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Types Of Breast Cancer Surgery

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Ismail Munir

Overview

According to the American Cancer Society, nearly 297,790 cases of breast cancer were diagnosed in 2023, making it the second most common <a href="https://merisehat.pk/disease/types-of-breast-cancer">type of cancer </a>diagnosed in women after skin cancer. Although rare, men may also develop it too<a href="#accordion">[6]</a>. 
&nbsp;

Surgical intervention is one of the primary interventions your doctor may offer as part of your treatment plan. These recommendations tend to be personalized, depending on multiple factors, including:

<ul>
	<li>The stage of your tumor</li>
	<li>The subtype of your tumor</li>
	<li>Your age</li>
	<li>Your overall health</li>
	<li>Your preference</li>
	<li>Your menopausal status (for women)</li>
	<li>The presence of known mutations in inherited breast cancer genes</li>
	<li>Genomic test results (if appropriate) 
	&nbsp;</li>
</ul>

Generally, surgery is recommended for localized breast cancer but is not considered an effective solution for metastatic breast cancer. It&rsquo;s also important to note that these interventions can be diagnostic or cosmetic<a href="#accordion">[1]</a>. 
&nbsp;

The different types of breast cancer surgeries include: 
&nbsp;

<ul>
	<li>
	<h5>Mastectomy</h5>
	</li>
</ul>

This is the most common surgery for breast cancer.

Also known as breast removal surgery, it treats both early- and late-stage breast cancers. In some cases, a prophylactic mastectomy may be preferred as a preventive measure, especially if the individual poses a high risk of developing the condition<a href="#accordion">[1]</a>. 
&nbsp;

Mastectomy can be further divided into:

<ol>
	<li>Double Mastectomy &ndash; This refers to the removal of both breasts. The procedure can be done as a preventive measure. But it may also be the need of the hour if the cancer has spread to both breasts. 
	&nbsp;</li>
	<li>Total Mastectomy &ndash; The entire breast is removed. However, the chest muscle beneath it is spared. 
	&nbsp;</li>
	<li>Nipple-Sparing Or Skin-Sparing Mastectomy &ndash; This is the removal of your entire breast tissue. However, the surgeon may leave your skin and nipple, if possible, for breast reconstruction. 
	&nbsp;</li>
	<li>Radical Mastectomy &ndash; This is a rare option. Your doctor will go with it only if the breast cancer has spread through your chest muscles and requires removing your chest muscles, underarm lymph nodes and, of course, your breasts. 
	&nbsp;</li>
	<li>Modified Radical Mastectomy &ndash; This involves removing your underarm lymph nodes along with the breast tissue. It&rsquo;s considered if there&rsquo;s a risk of cancer spreading. It&rsquo;s as effective but less disfiguring as a radical mastectomy. 
	&nbsp;</li>
</ol>

<ul>
	<li>
	<h5>Lumpectomy</h5>
	</li>
</ul>

Early-stage breast cancer? Prefer surgery, but want the doctors to only remove the tumor and leave the rest of your breast intact? Then lumpectomy is the option for you.

Also known as breast-conserving surgery, a lumpectomy will remove only a part of your breast tissue. This is possible if your lump is small and hasn&rsquo;t spread to any other part of the body yet.

Your doctor will most probably also remove a margin of the surrounding tissue to ensure the procedure doesn&rsquo;t miss any cancer cells in your breast. 
&nbsp;

Depending on your condition, you may also be recommended radiation therapy 4-8 weeks after surgery to minimize the risk of recurrence[4]. It&rsquo;s as effective as a total mastectomy to treat early-stage breast cancer<a href="#accordion">[1]</a>.

For instance, a lumpectomy without radiation therapy to treat ductal carcinoma in situ has a 25&ndash;35% chance of recurrence. With radiation therapy, this risk is reduced to 15%<a href="#accordion">[6]</a>.

However, some may choose a total mastectomy over a lumpectomy for the sole reason of avoiding radiation therapy. 
&nbsp;

Lumpectomy can be further divided into:

<ol>
	<li>Excisional Biopsy &ndash; This removes the tumor for biopsy. An analysis of the tumor can help doctors determine if the tumor is malignant or not. 
	&nbsp;</li>
	<li>Wide Local Excision &ndash; This removes not just the cancerous tumor but also a margin of surrounding tissue for good measure. The marginal tissue is tested for the presence of cancerous cells. 
	&nbsp;</li>
	<li>Quadrantectomy &ndash; This is a kind of segmental mastectomy, removing a quarter of your breast. It&rsquo;s a possible consideration if your tumor shows ductal spread, as the procedure also removes your duct-lobular system. 
	&nbsp;</li>
	<li>Re-Excision Lumpectomy &ndash; This is the same as a wide local excision. Except when the marginal tissue is reportedly positive for cancer cells, your doctor will reopen the surgical site and remove another margin of tissue to be tested again. The procedure is repeated until the tissue is seen to be cancer-free. 
	&nbsp;</li>
</ol>

<ul>
	<li>
	<h5>Lymph Node Dissection</h5>
	</li>
</ul>

The first place breast cancer spreads is your lymph system. It&rsquo;s literally a red flag &ndash; the cancer is no longer restricted to just your breast. Since breast cancer cells will likely drain into the lymph nodes under your arm next to the affected breast, your surgeon will remove one or more of these nodes for further analysis. 
&nbsp;

There are different lymph node procedures, including:

<ol>
	<li>Sentinel Lymph Node Biopsy &ndash; This is not a treatment option. Rather, it&rsquo;s an investigative procedure to find out if the cancer spreads to your lymph system. This type of biopsy can be conducted before or even during the operation to remove the original tumor from your breast. 
	&nbsp;</li>
	<li>Axillary Lymph Node Dissection &ndash; This type of biopsy is recommended when either the sentinel node biopsy returns positive for cancer or the surgeon has other reasons to suspect that cancer has spread to your lymph nodes. As a result, they will remove the lymph nodes under your arm since they contain axillary lymph nodes that can be analyzed for signs of cancer. 
	&nbsp;</li>
</ol>

<ul>
	<li>
	<h5>Breast Reconstruction Surgery</h5>
	</li>
</ul>

It&rsquo;s natural to feel awkward or bad about having one or both of your breasts removed as part of breast cancer treatment. For some people, body image directly influences their self-esteem. Reconstructive surgery can help restore the shape of your breasts.

It can be performed immediately after a mastectomy or lumpectomy or later as a separate surgery after chemo or radiation therapy if your tissues need to recover. 
&nbsp;

There are different breast reconstruction methods, including:

<ol>
	<li>Flap Or Autologous Reconstruction &ndash; Your doctor will reconstruct your breast using tissue from another part of your body, such as the belly or hips. Although the skin and muscles from these areas resemble the breast tissue in both looks and touch, your surgeon may opt for a combination of flap and implant reconstruction to get a more realistic result. 
	&nbsp;</li>
	<li>Implant Reconstruction &ndash; An implant is used to replace the breast tissue that was surgically removed. A silicone shell is filled with either silicone gel or saline to achieve the desired shape and volume. The surgeon can place it over your muscle. Alternatively, they can also place the implant under your muscle and cover it with either the original breast skin or a skin graft from another body part. 
	&nbsp;</li>
	<li>Nipple Reconstruction &ndash; This is usually a follow-up surgery once your breasts have been reconstructed. If you had a lumpectomy or a nipple-sparing mastectomy, then your nipple has been preserved and can be used to take a skin graft for breast reconstruction. If you had another procedure, your doctor may construct a new one using a skin graft from another part of your body. 
	&nbsp;</li>
</ol>

Note: A surgical mesh is a flexible, thin sheet made of biodegradable synthetic materials, nondegradable synthetic materials, or human or animal-derived tissues called acellular dermal matrices. The FDA has not approved any surgical mesh to be used in breast reconstruction or with breast implants<a href="#accordion">[2]</a>. 
&nbsp;

understanding the different types of breast cancer surgeries

Your breast cancer surgery is tailored to your particular needs and preferences. Your doctor may discuss your options, explaining the advantages and disadvantages, to help you make an informed decision. 
&nbsp;

<h5>Breast Reconstruction Surgery</h5>

<ul>
	<li>Your surgeon can begin it during the same breast cancer surgery. You also have the choice to delay it until after the cancer treatment or whenever it&rsquo;s feasible.</li>
	<li>Whether you have immediate or delayed reconstruction surgery, the downside is that follow-up surgery is needed to enhance the results. For instance, you may not like the look of your new breast or want to balance the size of your breasts.</li>
	<li>Sometimes, implants can harden or toughen, which can cause pain. Moreover, there&rsquo;s always the risk of implants splitting in the future, requiring additional surgery to fix them.</li>
	<li>It can be an outpatient or an inpatient surgery. And while many women receive general anesthesia, the surgery can be done under local anesthesia.</li>
	<li>Recovery Time: A mastectomy with reconstruction takes up to 6-8 weeks, the longest recovery period of all surgeries. 
	&nbsp;</li>
</ul>

<h5>Lumpectomy</h5>

<ul>
	<li>The procedure can be completed in an hour, whether it&rsquo;s done with or without sentinel node biopsy. You may also be allowed to go home on the same day.</li>
	<li>According to the American Cancer Society, the survival rate is the same for both mastectomy and lumpectomy combined with radiation<a href="#accordion">[3]</a>.</li>
	<li>A lumpectomy is not an option if you have a large tumor, are pregnant, or if cancer has spread outside the breast tissue<a href="#accordion">[7]</a>.</li>
	<li>Further, you may be uncomfortable with how your skin peels off or itches after radiation therapy. You&rsquo;ll also feel tired after the surgery.</li>
	<li>Recovery Time: It will take 5-10 days to recover and resume daily activities. 
	&nbsp;</li>
</ul>

<h5>Mastectomy</h5>

<ul>
	<li>Some candidates can even go home the same day after a mastectomy if their general health allows it.</li>
	<li>However, a mastectomy with a flap reconstruction or an axillary lymph node dissection simultaneously can be exhausting, taking nearly three hours in surgery alone. Consequently, recovery may require a hospital stay for one or more days.</li>
	<li>Besides this, you may experience neck and shoulder pain, especially if you have larger breasts.</li>
	<li>Recovery Time: This type of breast cancer surgery will take 3-4 weeks after surgery. 
	&nbsp;</li>
</ul>

Like any other surgery, other risks and complications include<a href="#accordion">[6]</a>:

<ol>
	<li>Blood Clots &ndash; This may present as chest pain, a painfully swollen leg, and shortness of breath. It&rsquo;s a healthcare emergency. Call your doctor immediately!</li>
	<li>Nerve Damage &ndash; This may cause tingling, numbness, or pain in the chest, upper arm, armpit, or shoulder. It may take several weeks to repair the nerves. Doctors may prescribe medication if the pain is unbearable or affects the quality of life.</li>
	<li>Infection &ndash; The site of the surgical wound will swell or turn red, indicating an infection. These surgical wound infections can be treated with antibiotics.</li>
	<li>Seroma &ndash; While fluid accumulation at the surgical site usually goes away naturally, it can become an issue and may need to be drawn out with a needle.</li>
	<li>Hematoma &ndash; There is swelling and pain when blood builds up in the tissues surrounding the wound. Again, it may go away on its own. But if it&rsquo;s unbearable, doctors can drain it.</li>
	<li>Lymphedema &ndash; This disrupts the lymph drainage system, causing swelling in the hand or the entire arm. Inform your doctor immediately!</li>
	<li>Excessive Bleeding &ndash; This happens rarely. However, it&rsquo;s best if you donate blood before surgery, especially if it&rsquo;s an extensive procedure like reconstruction or double mastectomy.</li>
	<li>Breathing And Heart Problems &ndash; There is always a possibility of an adverse reaction to general anesthesia. The fatality ratio is 1 in 200,000. 
	&nbsp;</li>
</ol>

Key Points

<ul>
	<li>Breast cancer surgery is to remove the tumor. Sometimes, a portion of the surrounding tissue is removed while conserving as much of the breast as possible.</li>
	<li>The location of the tumor, how far it&rsquo;s spread, and personal preferences may influence the type of breast cancer surgery.</li>
	<li>With the improvements in surgical interventions, they can be used to treat most stages of breast cancer, including noninvasive breast cancer, larger breast cancers, early-stage breast cancer, locally advanced breast cancer, and recurrent breast cancer. It&rsquo;s also preferred in cases of high breast cancer risk.</li>
	<li>It&rsquo;s seldom used to treat metastatic breast cancer.</li>
	<li>A simple or total mastectomy removes the entire breast, including the nipple. It&rsquo;s a choice when cancer hasn&rsquo;t spread to the lymph nodes. It can also be done to prevent or lower the risk of developing breast cancer in the first place.</li>
	<li>A modified radical mastectomy is preferred for invasive breast cancer because it removes the entire breast tissue, including the nipple and lymph nodes. However, the chest muscles are left untouched.</li>
	<li>While a modified radical mastectomy is effective in the majority of cases, a radical procedure is done if cancer has spread to the chest muscles, which rarely occurs.</li>
	<li>A skin-sparing mastectomy allows the surgeon to leave most of the skin for breast reconstruction. However, it&rsquo;s not an option when cancer cells are close to the skin or breast reconstruction is delayed.</li>
	<li>A lumpectomy is a partial mastectomy. It usually requires radiation afterwards, so it&rsquo;s not a good idea if the individual won&rsquo;t or can&rsquo;t have radiation.</li>
	<li>A sentinel lymph node biopsy is less likely to cause swelling in the arm or lymphedema compared to an axillary lymph node dissection.</li>
	<li>Breast reconstruction is possible right after surgery or later on.</li>
	<li>Other treatments, such as hormone therapy, chemotherapy, radiation therapy, and targeted therapy, may be used in combination with breast cancer surgery to treat the condition.</li>
	<li>The length of the hospital stay depends on the general health of the patient, the type of surgery, and how well they tolerate the operation. 
	&nbsp;</li>
</ul>