Surgery is generally the main line of attack for breast cancer. Lumpectomy (removal of the tumor and surrounding tissue) and mastectomy (removal of the entire breast) are the two main types of surgery used. Lymph node removal may also be necessary. In some cases, cryotherapy, which is being studied in clinical trials, may be an alternative.
Each type of surgery has its advantages and disadvantages. In this article, we will discuss in detail the types of surgery that may be an option for you.
One of the most common types of surgery offered to women with breast cancer is a lumpectomy. A lumpectomy is the removal of a “lump” of tissue containing the (possible) tumor cells and usually also the surrounding tissue. A lumpectomy may be called by several different terms, including a wide local excision, a partial mastectomy, a segmentectomy or a wedge resection. If you have a second operation to remove cancer that was left behind during the first operation, this is called a re-excision.
In a lumpectomy, the aim is to remove the cancer and a small amount of normal tissue around the tumor. Your doctor will most frequently recommend lumpectomy if they expect that this operation will be enough to completely remove the tumor.
It is important to discuss with your surgeon how much tissue will be removed and how certain they are this is the right approach for your particular situation.
Any surgery that preserves, or keeps, the majority of the breast is generally followed by radiation, so it is essential to also ask your physician about radiation therapy at as well. Currently, lumpectomy is the most common operation in people with breast cancer, however the frequency of use varies widely throughout regions depending on local standards of care, doctor experience and the local availability of reconstructive surgery facilities and trained plastic surgeons.
The other main type of breast cancer surgery is a mastectomy. Mastectomy is the removal of an entire breast. However, there are different types of mastectomy, so its good to ask your surgeon for as much detail as possible about your choices.
a) A “simple” mastectomy is the removal of an entire breast, leaving behind the muscles below the breast, and generally not removing any lymph nodes. This type of approach is most common if you have been told you have ductal carcinoma in situ (DCIS).
b) A modified radical mastectomy includes the additional removal of lymph nodes near the breast, located in your armpit. A modified radical mastectomy allows for the analysis of the lymph node tissue, to check if your cancer has spread, and help determine your further treatment needs.
c) Last, nipple-sparing mastectomy may also be possible. In this approach, the breast is removed, but the nipple tissue is preserved, and this can be useful in later breast reconstruction surgery to keep nipple sensation. Only some people can have this surgery because of the risk of leaving cancer cells behind when the nipple is preserved.
As with lumpectomy, mastectomies may be followed by radiotherapy.
3. Lymph Node Removal
In addition to surgery on the breast tissue itself, lymph node removal is often performed in invasive breast cancer, or if your surgeon suspects it may be invasive. Removal of the lymph nodes adjacent to the breast tissue, allows your medical team to perform a biopsy on the lymph nodes, and determine if your cancer has spread, or is likely to spread within your body. This is really important, as it helps your medical team decide how aggressive a chemotherapy or radiotherapy regimen needs to be, and helps them select the best treatment for your individual care.
It is also possible additional lymph nodes (such as those in your neck or collarbone) may be removed. This may happen if on manual examination, they appear to be enlarged. If your lymph nodes are found to be cancerous, then your physician will be able to decide on the right level of chemotherapy or radiotherapy to treat your disease. Lymph node surgery is always considered carefully, as the lymph nodes are needed to drain excess fluid effectively from your body.
Risks of Lymph Node Removal
Removal of the lymph nodes can lead in some woman to arm swelling in later years, which is a condition called lymphedema. This can lead to discomfort and a decrease in the function of your arm. Lymphedema is best managed by early treatment with a physical therapy. As mentioned earlier, it is good to ask your medical team about the all the risks of of your surgery so that you can be prepared and fully weigh the advantages and disadvantages of your treatment. Ask as many questions as you need to make the best choice for your own care.
Cryotherapy or cryosurgery is a being studied as a possible new type of treatment for breast cancer. Cryotherapy involves freezing of the cancer to kill the cells. Small needles are used to insert freezing gas into the area where the cancer cells are in the breast using either ultrasound or magnetic resonance imaging (MRI) to make sure the right cells are targeted and then frozen and killed.
It is not clear how effective cryotherapy is or for which people is might be best for. For more information on it, ask your surgeon or search for a trial near you using the National Cancer Institute’s clinical trial directory. (LINK)
4. Possible Additional Surgeries
Additional surgeries that may also be performed at the same time as your tumor removal are breast reconstruction, preventative (prophylactic) mastectomy, and prophylactic removal of the ovaries (oophorectomy).
a) Breast reconstruction surgery, in some cases is performed at the same time as a mastectomy or lumpectomy although it can also be completed later.
The decision to have or not to have breast reconstruction is a deeply personal choice. Your reaction to the type of surgery you have is normal. Knowing that you have choices about what your breast will look like after surgery can help you through a difficult time. It is important to discuss and work through how you feel about the loss of your breast. It is also important to consider the pros and cons of breast reconstruction in your own personal situation.
Breast reconstruction surgery, if you decide to have this type of surgery, will be performed by a plastic surgeon. The operation involves reconstructing your breast using either a “flap” of tissue from another place in your body (generally from your stomach, your back or your thigh), or by using an implant. Take the time to learn about your options.
b) Prophylactic Mastectomy – some people who have had genetic testing and are found to have a genetic mutation that increases their risk of having a second cancer in the other breast may decide to have both breasts removed. The most common genes associated with a risk of breast cancer are BRCA1 and BRCA2.
c) Prophylactic Removal of the Ovaries – People with abnormalities in the BRCA1 and BRCA2 genes also have a higher risk of ovarian cancer. People with ovaries are often advised to have their ovaries removed after they have had children to decrease the risk of ovarian cancer.
 https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/breast-cancer-facts-and-figures/breast-cancer-facts-and-figures-2019-2020.pdf, Accessed July 6th, 2020