Welcome to Talk Tuesdays.  This is part 2 with Dr. Coleman. 

 

Today we are talking about Breast Cancer Surgery.

What options are there for breast cancer surgery?

There are different types of cancer so first things will depend on what kind of cancer you have. Not all abnormalities that need surgery are cancer and not all cancer operations mean you will lose your whole breast. Again, don’t panic, there are a lot of options for surgery. You will need to discuss everything with your physician to determine what is the best course of action for you, but we will discuss some options. 

Breast conservation: this is also known as a lumpectomy or partial mastectomy. This is where a small-ish incision is made and the area of concern is removed with a small portion of normal breast tissue surrounding it. This is sometimes done using wire localization, but more recently this has moved to using radioactive seeds and such that can be located using a probe in the operating room. If a wire is used, this is placed by a radiologist into or close to the area of concern and secured/covered so as to help prevent dislodgment prior to surgery. Depending on if you have DCIS or invasive cancer will determine if you need any lymph nodes from your axilla (AKA armpit) removed. 

Mastectomy is where the whole breast is removed. There are different types of mastectomies out there. A simple mastectomy removes the nipple/areola/ and all breast tissue. A modified radical mastectomy is the same as a simple mastectomy except in this operation all of the lymph nodes in your axilla are removed as well. There are nipple sparing and skin sparing mastectomies as options also. All of these mastectomies can follow with breast reconstruction by a plastic surgeon either during the same operation or at a later date depending on the type of cancer you have and the other treatments that are needed after surgery. Understand that there are risks and benefits of each type of surgery and what may be best for you may not be the option you desire. 

 

What are lymph nodes and why are they removed?

The lymph nodes often times are said to “filter your blood”. If you have breast cancer that cancer is going to “drain” from your breast to those lymph nodes. If tumor is found in those nodes that is a sign of metastatic cancer. That’s why it is important to evaluate the lymph nodes in certain types of cancer, especially invasive cancer. This can be done in 2 ways - a sentinel lymph node biopsy or an axillary dissection. 

A sentinel lymph node biopsy can be done with breast conservation or mastectomy. When done with breast conservation a separate incision is made in the armpit to access the lymph nodes. With a mastectomy the same breast incision is used. A radioactive tracer is injected by nuclear medicine prior to surgery as well as a blue dye in the operating room. Both of these tracers help find the “sentinel” node. At least 3 nodes need to be taken in most cases and sometimes it will be more than that depending on whats seen in the OR. 

An axillary dissection involved removing all of the lymph nodes in the axilla. This is usually done at the time of mastectomy through the same incision. Sometimes it will be done after a SLN biopsy has shown metastatic disease that needs to be removed. But all the tissue is removed in this area. There are nerves and blood vessels there that can be injured and can make it difficult to lift your arm or cause your shoulder blade to stick out, but injury is not super common. 

What happens after surgery?

Depending on the type of surgery you had you may be able to leave that day or you may stay in the hospital. After a mastectomy you will have a drain. if you had an axillary dissection you will likely have 2 drains. You typically go home the day after surgery and drains will come out at your next clinic appointment where the pathology from the OR will be discussed in more detail. You will see an oncologist to discuss any need for chemotherapy an