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Breast Surgery

Every year thousands of women find a breast lump or abnormalities discovered on mammography. Luckily, the majority of these findings are benign or non cancerous. Breast surgery deals with the treatment of both benign and cancerous lesions.

Diagnosis of breast abnormalities begins with self-breast exams, as well as an exam by a professional. Radiological examinations with mammography and ultrasound, where applicable, are invaluable. Additional testing with MRI in select cases can also be extremely beneficial.

Breast masses can be divided into cystic (fluid filled) or solid lesions. Cystic lesions (single cysts) are of no consequence and can be simply aspirated if they are large enough to cause discomfort. Solid lesions, on the other hand, need to be investigated with tissue sampling. Non-palpable lesions that produce an abnormal mammogram may also require tissue sampling. Comparison with any previous mammograms can be extremely important in deciding if this is a new finding or something that has been present for a few years without change.

Tissue sampling now is mostly done by a needle biopsy. This often is combined with such radiographic techniques as mammography and/or ultrasound to get to the precise location of the abnormality. This type of biopsy is called incisional. A piece of the abnormal area is removed for tissue sampling. If no cancer is found, this area can safely be reexamined in 6 months to assure stability. An excisional biopsy can also be done using these techniques. The entire abnormal area is removed, but this does require a surgical procedure.

The surgical treatment for breast cancer in the year 2004 has various options. Most of the time the type of surgery the patient decides upon is a personal choice. The options include breast removal (mastectomy), with or without reconstruction, or lumpectomy with radiation therapy. A lumpectomy removes the malignant mass along with enough normal breast tissue to have negative margins and decrease the risk of local recurrence. This option does need to be in conjunction with radiation therapy. The possibility of needing chemotherapy has nothing to do with the surgical option chosen. Chemotherapy is determined by the size of the primary tumor and whether or not any lymph nodes are involved. Today with breast cancer, we try and find the very first lymph node that the tumor could drain into. This is called the sentinel node. This node is identified by a nuclear medicine test the day of surgery. During surgery, a dye is also injected into the breast. This identifies the sentinel node and is removed. Upon removal, if the node has no indication of cancer, there is no further lymph node excision. By limiting the amount of lymph nodes removed, you can decrease pain and decrease the incidence of lymphedema (swelling of the affected upper extremity). If, however, the sentinel node does have cancer in it, then additional lymph nodes will need to be excised.

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Frequently Asked Questions

How important are self-breast exams?
By examing your breast each month, you will become aware of any changes from month to month. Early detection of lumps is very important. In most cases a mass is found by the patient.
I have breast cancer. Will I need radiation after surgery?
If you have chosen breast conservation therapy with a lumpectomy, radiation is required to treat the entire breast. If a mastectomy has been chosen, (with or without reconstruction) rarely is radiation necessary. Those situations where radiation is warranted following a mastectomy include significant lymphatic involment of the skin (inflammatory breast cancers) and where numerous (4 or more) lymph nodes are involved with metastatic cancer in the axilla.
I have recently been diagnosed with breast cancer. Am I a candidate for "conservative" breast surgery?
Whether a person is or isn't a candidate for conservative breast surgery usually has to do with tumor size and breast size. Most patients are candidates. Conservative breast surgery does, however, have to be combined with radiation therapy.
What is a sentinel lymph node?
The sentinel node is the first lymph node a cancer will spread to. By identifying that node and removing only that node, one may be able to avoid removal of any other lymph nodes. As long as the sentinel node shows no evidence of cancer, no other nodes need to be removed. This technique is appropriate for breast cancer and melanoma.
Will I need chemotherapy for my breast cancer following surgery?
Whether or not a patient is a candidate for chemotherapy is not based on which operative procedure she and her physician have chosen (mastectomy vs. conservation therapy). It is usually dependent upon the size of the primary tumor and whether or not the lymph nodes are involved. Most of the time these factors are not known until after surgery. Other factors, such as pre or post menopause state, patients age, and physical condition are also important

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