Types of Breast Cancer Surgeries (The James)

Types of Breast Cancer Surgeries (The James)

 

Breast cancer affects nearly 200,000 women each year in the United States. The risk of developing breast cancer over a lifetime is 1 in 8, or 12% of all women. Breast cancer also occurs in men. Each year, about 2,000 men in this country learn they have breast cancer.

Breast cancer can be found on a mammogram, through self-exam, or felt by your doctor. It is important to follow these guidelines for the early detection of breast cancer:

  • Breast self-exam each month
  • Breast exam each year with doctor or nurse practitioner
  • Mammogram each year after age 40 or as recommended by your healthcare provider

 

Breast Cancer

Breast Tissue

Your breast is made up of different types of tissues that can change based on your hormones. Before menopause, your breasts are mostly made of dense, fibrous tissue and fat. As you pass through menopause, this fibrous tissue often turns to fat. This may cause your breasts to feel much softer and less lumpy. If you take estrogen after menopause, your breasts may remain fibrous. Fibrous tissue can sometimes hide a small cancer and make it more difficult to feel or find on a mammogram. It is important to have a mammogram each year and do breast self-exams each month. As you become older and have less hormonal effects on your breast tissue, it is easier to see a lump on a mammogram.

Types of Breast Cancer

Here is information on the different types of breast cancer.

  • Infiltrating/Invasive Ductal Carcinoma (most common type) is a breast cancer that starts in your milk duct and spreads through the ductal wall into your surrounding tissue. Once it has spread, the cancer cells can enter your lymph vessels and blood vessels. These vessels can carry cancer cells to other parts of your body.
    .
  • Ductal Carcinoma in Situ (DCIS) is a non-invasive type of breast cancer. The cancer cells are found only within the milk ducts. They have not spread through or outside the wall of the duct. It is important to surgically remove all traces of the DCIS to improve local control of the cancer.

 

  • Infiltrating/Invasive Lobular Carcinoma is a cancer that starts in the lobule of your breast. It has microscopic projections that can break through the lobule wall and move into your surrounding tissue. This can make it a more difficult to diagnose this cancer at an early stage.
     
  • Inflammatory Breast Cancer symptoms include redness and swelling of your breast with skin changes. These symptoms can be mistaken for a rash. This breast cancer can grow very fast. It has a higher chance of spreading to another part of your body and must be treated quickly using chemotherapy first, and then by surgery and radiation therapy.
     

Breast Cancer Surgery and Local Treatment

Breast cancer may be treated two ways: local (where your cancer was found) or systemic (your whole body). Local treatment may include surgery and possibly radiation therapy. If systemic treatment is needed, it may include anti-hormonal therapy (also known as "endocrine therapy") and/or chemotherapy. Using the information from your imaging and biopsy results, your health care team will talk with you about what treatment is best for your type of breast cancer.

You may have more than one option for local treatment. The size, type and location of your tumor will determine your treatment options. The entire breast must be treated. Either a portion of your breast tissue is removed (lumpectomy) or your entire breast is removed (mastectomy). In both types of surgery, your lymph nodes may also need to be checked.

Here is information about your possible surgery treatments.

Lumpectomy

A lumpectomy may be a treatment option after your cancer has been found. Your surgeon makes an incision on the surface of your breast near the area of the tumor. This incision may be curved to help keep the natural curve of your breast.

Your nurse will put a check by the procedure you will have:

___ Needle-Localization - This procedure is done the morning of your breast surgery if your surgeon is unable to feel the abnormal area of tissue. While you are awake, a thin wire is placed in your breast to "localize" or find the tumor. This helps to reduce the amount of breast tissue that is removed. Using ultrasound or mammogram as a guide, the specialized doctor (radiologist) will place a very slender wire or needle into your breast. The tip of the wire is put near your tumor. Part of the wire will extend outside your breast and will be taped in place. This wire will guide your surgeon to your tumor to be removed. The wire is then removed at the end of your surgery.

___ Radioactive Seed Localization (RSL) - This procedure can help your surgeon locate and remove your breast tumor. This method helps prevent damage to healthy tissue in the area. During the procedure, a special doctor (radiologist) will use mammography or ultrasound to guide placement of a very low- energy radioactive seed, the size of a grain of rice, into your tumor or abnormal tissue. This procedure is done before your breast surgery. When you have your surgery, the surgeon will use a handheld probe to find the radioactive seed to pinpoint the area that needs to be removed. The only way to remove the seed is by having surgery. For more information, including what to do if the seed comes out, ask for the patient education handout, Radioactive Seed Localization.

It is very important to remove all cancer cells from the area. The goal of a lumpectomy is to remove your cancerous tissue. Noncancerous tissue is also removed from around the edges of your tumor. This is called a clear margin of tissue. This margin will also be checked for cancer cells. If cancer cells are found in the margin, additional surgery is needed.  

A lumpectomy, followed by radiation therapy can be just as effective as a mastectomy for local treatment of your breast cancer. A lumpectomy provides the best cosmetic result and you should look normal in a bra afterwards. Your breast may not be as full in the area where your tumor was removed, but it should still be rounded. Oncoplastic surgery is a reconstruction option after a lumpectomy. This surgery uses plastic surgery techniques at the time of your lumpectomy to reshape your breast after the tumor is removed. It is important to talk with your surgeon about this procedure before your lumpectomy.

 

Mastectomy

A mastectomy is another surgical option used for the treatment of breast cancer. The size and location of your tumor or the number of tumors in your breast may make a mastectomy the best option for you. Typically, radiation therapy is not needed after a mastectomy. However, if your tumor is large or if several of your lymph nodes have cancer in them, radiation therapy to the area may be recommended.

 

Types of Mastectomy

  • Total Mastectomy removes all the breast tissue, the skin and the nipple. An incision is made on your chest wall angled towards your armpit. The edges of the incision are pulled together, creating a thin incision across your chest wall. During your surgery 1 to 2 drainage tubes will be placed under your arm. These tubes are called hemovacs and are used to prevent fluid build-up. Once healed, your chest area will be flat where your breast tissue was removed. The skin across your chest wall may have decreased sensation, especially to hot and cold. This may improve, as you continue to heal.
  • Modified Radical Mastectomy (MRM) removes all your breast tissue, skin and nipple as well as your axillary lymph nodes.
  • Radical Mastectomy removes all your breast tissue, skin, nipple and lymph nodes, and all or part of your chest wall muscle. This procedure is rarely done.
  • Nipple Sparing Mastectomy removes all breast tissue, but leaves the skin and the nipple of the affected breast.

 

Reconstruction

Surgery to create the appearance of a breast can be done after a mastectomy. The goal of reconstruction is to have a normal appearing breast in a bra or under clothing, but not when naked. If a large amount of your breast tissue is removed, often a more acceptable appearance can be achieved with a mastectomy and reconstruction.

This surgery can be started either at the time of the mastectomy (immediate reconstruction) or at a later time (delayed reconstruction). Most reconstructive procedures involve many steps and surgical procedures. There are several options for reconstruction and it is important to talk with a plastic surgeon before your mastectomy.

 

Axillary Lymph Node Evaluation

You have lymph nodes in several places in your body. Lymph nodes are in your neck, under your arms and in your groin. Lymph nodes help your body fight infection and drain fluid. If an invasive cancer has been diagnosed or is suspected, your axillary lymph nodes need to be checked. Your axillary lymph nodes are located under your arm and help drain fluid from your breast. This is the first place breast cancer is likely to spread. Checking the condition of your lymph nodes and the size of your tumor will help your doctor suggest the best treatment plan for you.

The best way to check your lymph nodes is with a biopsy. A biopsy is a procedure to remove a small sample of tissue. Your doctor may recommend a sentinel lymph node biopsy to check the first lymph node(s) that drain your tumor. This biopsy is done if your tumor is small and no axillary lymph nodes can be felt. If you have a lumpectomy, your sentinel node(s) may be removed during your surgery.

 

Sentinel Lymph Node Biopsy

The sentinel lymph node(s) is the first lymph node(s) that drains the breast tumor. The goal is to find this first node and check it for cancer cells. If the node(s) has cancer cells, then other nodes may also be affected.

There are several steps done to find a sentinel node(s). A few hours before surgery, a tiny amount of radioactive material (radionuclide) called a tracer, will be injected by a doctor around your areola. The tracer will track through your breast lymph vessels and drain into your axillary lymph nodes. This process can take 1 to 2 hours. A special wand called a gamma probe will be used to track the tracer and find your sentinel node(s).

In the operating room, a blue dye may also be injected into your tumor. This dye will help to show the lymph pathway and find your sentinel node(s). This dye will make your urine bluish-green for a short time.

Once your sentinel lymph node(s) is found, your surgeon will make a small incision under your arm and remove it. A special doctor (pathologist) will look at the node(s) immediately to see if cancer cells are present. The pathologist will do more testing after your biopsy to check the sentinel lymph node(s) in more detail. Your doctor will talk with you about your results at your post-operative visit. If cancer cells are found, an axillary lymph node dissection may be done.

An axillary node dissection is done to remove all of your axillary lymph nodes under your arm. This may be done if cancer cells are present in your sentinel lymph node(s). Your nurse will give you more information if this procedure will be done.

 


Care After Biopsy or Lymph Node Dissection

When your lymph nodes are removed, a space is created in your armpit. This space can fill up with fluid. At the end of your surgery, 1 to 2 drainage tubes are put in to drain this fluid and to promote healing. These tubes are called a Hemovac or Jackson-Pratt drains. The drainage tube(s) exit your body on the side of the surgery, a few inches below your armpit. Stitches hold your tube(s) in place. The tube(s) are left in place for about 2 to 3 weeks after surgery. A container is attached to the end of the tube to collect the fluid. It is important to empty your container 2 times each day or when it is halfway full. Your nurse will give you a Wound Drainage Record Sheet to record your drainage. Write down the date, time, amount and color of the fluid from each drain every time you empty a drain. It is important to bring this record sheet with you to all of your appointments. An appointment will be made before you leave the hospital to have your tube(s) removed in the doctor’s office when your drainage decreases.

 

Side Effects of a Biopsy or Lymph Node Dissection

One of the side effects of removing one or more lymph nodes from under your arm can be a temporary or permanent swelling called lymphedema. If this happens, your health care provider will refer you to a physical therapist to help you manage this problem.

In the past, patients who had one or more lymph nodes removed, were asked to follow "limb precautions" or "lymphedema precautions". This was done, because at that time, breast cancer removal surgery was more invasive and lymphedema (arm swelling) was more common. Advances in breast cancer treatment and research on lymphedema has now reduced this risk.

As a result, not all patients need to follow the strict limb precautions that were once encouraged. The risk for lymphedema varies with patients and depends on the surgery and treatments you have received. Your health care provider will tell you if you need to follow limb precautions and you will be given information on how to care for your arm. These precautions are not meant to change your life, but to help reduce the risk of lymphedema after your breast cancer surgery.

Many options are now available to help treat lymphedema and may be included as part of your plan of care. Talk to your health care provider if you have any questions or concerns about limb precautions and lymphedema.

Call your doctor right away if you have signs of infection in the affected arm, or if swelling continues. Signs of infection include:

  • Pain
  • Arm is warm to the touch
  • Redness
  • New or sudden swelling
  • Fever of 100.4 degrees Fahrenheit (38 degrees Celsius) or higher
  • Chills or general achiness

 

For more information:

  • The James Patient Education office at 614-293-5853
  • The breast/chest cancer support group and other James Care for Life resources can be found at www.cancer.osu.edu/patient-support

  • The Patient and Family Resource Center located on the ground floor of The James near the grand staircase. Staff at the center can prepare a packet of information with answers to your health-related questions. To make a request for health information, you may:
    • Visit the center during business hours
    • Call 614-366-0602
    • Send an email to cancerinfo@osumc.edu.
    • If you are unable to visit the center, the information will be delivered to your hospital room or mailed to your home address at no charge.
  • The JamesLine at 1-800-293-5066
  • The National Cancer Institute (also in Espanol) at 1-800-4-Cancer (1-800-422-6237)

James Patient Education Materials Include:

  • Breast Biopsy Methods
  • Cancer Internet Resources
  • Making the Most of Visits with Your Doctor
  • Cancer Genetics Consultation

 

© September 14, 2021. The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute.

This handout is for informational purposes only. Talk with your doctor or health care team if you have any questions about your care.