Breast Cancer Surgery

Breast Cancer Surgery

What is Breast Cancer Surgery?

Breast cancer surgery is a key component of breast cancer treatment that involves removing the cancer with an operation. Breast cancer surgery may be used alone or in combination with other treatments, such as chemotherapy, hormone therapy, targeted therapy and radiation therapy.

For people with a very high risk of breast cancer, breast cancer surgery may be an option to reduce the risk of future breast cancer.

Breast cancer surgery includes different procedures, such as:

. Surgery to remove the entire breast (mastectomy)

. Surgery to remove a portion of the breast tissue (lumpectomy)

. Surgery to remove nearby lymph nodes

. Surgery to reconstruct a breast after mastectomy

Which breast cancer operation is best for you depends on the size and stage of your cancer, your other treatment options, and your goals and preferences.

Before Breast Cancer Surgery

Why it's done

The goal of breast cancer surgery is to remove cancer cells from your breast. For those who choose breast reconstruction, a procedure to place breast implants or reconstruct a breast from your own tissue (flap surgery) may be done at the same time or in a later operation.

Breast cancer surgery is used to treat most stages of breast cancer, including:

. A high risk of breast cancer. People with a high risk of breast cancer based on a strong family history of the disease, certain noncancerous breast biopsy results or a gene mutation might consider preventive (prophylactic) mastectomy with or without immediate breast reconstruction as an option to prevent breast cancer.

. Noninvasive breast cancer. People diagnosed with ductal carcinoma in situ (DCIS) may undergo lumpectomy, which may be followed by radiation therapy, though mastectomy with or without breast reconstruction may also be an option.

. Early-stage breast cancer. Small breast cancers may be treated with lumpectomy or mastectomy with or without breast reconstruction followed by radiation and, sometimes, chemotherapy, hormone therapy or targeted therapy.

. Larger breast cancers. Larger cancers may be treated with mastectomy, though sometimes chemotherapy, hormone therapy or targeted therapy is used before surgery to make it possible to perform a lumpectomy. Additional treatment with radiation therapy, chemotherapy, hormone therapy or targeted therapy may be recommended.

Read more about : What’s the Difference between Breast Augmentation and Breast Implants?

. Locally advanced breast cancers. Breast cancers that are very large or have spread to several lymph nodes are often treated first with chemotherapy, hormone therapy or targeted therapy to shrink the tumor and make surgery more successful. These cancers may be removed using mastectomy or lumpectomy, followed by radiation therapy.

. Recurrent breast cancer. Breast cancer that returns after initial treatment may be removed with additional surgery. Additional treatments may be recommended.

Surgery is seldom used to treat breast cancer that spreads to other parts of the body (metastatic breast cancer).

Risks and Complications

Breast cancer surgery is a safe procedure, but it carries a small risk of complications, including:

. Bleeding

. Infection

. Collection of fluid at the operative site (seroma)

. Pain

. Permanent scarring

. Loss of or altered sensation in the chest and reconstructed breasts

. Wound healing problems

. Arm swelling (lymphedema)

. Risks related to the medicine (anesthesia) used to put you in a sleep-like state during surgery, such as confusion, muscle aches and vomiting.

During Breast Cancer Surgery

Types of Breast Cancer Surgery

If surgery is necessary, the type will depend on both the diagnosis and individual preference. Types of surgery include:

. Lumpectomy: This involves removing the tumor and a small amount of healthy tissue around it.

A lumpectomy can help prevent the spread of the cancer. This may be an option if the tumor is small and easy to separate from its surrounding tissue.

. Mastectomy: A simple mastectomy involves removing the lobules, ducts, fatty tissue, nipple, areola, and some skin. In some types, a surgeon will also remove the lymph nodes and muscle in the chest wall.

. Sentinel node biopsy: If breast cancer reaches the sentinel lymph nodes, which are the first nodes to which a cancer can spread, it can spread into other parts of the body through the lymphatic system. If the doctor does not find cancer in the sentinel nodes, then it is usually not necessary to remove the remaining nodes.

. Axillary lymph node dissection: If a doctor finds cancer cells in the sentinel nodes, they may recommend removing several lymph nodes in the armpit. This can prevent the cancer from spreading.

. Reconstruction: Following mastectomy, a surgeon can reconstruct the breast to look more natural. This can help a person cope with the psychological effects of breast removal.

The surgeon can reconstruct the breast at the same time as performing a mastectomy or at a later date. They may use a breast implant or tissue from another part of the body.

What you can expect

During Breast Cancer Surgery

Breast cancer surgery is done in a hospital. Before the procedure, you're given medicine (general anesthesia) that keeps you in a sleep-like state.

What happens during your surgery will depend on the operation, but you can expect:

. An incision in your breast to remove cancer and surrounding tissue. How much tissue is removed will depend on whether you undergo lumpectomy to remove part of the breast tissue or mastectomy to remove all of the breast tissue. The placement and length of the incision depends on the location of the cancer within the breast.

. An assessment of the lymph nodes in your armpit. During a sentinel node biopsy, the surgeon removes a few lymph nodes into which a tumor is most likely to drain first (sentinel nodes). These are then tested for cancer. If no cancer is present, no additional lymph nodes need to be removed.

If cancer is found, the surgeon may remove more lymph nodes or recommend radiation therapy to your lymph nodes after surgery. Sometimes both lymph node treatments are combined.

. Closure of the incision. The surgeon closes the incision with attention to your appearance. Dissolvable stitches are placed to reduce scarring.

. Reconstruction, if you choose. If you are undergoing mastectomy and choose breast reconstruction, the reconstruction is most frequently started at the time of your cancer operation. In some cases, reconstruction may be delayed and done in a separate surgery.

Read more about : Breast Reconstruction

Read more about : Cervical Cancer treatment

After Breast Cancer Surgery

After surgery

After your surgery, you can expect to:

. Be taken to a recovery room where your blood pressure, pulse and breathing are monitored.

. Have a dressing (bandage) over the surgery site

. Possibly have pain, numbness and a pinching sensation in your underarm area.

. Receive instructions on how to care for yourself at home, including taking care of your incision and drains, recognizing signs of infection, and understanding activity restrictions.

. Talk with your health care team about when to resume wearing a bra or wearing a breast prosthesis.

. Be given prescriptions for pain medication and possibly an antibiotic

. Resume your regular diet

. Shower the day after surgery

Expect to spend one night in the hospital after mastectomy if you also undergo breast reconstruction. Those undergoing mastectomy without reconstruction or lumpectomy may leave the hospital the day of surgery.

Aftercare and Recovery

These are general guidelines for recovering from breast cancer surgery. Always follow your doctor's specific instructions for care after your operation.

. Drainage Device

After your surgery, you may be discharged from the hospital with an external drainage device in place. The drains will remove and collect fluid from the surgery site. Your doctor will show you how to care for the device before you leave the hospital. This usually includes emptying the drains, measuring the fluid, and keeping an eye out for any problems.

The amount of fluid that drains will gradually decrease. The fluid color may also change from a cherry red to a yellow-red and then to a straw color. Usually, the drainage system is removed within 1 to 3 weeks after surgery.

. Wound dressings

After your surgery you will have an adhesive dressing applied to your wound. You may have dissolvable stitches that don’t need to be removed, or non-dissolvable stitches that need to be removed seven to ten days after surgery. You may also have steristrips (narrow adhesive strips used to close a wound) that will need to be removed.

Sometimes a thick, firm dressing (pressure dressing) is also applied to help reduce swelling or bleeding initially after surgery. Pressure dressings are usually removed after a day or two.

. Getting Your Incision Wet

Keep your incision clean and dry for 1 week after surgery. You may need to take sponge baths rather than showers. Bathing in a bathtub is ok if you keep the incision area dry.

Small pieces of tape will remain over the incision. They usually fall off by themselves.

Don’t go swimming until your doctor and surgeon say it’s ok.

. Skin Care

The area may be black and blue right after breast cancer surgery. This will go away in a few days. You might be numb or uncomfortable or have tingling on the inner part of your upper arm or in your armpit. This is normal.

A warm shower feels nice, but wait at least a week after surgery.

When shaving under your arm or applying deodorant, look in the mirror to avoid irritating the incision.

As it heals, the incision may feel thick and tough. Massage the area with a mild lotion, vitamin E, or pure lanolin. Highly perfumed lotions and any product containing alcohol may be irritating. After several weeks, the scar will soften.

. Pain Relief

Your doctor will give you a prescription for pain medication after breast cancer surgery. Ask about taking over-the-counter pain relievers in addition to, or instead of, your prescription pain medicine.

Don’t take aspirin or products with aspirin for the first 3 days after the procedure. They can make you more likely to bleed.

. Exercises after Surgery

Daily stretching exercises can help you regain mobility, but talk to your surgeon about when to start them.

. Arm lifts. While standing or sitting on the edge of a chair, lift both arms over your head with your elbows close to your ears. Hold for a count of five and repeat.

. Arm swings. While standing, swing both arms forward and back from your shoulders (like a pendulum). Keep your elbows straight. Increase the distance of the swing each time. Repeat 10 times.

. Wall climbing. Stand facing a wall with your feet close to the wall. Put your arms out in front of you with your hands on the wall. Climb the fingertips of both hands up the wall, until your arms are stretched over your head. Climb your fingers back down the wall. Repeat 10 times, trying to reach higher each time.

. Driving

Ask your doctor before you get back behind the wheel. Most women can start driving again 10 to 14 days after surgery.

. Follow-Up Exams

Regular follow-up visits are important after breast cancer treatment. Your doctor will watch you closely to ensure that the cancer hasn’t returned. Checkups usually include exams of the chest, underarm, and neck.

From time to time, you'll get a complete physical and an annual mammogram. No other regular X-rays, scans, or blood tests are usually needed.

A woman who's had cancer in one breast has a higher-than-average risk of developing cancer in the other breast. You should continue to do monthly breast self-exams, checking both the treated area and your other breast. Report any changes to your doctor right away.

. Needles in Your Arm

It's best not to have blood taken, or an injection given, in the arm on the side of your body where you had breast cancer surgery. If you have to have blood drawn or get medication in this arm, tell the health care professional that you've had breast surgery.

When to Call the Doctor

Breast cancer surgery is generally safe, but as with any surgery, there are risks. Possible problems include:

. Infection

. A buildup of blood under your skin (hematoma)

. A buildup of fluid under your skin (seroma)

. Swelling in the arm (lymphedema)

. A bad reaction to anesthesia

Many women opt for breast reconstruction right after their cancer is removed. Problems that can stem from that operation include:

. Poor healing

. A leak or rupture of your breast implant

. Scar tissue around your implant

Talk to your doctor about the risks before your surgery. The medical staff will keep an eye out for problems while you're in the hospital. Once you’re home, watch for these symptoms:

. Infection. Look for redness or swelling of the incision with pus or foul-smelling drainage. You may have a fever. Usually, antibiotics can treat these infections.

. Lymphedema. Look for swelling of the arm or hand on the side of the surgery. This happens to some women after the lymph nodes under the arm are removed. It may go away on its own, but you may need to see a physical or occupational therapist. Treatments include:

. Draining the fluid

. Compression bandages to keep the swelling down

. Skin care

. Arm exercises

. Seroma. You may notice swelling from a buildup of fluid at the site of the surgery. Usually, your body absorbs this fluid. If the swelling doesn’t go down on its own, your doctor may need to use a needle to drain the area.

A small amount of swelling is normal for about a month after surgery. Sometimes, raising your arm on pillows will ease it.

You may have pain and stiffness in your shoulder as you recover. You may also have numbness or unusual sensations in the upper arm or armpit. These side effects usually go away over time.

Other physical problems to tell your doctor about are:

. Loss of appetite or weight

. Changes in menstrual periods

. Blurred vision

. Dizziness, coughing, or hoarseness

. Headaches

. Shortness of breath

. Digestive problems that seem unusual or that don't go away in 2 or 3 days

Breast cancer survival rate

Breast cancer survival rates vary widely based on many factors. Two of the most important factors are the type of cancer you have and the stage of the cancer at the time you receive a diagnosis. Other factors that may play a role include your age, gender, and race.

According to the ACS, a person who receives treatment for stage 0 or stage 1 breast cancer has a 99% chance of surviving for at least 5 years after being diagnosed, when compared to women who do not have cancer.

If breast cancer reaches stage 4, the chance of surviving another 5 years reduces to around 27%.

Regular checks and screening can help detect symptoms early. Women should discuss their options with a doctor.

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