Breast Surgery

For many women, the prospect of breast surgery is upsetting. However, a decision to undergo breast surgery does not necessarily mean that a woman will lose her breast. Major progress has been made in reconstructive surgeries, so that 85 percent of patients can undergo a procedure which will preserve the appearance of their breast(s). Women with invasive breast cancers have also had proven success in breast preservation.

The surgeries most often performed when there is a diagnosis of breast cancer are:

• Partial mastectomy
• Mastectomy
• Breast Reconstruction

  Partial mastectomy

  Partial mastectomy is the most common form of breast cancer surgery. Your surgeon will remove only the part of your breast containing the tumor, and some of the normal tissue that surrounds it.

  All of the removed tissue will be carefully examined by our pathologists, to verify that the margins (the normal tissue surrounding the tumor) are cancer-free. Although you will have already discussed your treatment plan with your doctor, the course of treatment may change, depending on the results of your surgery.

  Any form of surgery that removes only part of the breast is considered "breast-conserving" or "breast preservation" surgery. You may hear your surgeon use any one of several names to describe your procedure: biopsy, lumpectomy or partial mastectomy.

  Technically, a lumpectomy is a partial mastectomy, because part of the breast is removed. However, the amount of tissue removed can vary greatly. Discuss with your surgeon the plans for your surgery and reconstruction, so that you have a clear understanding of all your options.

  What can I expect?

  1. After the anesthesia takes effect and you are fully unconscious, an incision is made into the breast. Part of the breast tissue that surrounded the tumor is removed from the overlying skin and the underlying muscle.
  2. One or two small plastic drains are usually left in place to prevent fluid from collecting in the space where the breast tissue used to be.
  3. Your surgeon will usually decide to remove these drains when the amount of fluid drainage decreases to an acceptable volume. This may take from a few days to more than a week. Many women go home with their drains and have them removed during a subsequent office visit.

  How should I prepare?
  Your breast surgeon and nurse care coordinator will give you specific instructions about preparing for surgery. These will likely include:

  • Guidelines on eating and drinking
  • Tips to quit smoking
  • Instructions to take or avoid certain vitamins and medications for a period of time before your surgery
  You should arrange for someone to drive you home after your surgery, and to help you for a few days.

  Mastectomy

  Mastectomy is the surgical removal of the entire breast, usually to treat serious breast disease.

  The most common reason for performing a mastectomy is breast cancer. Mastectomy is an alternative to breast conservation surgery.

  Deciding which type of surgery is best for you is complex and involves many factors. When you are diagnosed, you and your medical team will discuss your medical circumstances, personal needs and preferences. Important issues you and your team will consider include: the size of the tumor in relation to the size of your breast, whether there is more than one tumor in your breast and the side effects of radiation therapy.

  There are four general types of mastectomy:

  • Subcutaneous mastectomy -- the entire breast is removed, but the nipple and areola (the pigmented circle around the nipple) remain in place
  • Total (or simple) mastectomy -- removal of the whole breast, but not the lymph nodes under the arm (axillary nodes).
  • Modified radical mastectomy -- removal of the whole breast and most of the lymph nodes under the arm (axillary dissection)
  • Radical mastectomy -- removal of the chest wall muscles (pectorals) in addition to the breast and axillary lymph nodes. For many years, this operation was considered the standard for women with breast cancer, but it is rarely used today.

  What can I expect?

  1. After the anesthesia takes effect and you are fully unconscious, an incision is made into the breast. The breast tissue is removed from the overlying skin and the underlying muscle.
  2. One or two small plastic drains are usually left in place, to prevent fluid from collecting in the space where the breast tissue used to be.
  3. Your surgeon will usually decide to remove these drains when the amount of fluid drainage decreases to an acceptable volume. This may take from a few days to more than a week. Many women go home with their drains and have them removed during a subsequent office visit.
  How should I prepare?
  Your breast surgeon and nurse care coordinator will give you specific instructions about preparing for surgery. These will likely include
  • guidelines on eating and drinking
  • tips to quit smoking
  • instructions to take or avoid certain vitamins and medications for a period of time before your surgery
  You should arrange for someone to drive you home after your surgery, and to help you out for a few days.

  What can I expect afterwards?
  Mastectomy is very safe surgery, and most patients recover well with no complications. As with any surgery, however, there are risks. Complications are possible, but please keep in mind that they are very unlikely. You should discuss every aspect of the surgery and its aftermath with your doctors and nurse care coordinator. The more information that you have before the surgery, the more comfortable you will feel.

  Breast Reconstruction

  Breast reconstruction is a surgical procedure that restores the appearance of a breast for women who have had their breast removed due to tumors and/or cancer. The surgery rebuilds the size and shape of the breast, and, if you desire, the nipple and areola (the darker area surrounding the nipple).

  You may want to know the following about breast reconstruction:

  • Breast reconstruction is performed by a plastic surgeon
  • Breast reconstruction can help restore your appearance. The techniques for achieving excellent post-surgery appearance have greatly improved over the last few years.
  • The goal of reconstruction is to restore symmetry of the breasts when a woman is dressed. The difference between the reconstructed breast and the unaffected breast will still be seen when the woman is nude
  • Reconstruction will not restore normal sensation
  Deciding whether to have breast reconstruction is a matter of personal choice. If you decide to have breast reconstruction, you and your doctors will evaluate the best timing to do so. Breast reconstruction can take place during the mastectomy operation, or at a later date, after other necessary treatments are given.

  Each case is different, and you should discuss all of your options carefully with your surgeon and any other treating physicians. Once you have all the information, you will feel prepared to make the best decision.