical trial, found that a carefully selected group of patients who responded remarkably well to chemotherapy could skip surgery altogether.
Fifty patients over age 40 with two types of breast cancer and early-stage disease were enrolled in the trial.
All patients underwent chemotherapy, followed by biopsies to determine whether their tumors had responded well to the treatment. Thirty-one patients about 60 percent responded remarkably well and were able to forgo surgery, the researchers found.
The elimination of surgery for invasive breast cancer is the ultimate form of breast-conserving therapy, he said.
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What Is An Aggressive Breast Cancer
Triple-negative breast cancer is considered an aggressive cancer because it grows quickly, is more likely to have spread at the time its found, and is more likely to come back after treatment than other types of breast cancer. The outlook is generally not as good as it is for other types of breast cancer.
Should I Have Chemotherapy Before Breast Cancer Surgery
Although breast cancer treatment usually starts with surgery, there are some situations in which your doctor may recommend chemotherapy first. For example, if you have a large tumor and small breasts, chemotherapy may shrink the tumor enough to make a lumpectomy possible. Having chemotherapy as the first treatment for breast cancer may destroy cancer in the lymph nodes, which may help some women avoid having their lymph nodes removed. For women with some types of advanced breast cancer such as inflammatory cancer, having chemotherapy as the first step in treatment is standard to be sure all the cancer cells can be removed surgically. In studies involving thousands of women, this has been shown to be just as safe as having surgery first.
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Surgery To Remove Just The Area Of Cancer
Surgery to remove the area of cancer in the breast is called breast conserving surgery or a wide local excision.
The surgeon takes away the cancer and a border of healthy tissue all around it. They leave behind as much healthy breast tissue as possible.
You usually have radiotherapy to the breast after this type of surgery.
How Much Does Breast Surgery Cost
The cost of breast surgery depends on the procedure, the surgeons experience and the geographic location of the office. There are fees for the anesthesia, the facility, tests, clothes, prescriptions and the surgeons fees. Ask about payment plans.
Last reviewed by a Cleveland Clinic medical professional on 02/26/2021.
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Recovering From A Mastectomy
In general, women having a mastectomy stay in the hospital for 1 or 2 nights and then go home. How long it takes to recover from surgery depends on what procedures were done, and some women may need help at home. Most women should be fairly functional after going home and can often return to their regular activities within about 4 weeks. Recovery time is longer if breast reconstruction was also done, and it can take months to return to full activity after some procedures.
Ask your health care team how to care for your surgery site and arm. Usually, you and your caregivers will get written instructions about care after surgery. These instructions typically cover:
What Are The Risks Or Complications Of Breast Cancer Surgery
Possible complications include:
- Wound infection: Notice any telltale symptoms such as redness, heat or swelling at the site.
- Blood clots: Call your healthcare provider if you have a painfully swollen leg, chest pain or shortness of breath.
- Seroma: This is a build-up of fluid at the surgical site. It usually goes away on its own, but you can have the fluid drawn with a needle if it bothers you.
- Lymphedema: Disruption of the lymph drainage system can sometimes cause swelling in your arm or hand. Let your healthcare provider know if this occurs.
- Nerve damage: Nerve damage during surgery may cause numbness, tingling or pain in your chest, armpit, upper arm or shoulder. The nerves usually repair themselves, but it may take several weeks. Your healthcare provider can give you medication for the pain.
- Hematoma: This is when blood collects in the tissues around the wound, causing pain and swelling. It goes away on its own, but it can take several months. You can have the swelling drained if you need to.
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New Developments In Cancer Research
Progress in the field.In recent years, advancements in research have changed the way cancer is treated. Here are some recent updates:
Uterine cancer.Women who use chemical hair straighteners frequently could have a higher risk of developing uterine cancer than women who have never used the products, according to new findings from a national study that has followed nearly 34,000 U.S. women for more than a decade.
Cancer vaccines.For a long time, the promise of cancer vaccines that would protect healthy people at high risk of cancer has only dangled in front of researchers. Now, though, encouraging animal data and preliminary studies in human patients are making some doctors feel optimistic.
Tumor microbiome.Two new studies have revealed that cancer is rife with bacteria and fungi. This so-called tumor microbiome is proving so distinctive in each type of cancer that some scientists hope to find early signs of hidden tumors by measuring the microbial DNA these microbes shed into the blood.
A detection trick.In a surprise discovery, researchers found that cells from some types of cancers escaped destruction by the immune system by hiding inside other cancer cells. The finding may explain why some cancers can be resistant to treatments that should have destroyed them.
Some patients prefer radical surgery even if it does not improve survival, he noted, while for others even a minor procedure to remove the tumor can be emotionally grueling, even if it goes well.