Lets Talk Surgery...

The surgical options for cancer in the breast fall into two categories: partial mastectomy vs. mastectomy.

Lets start at mastectomy. There are a few varieties but in the simplest words this equals removal of all of the breast tissue. Sometimes we spare the skin for reconstruction, this is a skin sparing mastectomy. Sometimes we spare the nipple and areola for reconstruction, this is a nipple sparing mastectomy. Sometimes we have to remove (or a patient may choose to remove) the nipple, areola, breast tissue and the majority of the skin without reconstruction, we call this a simple or complete mastectomy. Sometimes if the cancer is extensive and requires removal of the underarm lymph nodes in addition to the breast tissue, this is referred to as a modified radical mastectomy. Radical mastectomies are generally no longer performed.

Then there is a partial mastectomy, also known as "lumpectomy" or "breast conservation therapy." This is where the area in the breast that has the cancer, and a small rim of normal breast tissue, are removed. This preserves the remainder of the natural breast. Once the cancer is removed, the rest of the breast tissue is sutured back together to cover the spot where the piece of tissue was removed.

Generally, a partial mastectomy goes hand in hand with radiation, as is considered "standard of care." There are exceptions to this rule that doctors take into consideration. Radiation is a treatment using energy rays, like laser light therapy, on the breast to try and kill off any tiny cancer cells that could be left after partial breast surgery. Radiation is different than chemotherapy, generally you don't get sick or lose your hair with radiation. The reason radiation is paired with a partial mastectomy is research showed us that there is a higher chance that the cancer could return in the breast if only the partial surgery was done without the radiation. Adding radiation to the partial mastectomy makes it nearly equivalent to having a mastectomy (complete removal of the breast) in the chance of cancers return.

Depending on the surgeon and other factors such as other medical problems, health status, cancer patient vs high risk patient, and level of home support can influence decisions on if these procedures may be done as an outpatient. Generally partial mastectomies are done as outpatient surgeries, meaning you come in and go home same day of the surgery. A mastectomy varies more, sometimes patients can go home same day, but other patients are recommended to stay overnight. This happens more in patients with cancer, who have had chemotherapy prior to surgery or who have chosen to have breast reconstruction with other tissue from their body.

Choosing what type of surgery is best for each patient is a team approach with the patient often making the ultimate decision. There are instances when partial mastectomies are not a good option, such as with large cancers and smaller breasts or cancer in multiple areas making it difficult to get all the cancer out in pieces. In general, a patient's wishes for type of surgery should be considered when making surgery decisions. The surgeon may explain why their recommendation leans towards one surgery type versus the other.

If a patient chooses to have a mastectomy, they can choose one breast (unilateral) vs both breasts (bilateral.) A patient can chose to have reconstruction. The plastic surgeons will then review the patient and make sure they are a candidate for the types of reconstruction available. The types of reconstruction generally fall into the category of implant based versus autologous tissue flap based (your own tissue). Additionally, a patient can choose to have no reconstruction after mastectomy. This can mean a patient wishes to have no internal reconstruction but wishes to wear a bra with prosthesis that mimic the appearance of breast tissue while wearing the bra. This can also mean no form of reconstruction internal or external, and generally this is known as "going flat." All of these options are accepted and valid.

Sometimes making a surgery plan for breast cancer is not straight forward. Not every patient is a candidate for all the treatment options for a variety of reasons. It is encouraged for patients to have a preference or wish for what type of surgery they want but be open to the discussion with their doctors as to why one option may or may not be the best or safest for them.

More to come about lymph node surgery and after surgery care!

As always, thank you for being here!

~Dr. C