Surgery has an important
role in the treatment of patients with breast cancer. Most women can choose
between breast-conserving surgery (lumpectomy with radiation therapy)
or removal of the breast (mastectomy). Clinical trials have proven that
both options provide the same long-term survival rates for most types
of early breast cancer. However, neither option guarantees that cancer
will not recur. Whichever choice you make, you will need close medical
followup for the rest of your life.
BREAST
CONSERVING SURGERY
Lumpectomy
The surgeon removes the breast cancer and some normal tissue around it
(in order to get clear margins). This procedure usually results in removing
all the cancer, while leaving you with a breast that looks much the same
as it did before surgery. Usually, the surgeon also takes out some of
the lymph nodes under the arm to find out if the cancer has spread. Women
who have lumpectomies almost always have
radiation therapy
as well. Radiation therapy is used to destroy any cancer cells that may
not have been removed by surgery.
Partial
or Segmental 
Mastectomy
Depending on the size and location of the cancer, this surgery can conserve
much
of the breast.
The surgeon removes the cancer, some of the breast tissue, the lining
over the chest muscles below the tumor, and usually some of the lymph
nodes under the arm. In most cases, radiation therapy follows.
MASTECTOMY
Total
Mastectomy
The surgeon removes the entire breast. Some lymph nodes under the arm
may
be removed,
also.
Modified Radical 
Mastectomy
The surgeon removes the breast, some of the lymph nodes under the
arm, and the lining over the chest muscles, and sometimes part of the
chest wall muscles.
Radical
Mastectomy
The surgeon removes the breast, chest muscles, and all the lymph nodes
under the arm. This was the standard operation for many years, but it
is used now only when a tumor has spread to the chest muscles. A mastectomy
may be recommended when: Cancer is found in more than one part of the
breast. The breast is small or shaped so that a lumpectomy would leave
little breast tissue or a very deformed breast. A woman chooses not to
have radiation therapy. A woman prefers a mastectomy.
POSSIBLE PROBLEMS:
As in any kind of surgery, there is a risk of infection, poor wound
healing, bleeding, or a reaction to the anesthesia used in surgery. There
may be a collection of fluid under the skin; or tingling, numbness, stiffness,
weakness, or swelling of the arm. (See lymphedema.) Physical therapy and
exercise can help to restore arm movement and strength.
After
a mastectomy, a woman may choose to:
- Wear a breast
form, called a prosthesis, that fits in her bra. To find stores that
have breast forms and fitters, talk with your doctor, nurse, or a volunteer
from the American Cancer Society Reach for Recovery program or other
breast cancer organization, or other women who have had breast cancer.
- Have her breast
reconstructed by a plastic surgeon.
- Do nothing.
Some health insurance
plans pay for all or part of the costs of a prosthesis or for breast reconstruction.
However, there may be health insurance rules about where aw oman can have
breast reconstruction surgery or where to buy a prosthesis. For details
about your health plan coverage, contact your insurance company.
QUESTIONS
TO ASK BEFORE SURGERY
- What kind of surgery
do you recommend for me?
- How much of my
breast will be removed?
- If I have a mastectomy,
will I be able to have breast reconstruction?
- Do you recommend
it at the time of surgery or later?
- Will I meet with
the plastic surgeon before surgery?
- Will you remove
any of my lymph nodes?
- Where will the
operation be done?
- Will I have local
or general anesthesia?
- How should I feel
after the operation? If I have pain, how can I get relief?
- What side effects
should I report to you?
- Where will the
scars be? What will they look like?
- Will a nurse or
physical therapist teach me how to exercise and care for my arm?
- How long will I
stay in the hospital? Will I need follow-up care?
- When can I get
back to my normal activities? What activities should I avoid?
- What do I need
to do to prepare for surgery?
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