Breast Surgery

There are two categories of breast surgery: medical and plastic. Breast cancer is by far the most common medical reason for needing breast surgery, but it is sometimes also done to remove non-cancerous breast lumps or reduce very large breasts that are causing back pain.

Types of Medical Breast Surgery

Mastectomy

The most common surgery for breast cancer is mastectomy, the removal of the entire breast. Mastectomy can treat breast cancer in both the early and later stages. Some women who are considered at a high risk for breast cancer, such as those with a BRCA1 or BRCA2 mutation, choose to have a mastectomy as a preventive measure. Types of mastectomy procedures include:

• Total mastectomy: Removal of the entire breast, sparing the chest muscle
• Double mastectomy: Removal of both breasts, either because cancer has spread or as a preventative measure
• Skin- or nipple-sparing mastectomy: For women who choose to have a reconstruction before their mastectomy, this surgery spares the skin and, if possible, the nipple, to use for breast reconstruction
• Radical mastectomy: Removal of the breasts, underarm lymph nodes and chest–this is rare and only performed when breast cancer has spread to the chest muscles
• Modified radical mastectomy: Removal of the breast tissue and underarm lymph nodes

Lumpectomy

Also known as breast-conserving surgery, lumpectomy is an alternative to treat early-stage breast cancer. It removes just the part of the breast surrounding the tumor, or “lump,” as well as a margin of surrounding breast tissue to ensure that no cancer cells are left in the breast. While lumpectomy allows a woman to keep most of her breast, it is usually accompanied with radiation therapy to keep the cancer from returning. Types of lumpectomy procedures include:

• Excisional biopsy: This is a procedure to remove a tumor and examine it in the lab and determine if it is cancerous
• Wide local excision: Surgery to remove a cancerous tumor and a margin of surrounding tissue, which is tested after the procedure to make sure it’s cancer-free
• Quadrantectomy: Removal of roughly a quarter of the breast, including the milk-producing duct-lobular system
• Re-excision lumpectomy: If the marginal tissue tests positive for cancer cells after a lumpectomy, the surgeon will reopen the surgical site to remove additional tissue

Lymph Node Dissection

The lymph system is the first place cancer spreads. In lymph node dissection, the surgeon removes and analyzes one or several of the lymph nodes next to the breast where the tumor is located. Lymph node procedures include:

• Sentinel lymph node biopsy: This is done to find out if cancer has spread to the lymph system. The sentinel lymph node is the first node that filters fluid draining away from the affected breast. The surgeon may perform a sentinel node biopsy in advance of or during surgery to remove a breast tumor. The node will then be examined under the microscope to look for cancer cells.
• Axillary lymph node dissection: If the sentinel node biopsy tests positive for cancer, a larger portion of the lymph nodes may be removed.

The decision to have reconstructive breast surgery is a personal one. Both our breast and cosmetic surgeons perform reconstructive breast surgery.

Have you had your mammogram yet? The Community Memorial Breast Center recommends annual screening mammography starting at age 40. Remember, early detection is your best protection.